Form No.

49A
: Apptication fotAllotrnent ol Pemanent Account Numb€r
En tte case oflndian Citizens/lndian Companies/Entities incorporated in lndia/
. unt:rtoo*9":T,,:,':sJormed in lodial
To rvoid histate iB), Fl€a66 rollow lh. lc.omPsnying inslruclion6 and etahples borore frlling uplh6lom

--al Esessing ofllcet (Ao code)

Area eode AO type Range code AO No.

W B G1 2_ o 5 a \

9ir,
?Y'" ",Gfl:q-
l/We hereby request that a pelmanent account number be allolled io me/us.
Sisnature / Len Thumb IhPn
lA/Ve gNe below necessa'y partlculars:

1 F!ll Narn.r {Full expahded name to be mentioned as apperrlng in proot ot identity/drte ol birth/addrcss documents: initials are not perrnitted}
Please select title, as applicable Shri smt. Kumari IV/s

E
Last Name / Surname S r\ l-l
Fir6t Name R U r+ L) L
Middle Name t+ r\,t t N

tr rTTt_l -rn
2 Abbrevlations of the above name; as you wotild like lt, to be printed on the PAN card

R tr U L ft fr {\ t N s E K tr TT fI
U
tt Tf at I T tt
3 Have you ever been known by ahy otter name? Yes No (please lick as applicable)
llyes, please give that other name

Please sel*t title, as applicable Shri Smt. Kumari M/s

Last NameI Surname

First Name
Middle Name

4 Gender ffor lndividual applicants only) Male Transgender (please tick as applicable)

5 Date of Bi.th/lncorporation/AgreemenvPartnership or Trust Deed/ Formation of Body of individuals or Associaticn of Persons

-, Day Month Yeaa .'
o I o t 9 2 r
6 Details ot Parents (applicable only tor individual applicants)
Whether mother is a single parent and you wish to apply for PAN by turnishing the name ofyou. mother only?
Yes No {please tick as applicable)
lf ye6, please fill in mother's name in the appropriate spaoe provide below.
Fa{her's Name (lrandatory except where mother ls a single parent and PAN ls applled by furnishing the name of mother only)
Last Name / Surname ) E K H
First Name R U
-l N ft B: L
Middle Name

fiITI rl II rl-rrrL -rT TT T

Mother's Name (optional excepl where mother is a single parentand PAN is applied by furnishing the name of mother only)
'
n-rn
Last Name /Sumame L_l
First Name f tt tlll [T L]
lItltllltllltillltll
I

Middle Name
Select the name of eith father or motherwhich you may like to be printed on PAN card (Se/ect ane onlyl
rll l

Fathels name l\rother's name (Ptease tick as appticable)

(ln case no optlon is provided then PAN card will be issued with father's name exoept where mother is a single parent anU you wish to apply for PAN
by furhishing name ofthe mother only)'.
? Address
Residence Address
Flat / Room / Door / Block No. rtlllltiltrtll
Name of Prehises lBuilding /Villege € I P 0 E lllt tttltll
tttlt
I

:TT- II
I

Road / Streej /LanePost ofiice P fl R U L ( A

Area / Locality /Tal!ka/ Sub- Division a. fr l{ P U
q tt * T ll IILIIIt=t tIII
TowniCitli/District E L R B fJ rl f\ TfTTfTfT-N
 Office Address
Name of office :-_
Fiat I Room / Door / Block No.

Name of Premises I Buitding lVillage

Road / Streel/laEePost Oilce
Area I Locality lfaluka/ Sub- Division
Towr/City/Distdqt
State / LJnion leraitory Pincode / ZjD code

I
-r--r
tt
Country Name

I
I
Address for Communication
Telephone Number & Email lD detaits
[f nesioence
tr Office {Please tick as applicable}

Country code Area/STD Code Telephone / I,iobile number

Email lD
0 I tll III tt6 219, 1- 1 6 r l I \ |l
10 Status of applicant
Please select status,
V as applicable

II
Government

ffindividual
l--l r*"t"
Hindu undivided family

Body of lndividuals
IT Company

LocalAuthority
Partnership Firm

Artificial Juridical Persons

Association of Persons

Limited Liability Partnership

ll
_T_fT
ReEislration Numb€r (fot compahy, tirms, LLps etc.)

t2
II If ITTTI I I
ln case ol a person, who is requlred to quole Aadhaar number ot the Enrolment lD o, Aadhaar application form as per seclion 13g AA
Please mention youiAADHAAR numb€r (if allotted) Lt16l'-{ 16 o 1 L 79 2 t
IfAADHAAR number is hot allotted, please rnentioh the enrolment lD ofAadhaar a
-T_r l1 TT_T_TT tl cation forrn

iTT-rr I
-rT-fT-r-
Name as per AADHAAR letter or card or as the Enrolment lD of Aadhaar ication form
R. 0 tt U L R I"\ 1 N 5 E K H

I
!
't3 Source of lncomo Ptease select, as applicable

!
Salary CapitalGains
lncome from Business /
lncome from House property
Profession BusinesslProfession code II [For Code: Refer instructions] lncome from Other sources
No income
14 . Repre6entative Assessee (RA)
Full name, addre6s ofthe Represehtative Aa6essee, who is a66essible under the lnoome Tax A6l in respect ofthe peEon, wt1ose particutars have
beeh given in the column 1-13.
Full Name (Full exFanded name : Initials a.e not permitted)
Plea6e select title,
M as applicable
tr_I
It1
shra Smt
_l I Kumari [4/s
-TTr-t
Last Name,/ Surname
-r f]TT-T_Iltl
If Tl-rT-r-
frrT-r tt
First Name
lViddle Name

Addtess
T_ t- II rrtl I

Flat / Room / Door / Block No

TT_T
IIIIII rI IIII IIIIIIII
Name of Premises / Building / Village
t1
Road / Street I Lane,/Post Offioe
Area / Loca,ity / Taluka/ Sub- Division
rIII II
ITIIIII IITII
Town/City/District
State / Unjon Territory
ITI Pincode
IITT IIIII
15 Documents submitted as Proof of ldentity lpol), proot
fT TT_TT ll
of Address {POA)and Proof of Date of Birth (PoB)
l/We have enclosed €d{1r\49^- (}^g..d as proof of identity, t----7
a6 proof of addrcss and
b0*l^. as proof of date of birth
lPlease refer to the irstruotions (as spedfied in Rute 114 of I .T. Rules, 1962)for list ol mandatory certifed document6 to be s!bmitted as appticablel
[Annexure A, Annexure B &Annexure C areto be used whe rever ap icablel
,6 I
, the applioant, in the oapacity of 9U.
do hereby decl are that what is stated above is true to the best of my/our information and beliel

Place *dr,'d)^oA Puh *?,t Vfrqoe-

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Enrollment No.: 1 058/33073/05873

To
RUHUL AI\,4IN SEKH

Gazipur
Parulia
6 Mavureswar - I Bkbhum
West BengalTS'1213

iltlililililIt il illt1ilil tilll flll

M1913752595FT

gq6'1 3IItm iF-#ntF/ Your Aadhaar No. :

4646 0292 2164

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RUHUL AMIN SEKH
Father: AUJNABI SEKH
DOB : 01/01/1982
Male

64
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2020

ilication Aclorowl ent Recei t(F orm49A)

PAN
from: SHRI RUHUI- AMIN SEK H
Received Rs.io7 o0/- (i ncl.of taxes)
u-Go30950104
Application No./coupon No :
RUHUL AMIN SEKH
Name as to be Prin!€d eniAN card
.r
i'IALE
Gender: - -: otlotl,-9A2
:
Date of Birth/lncorpor€tlon
AUJNASI SEKH
Father's Name:
xxxx-xxxx-2164 (MENTIoNED'MATCHED)*
Aadhaar number:
RUHUL AMIN SEKH
Name as Per Aadhaar:
629596A31T / JAYANTADIGITALI@GMAIL'CO]iI
Applicanf s Contact details:
RESIDENCE
Communication Address:
WEST BEI{GAL
Residence State:
Not Mention€d
Office State I
AADHAAR Card issued bv UIDAI (In coPy)
Proof of ldentity: (In Copv)
AADHAAR Card issued by UIDAI
Proof of Address: UTDAI (In Copy)
AADHAAR Card issued by
Proof of DOB:
24l02l2o2o
Date of ReceiPt:
Both Physical PAN Ca'd and e-PAN
Mode of Pancard:
OZTITI.S . WfiL BE I.INKED U]TTH
PAN'
AADIIAAR MATCIIED US I NG DEMOGRAPHIC (Sisn/StamP)
D HARP U R
R BAZAR MAIN ROADO, GADA Received for sLlbmission to
DOGMA so FT LIMITE D. JAYANT G RAI G ADADHARPU
DOG MAAD 7 39 539 UTIITSL
R ,s B R BH U I!4 WEST BENGA L 7 3 1 2 m
36 74472 a a ntad iq ta 1 @s m a
Cen tre Co ntact D eta ls 9 9 3
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