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Form 49A Application for Allotment of Permanent Account Number

[In the case of Indian Citizens/Indian Companies/Entities incorporated in India/
Unincorporated entities formed in India]
Under section 139A of the Income Tax Act, 1961

Date: 20/10/2018
Print

AADHAAR matched using Demographic details - will be linked with your PAN.

Payment Status: Success

Your Payment of Rs.107.00/- for one PAN Application has been accepted subject to realization
and final settlement confirmation from your Banker.
Please quote Reference No. 7554006979 for any future correspondence.

Application/Coupon number : U-N003140029

PAPER APPLICATION (physical submission by

Application Mode
applicant)
PAN Card Mode Both physical PAN Card and e-PAN

Assessing Officer(AO Code)

Area Code AO Type Range Code AO No
PTN W 28 2

1. Full Name (Full expanded name: initials are not permitted):

Title:- SHRI Last Name / Surname :- KUMAR First Name:- ABHISHEK Middle Name:-
2. Abbreviation of the above name, as you would like it, to be printed on the PAN card:- ABHISHEK KUMAR
3. Have you been known by any other name? N
Last Name / Surname :- First Name:- Middle Name:-
4. Gender:- MALE
5.Date of Birth / Incorporation/Agreement/Partnership or Trust Deed/Formation of Body
24/06/2000
of Individuals/Association of Persons:-
6. Father's Name : Last Name / Surname :- SINGH First Name:- VINAY Middle Name:- KUMAR
Last Name / Surname :-
Mother's Name : First Name:- LALI Middle Name:-
SHARMA
The name of either father or mother which you may
FATHER'S NAME
like to be printed on PAN card :
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7. Address:-
Residential Address:-
Flat/Door/Block No.:- WARD NO. 6
Name of
ADAURI
Premises/Building/Village:-
Road/Street/Lane/Post
ADAURI
Office:-
Area/Locality/Taluka/Sub-
PURNAHIYA
Division:-
Town/City/District:- State/Union PIN Code:-
Country:- INDIA Zip:-
SHEOHAR Territory:- BIHAR 843334
Official Address:-
Office Name:-
Flat/Door/Block No.:-
Name of
Premises/Building/Village:-
Road/Street/Lane/Post
Office:-
Area/Locality/Taluka/Sub-
Division:-
State/Union
Town/City/District:- PIN Code:- Country:- Country:-
Territory:-
8. Address for
RESIDENCE
Communication:-

9. Telephone Number & Email ID Details :-

Country Area/STD Telephone/Mobile Email
91 06222 8676921875 abhi2413singh@gmail.com
Code:- Code:- Number:- Address:-
10. Status of the Applicant:- Individual
11. Registration Number(for
Company,firms,LLP's etc):-
12. Please Mention your AADHAAR
935145614375
Number(if allotted) :-
If AADHAAR number is not
allotted, please mention the
enrolment ID of Aadhaar application
form :-
Name as per AADHAAR letter/card
or as per the Enrolment ID of ABHISHEK KUMAR
Aadhaar application form :-

13.Source of Income

SALARIED Capital Gains

Income from Business/Profession Income from Other sources

Income from House property No income

14. Full Name, address of the Representative Assessee, who is assessable under the Income Tax Act in respect of the
person, whose particulars have been given in colmns 1 to 13.
Title:- Last Name:- Middle Name:- First Name:-
Flat/Door/Block No.:-
Name of
Premises/Building/Village:-

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Road/Street/Lane/Post
Office:-
Area/Locality/Taluka/Sub-
Division:-
Town/City/District:- State/Union Territory:- PIN Code:-

15. I/We have enclosed AADHAAR Card issued by UIDAI (In Copy) as Proof of Identity , AADHAAR Card issued by
UIDAI (In Copy) as Proof of Address and AADHAAR Card issued by UIDAI (In Copy) as Proof of DOB.
16. I/We ABHISHEK KUMAR ,the applicant,in the capacity of HIMSELF/HERSELF do hereby declare that what is stated
above is true to the best of my/our information and belief.

ADAURI

Signature/Left thumb impression of the

Place Date
applicant

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