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    Ram
    1) Uttam Sarkar is requesting a new PAN card or changes/corrections to his existing PAN card number EBZPS6559A. 2) He provides his personal details like name, date of birth, gender, address in Surat, Gujarat, India. 3) He mentions his Aadhaar number for verification and declares that the information provided is true to the best of his knowledge. 4) Uttam encloses one document in support of the proposed changes/corrections to his PAN details.

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    Encrypt Signedfinal

    Uploaded by

    Ram
    42 views2 pages
    1) Uttam Sarkar is requesting a new PAN card or changes/corrections to his existing PAN card number EBZPS6559A. 2) He provides his personal details like name, date of birth, gender, address in Surat, Gujarat, India. 3) He mentions his Aadhaar number for verification and declares that the information provided is true to the best of his knowledge. 4) Uttam encloses one document in support of the proposed changes/corrections to his PAN details.

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    881058206203523_encrypt_signedFinal

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    1) Uttam Sarkar is requesting a new PAN card or changes/corrections to his existing PAN card number EBZPS6559A. 2) He provides his personal details like name, date of birth, gender, address in Surat, Gujarat, India. 3) He mentions his Aadhaar number for verification and declares that the information provided is true to the best of his knowledge. 4) Uttam encloses one document in support of the proposed changes/corrections to his PAN details.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    42 views2 pages

    Encrypt Signedfinal

    Uploaded by

    Ram
    1) Uttam Sarkar is requesting a new PAN card or changes/corrections to his existing PAN card number EBZPS6559A. 2) He provides his personal details like name, date of birth, gender, address in Surat, Gujarat, India. 3) He mentions his Aadhaar number for verification and declares that the information provided is true to the best of his knowledge. 4) Uttam encloses one document in support of the proposed changes/corrections to his PAN details.

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    Acknowledgement Number : N- 881058206203523

    Only ‘Individuals’ to
    Only ‘Individuals’ to
    affix recent Request For New PAN Card Or/ And Changes Or Correction in
    affix recent
    photograph
    Permanent Account Number (PAN) photograph
    (3.5 cm x
    (3.5 cm x
    2.5 cm) EBZPS6559A 2.5 cm)
    Please read Instructions ‘h’ & ‘i’ for selecting boxes on left margin of this form.
    Sign/ Left Thumb impression
    across this photo
    1.Full Name (Full expanded name to be mentioned as appearing in proof of identity/address

    Please select title, as applicable Shri Smt Kumari M/S Signature / Left Thumb Impression of
    Applicant (inside the box)
    Last Name/Surname SARKAR
    First Name UTTAM
    Middle Name
    Name you would like it printed on the PAN card
    UTTAM SARKAR
    2 Details of Parents (Applicable only for Individual Applicants)
    Whether mother is a single parent and you wish to apply for PAN by furnishing the name of your mother only? Yes No
    If yes,please fill in mother's name in the appropriate space provided below.
    (please tick as applicable)
    Father's Name (Mandatory except where mother is a single parent and PAN is applied by furnishing the name of mother only)
    Last Name/Surname SARKAR
    First Name KARTICK CHANDRA
    Middle Name
    Mother's Name (Optional except where mother is a single parent and PAN is applied by furnishing the name of mother only)
    Last Name/Surname
    First Name
    Middle Name
    Select the name of either Father or Mother which you may like to be printed on PAN Card (Select one only)
    In case no option is provided,then PAN Card will be issued with Father's Name. Father's Name Mother's Name
    (In case no option is provided then PAN card will be issued with father's name except where mother is a single parent and you wish to apply
    for PAN by furnishing name of mother only)
    3. Date of Birth/Incorporation/Agreement/Partnership or Trust Deed/ Formation of Body of individuals or association of Persons
    Day Month Year
    02/06/1981
    4. Gender(for individual applicants only) Male Female Transgender
    5. Photo Mismatch 6.Signature Mismatch
    7. Address for Communication Residence Office
    Name of office
    Flat / Room / Door / Block No. 529 ANAND NIWAS NEW
    Name of Premises / Building / Village FLOWER SCHOOL KRISHNA
    Road / Street / Lane/Post Office NAGAR KRISHNA NAGAR
    Area / Locality / Taluka/ Sub- Division Ichchhapor
    Town / City / District Surat
    State / Union Territory PIN Code ZIP Code Country Name
    GUJARAT 394510 null INDIA
    8. If you desire to update your other address also, give required details In additional sheet.
    9. Telephone Number & Email ID details
    Country code Area/STD Code Telephone / Mobile number
    91 7405610193

    Email ID [email protected]
    10. Please mention your AADHAAR number (if allotted) XXXXXXXX1312
    Name as per AADHAAR letter/card UTTAM SARKAR
    11. Mention other Permanent Account Numbers (PANs) inadvertently allotted to you
    PAN PAN

    PAN PAN
    12. Verification

    I/We UTTAM SARKAR 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.
    belief.
    I/We have enclosed
    changes/corrections. 1 (number of documents) in support of proposed
    Place SURAT
    DD MM YYYY
    Date 20/03/2023 Signature / Left Thumb Impression of
    13. Other Address :

    Name of office
    Flat / Room / Door / Block No.
    Name of Premises / Building / Village
    Road / Street / Lane/Post Office
    Area / Locality / Taluka/ Sub- Division
    Town / City / District

    State / Union Territory PIN Code ZIP Code Country Name

    Signature / Left Thumb Impression of


    Applicant (inside the box)

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