D-1638 /77 .

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6
App lica tion Num ber : GOS 616 243
Cou pon Num ber : G05 616 243 6

I Asse ssing Officer(AO Code) I

IIAO Type l!Range Code IIAO No I
/Area Code
II II II
I
11. Full Name (Full expanded name: initials are not permitted): II
Fitle :- SHRI I/Last Name:- RAIKWAR IIMiddle Name:-
First Nam e:-
RAMKISHOR I
wou ld like It, to be print ed on the PAN card
:- I
2. Abb revia tion of the abov e name, as you
RAM KISH OR RAIKWAR
l3.Have you been know n by any othe r nam
e? N I
I l!Last Name:- !!Middle Name:- IIFirst Nam e:- I
[4. Gen der; -
IIM I
ent/P artne rship or Trus t Deed/Formation of Bod y of !01101,1988
5.Da te of Birth / Inco rpor ation /Agr eem
Indiv idua ls/A ssoc iatio n of Pers ons: -
/6. Father's Name:
lLas t Nam e:- RAIKWAR
IIMlddle Nam e:- N/A IIFtrst Nam e:- JAN UWA I 'I
)
11. Add ress :- I
l Res iden tial Add ress :- l1WZ-s13 E ]
[,=1at1Door/Block No.:-
IIBASAI DARAPUR ]
lName of Prem ises /Bui lding Nilla ge:-
IIRAMESH NAG ARJ
[Roa d/St reet /Lan e/Po st Offic e:- 1 :,1
. .
~rea /Loc ality /Tal uka/ Sub -Div ision :-
Hstate/Un1on Terrrtory:-
DEL HI IIPIN Cod e:- 1100 16 ICountry .• lNOI A - ~
frow n/Ci ty/O ifi.tr ict:- WES T DEL HI
_J
1
[Official Add ress :- 11 7

r
 Name:•
II
~ 8

~oor/B lock No.:•

i
ffiEe of Premlses/BulldlngNlllage:- U

~;;oa:::: ::d/=S= tr=ee=t/ =L:::a=n e=/P=o= s=t=O= ffi=c=e= :•===== ====== ======
=~'!=' === ==~
Eea/Loc alityfralu ka/Sub- Division :- II
_ _____.!lcountry:-
,~~=o=w=n=/C=ity==/D=is=t=ri=ct=:•=====:::::lu~s=t=at=e=/U=n=io=n=T:::::e=rr=it=o=ry=:•===~'1-IP_IN_C_od_e_:_-
~- Address for Commun ication:- IIRESIDENCE I

~. Telephone Number & Email ID Details :-

Country Cl
Area/STD ~ Telephone/Mobile 880059125 SHISH. [email protected]
Code:- L..J
Code:- ~ Number:-
j10. Status of the Applican t:- !llndividual
11. Registration Number(for
~==~
II
Company,firms,LLP's etc):-
::::::::===:;::::::=========:
12. Please Mention your 221602381486
AADHAAR Number(if allotted) :-
j13.Source of Income

Business/Profession code:- 10=

the Income Tax Act in
14. Full Name, address of the Representative Assessee, who is assessable under
respect of the person, whose particula rs have been given in colmns 1 to 13.
jLast Name:- !!Middle Name:- IIFirst Name:-

flat/Doo r/Block No.:-

fName of Premise s/Buildin gNillage :-
!Road/Street/Lane/Post Office:-
jAreaJLocality/Taluka/Sub-Division:-
I
==~,
l!:~=o=wn=/C=ity=/D=is=t=ric=t=:-===::::;;:11s=t=at=e/=U=n=io=n=T=e=rr=it=ory=:-====,;;::1P=IN=C=o=de=:=-=

15. I/We have enclosed AADHAA R Card issued by UIDAI (In Copy} as Proof
of Identity ,
Copy Electrici ty bill not more than 3 months old. as Proof of Address and AADHAAR
Card issued by UIDAI (In Copy) as Proof of DOB.
LF do
16. I/We RAMKISHOR RAIKWAR ,the applican t,in the capacity of HIMSELF/HERSE
stated above is true to the best of my/our informat ion and
hereby declare that what is
belief.

BASAIDARAPUR

Signatu re/left
Place
I
__
Date
Ithumb impress ion
. of the applican t
 Ml'l OM PAIU(ASH
Sanc.tfonelft.tnld (l<WJICVA) 00 200 CA No. : 60006830172
Contra t D•m1mlf EnerglHtlon Data 24/03/1986
rm,,... , r11t1or Security Dapoalt 3225 00
Olatrt I MOTi NA<)AR SLD Ctuirgaa 0 00
Zoo• l A~J\a(I Mflrl(II Connection type : PERMANENT
MHUND Mt112AOIJ1 T11rltt t;ategory NOLT
wa1~1n1111111111,rico 00013'1/0'.178/001 8111 Batla · Actual(KVAH)
1'olofrlll11r No 1301 ;,!,,6/1 Bill Remark BILL ON READING
BIii Date ✓131111'021
Propnlct con U"1or(Tcn nt) NO
1:3111 No 010e04156244

Dl1ct>nnecnon N~tic.. ettachod ''°"9 with thl-. bill

Dua Data: 14-DEC-2021

(Immediate for ArnlaR)
.~
Total Amount Payable
t 2590.00

11111111m11111rn11 mm11m1111mm1111111111~m11111 m
11060006830172000 00025900000000000 000

UoO;....Jii,i. _ _,. -.:1.i1ta:o!tftfl,, ,...,1ct-o,ros

_ _ _ ...__ ltl3~'""1"'1lboar&!W>k farta>Cl&du<:edllllogh e,n,te
..!::'...., ~ioh7o0'"1Sittoourcu-.1-...., ,...
rz:lJil====ar~-Co nMcl/ltlpo, call
o, ,,,...._ ~ re,qu,st pea..,.~ C 24111 hftJplJt)e
"-"~•~.., 0 !:;7~~~:•~:~~•at w.ht ra,"'09M"t-ddlrnm fixed Charges 1..-,n~
2.00"250.CC' ) 994&=497.30
'497.30
I TO 16 CW.21121 I for Rs 2A9.IU ,TDS doducle<I R< 0 00
':10~1DT•to-]!r0elh,0.1 nt,u1,onL..,,.lwdCANo b000bel0172 Plonse""lm•on
_ tunbef : • wtllle making r>otnllfflt U'\rough W•qoo. Choque atl()IJ(d be AJc pay. .,

fl Energy Charges/ A !iiOJ 414.00

="'Y
• - 00,__on06-0CT"202t
11- nr ~.,_,tar DCir tJ br IMCDMed:"12 O"I f\On pa-,,n IC or~ pey-.",le '1•,e1 lndudtnQ errtt<lf'ft nnttr JJnlts Rwte(?) Amount(")
.\ct.200~ •ftO "111> CNl>t.,,- VI of OERC (Supply ~ ttnd 6.00 414 .00
69 X
PAC, btlna le-'ed o., Cn.ry; & f,.-.t,J Cl•rw,cr. ct.,~ P,u._.1.,iviwl PPAC
0.2' ancl D 019n1,a, !'PAC@ 8 50% lo, <ho pono,J horn 010421 10
0

;
•-P.._,.c..e.. I

(1 TPDOL...,,....,,~F61o ct< Ks-t1l;1t911r,Oot~lt10015

'

'

Coneumptjon Hlstocy _ --
T01alAmo11nt '"'
- -

'
fBilino Period IDe-;i UnJts B1l!Ball Current ,;,>uosictv f'ro,m;lon;ill
Deman<.I em Ret.irttt' - Payable
Power Purchase Cost Adjustment Charge (PPAC)
j.c..OQ.'21-::1'-,tr.lJ 33 111 ~ 1ffl 3(l 000 000 1•1000
PPAC on Fixed Charges/~ ~ tR 8.16
zs,oe'2t 2l,W'21 :l!J ~ /,ciual 126~.06 0.00 000 7080-~
# PPAC on Energy Charges / i»ulf ~ 1R 6.79
t:Jn7 <1 ~ ....A/21 33 ~ .Actual 131'.87 0.00 000 5750 00
Differential PPAC on Fixed Charges 42.27
I e.«)121 22,W 121 3.5 9!i Aehlil 1420 13 000 000 "380.00
fl Dlfferen~al PPAC on Energy Charges 35.19
18105a'21-17~'21 31 '27 ,t,ctull 82•89 0.00 0.00 29:1000
2070 00 Surcharge I rii'lR
17/04 '21-17.0S'21 31 2 Actual 66931 000 000 39.78
On Fixed Charges @ 8% /~,ft~ ~
33.12
~ On Energy Charges @ 8% / iiv!I ~ 'R

OCT'.21 Pension Trust Charges

On Fixed Charges / '!'mll ¥ 1R 34.81
708000 &431 00
28.98
On Energy Charges / ~ ~ '"
24.46
Electricity Tax@5% (on#)/~ 1fR

1164.86
11111m111111111111m11
060006830172 N CJr t 0 man

ry/
Provisional
Total Amount
Subsidy Bili Refund 2-.le

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