[Application Number{AQGS274005. TUWIIINIIUL||> eons crease ravoCoaESaT — ASSES 7 S983 Jpaymentdate: [1008/2023 RsA0700- ——__—) pplication Source: EWALLET = A- CSC E GOVERNANCE SERVICES INDIA LIMITED ——apptcaton oate(100S12025—] User id:[114361330019. “Juser Name ] IPAN CARD MODE : Both physical PAN and e-PAN Card lication Mode : Physical lication Form No. 494 Applicaton for Allotment of Permanent Account Numbet {ln the case of indian Citizens! Indian Companies/ Entities incorporated in ina Ce ‘Unincorporated efits formed in nda} i Seotue sas ps og a dot eon 3 Assessing officer (AO code) Teacede | AOiype | Range cous —[ AO Nas cuaieeenl EL ew afd 111 ee Aaa TH Sic, We hereby request that a Permanent Account Number be allotted to metus We give below necessary particulars: Saul Treinen 1 Full Name (Full expanded name to be mentioned as appearing in poat of iden dlocaments nals are not permite) Please select tile, [7] as applicable she Is. [ov] Kumari ws Last Name / Sumeme Uls|KIAIN — FistName Mile Name 2 tions ofthe above name, as you would ike it tobe printed o 7 ss M/U|S/K]AIN I 3 Have you ever boen known by any other ves [¥]No {please tick as applicable) rye, pace ge at oti rane Petse select tte [Jou scpuctie [Jom [Jone ont (ie Last Name /Sumame First Name Middle Name 4) Gender (for individual applicants only) 5. Date of Birthtncorporation/AgreementPartnership or Trust Deed Formation of Body of individuals or association of Persons ‘8 Details of Parents (applicable only fr individual applicants), \Wnether mother fa single parent and you wish to apply fr PAN by furishng the name of your mater only? Yes{__] No yes, please it in mother’s name inthe appropriate space provide below. (please tick as applicable) Mothers's Name (optional except where mothor is and PAN Ts applied by: Last Nama / Sumame First Name Middle Namo Select the name of ether fathor or mother whieh you may ke Toa Bntad on PAN card aoa ony {Incase no option is proved then PAN card wil be is PAN by fumishing name ofthe mather only) 7 Address Father's name sued with father's name except where mothers a single parent and you wish to apply for Mother's Name (reed us yptiab Residence Address Flat! Room / Door Block No. [Name of Promises /Bulding / Viloge Road / Steet Lane Post Ofice ‘Area! Locality! Taluka Sub- Dison own Cty District Stato / Union Torttory MADHYA Pincoda Zip code Glico ldieas PRADESH|al7[1‘Area / Locality! Taluka Sub- Dvigon Ton Cy Diet MADHYA PRADES H/4/7/1/0[0[7 INDIA 8 Adéress fr Communication 7] Residence Dlotice (Please ck as applicable) Telephone Number & Email 1D detats County cade AealSTD Cove ‘Rlephane Mate nurber 9a 78 [6[9]2[9[e[7]7]21_1 Email'0 _[[email protected] {0 Stats of applicant Pass ste sats, [Jas applet [Eldvoreeat Z]incvicvst — [Jina uncivies tamty — [Jeompany [rernerstip Fm [association of Persons Cr» Jooiroriniuas — [Juccataunony [Jaan reat aon] ints usnty Parenti 11 Ragstration Number (or company, fms, LPS ete) 12 1n Gass of person, whe raqulred to quote Assn beth EnolnentO of Aachaar aplication form a pr section 139AA Pease monton your AADHAAR number atoted) [90] 8] 8] [5]3] 4] 8] [e] 8] 3] 2 WAADHAAR number's ot alloted, ploase mention the enrolment iD of Aadha’ application form "Name as per AADHAAR ltter/card or as por the Enrolment IO of Aadhaar application form U) MIUTSTKTATN 413. source of ncome LO satery [7 trcome tom House property Piease select, [V/] 2s applicabio Noincome LD) copa cans Income from Business Profession _Business/Profession code [For Code: Refer instructions) [_] income rom Otner sources ‘4 Representative Assossee (RA) Full name, address of the Representative Assesses, who is assessible under the Income Tax Ac in respect ofthe person, whose particulars have ‘been given in the column 1-13 Full Name (Full expanded name : initials are not permitted) Piease select tte, [7] Last Name / Surname First Name Middle Name Address Flat / Room / Door / Block No. Name of Premisos/ Busing /Vitage Road / Street Lane!Post Office ‘Area! Localty | Taluka! Sub- Division Town/City / Distt State / Union Terry MADHYA P Ra DE s #]4[7]i]o]o]i| |Pincoae 418 Documents submitted as Proof of identity (POH), Proof of Address (POA) and Proof of Date of Birth (DOB) 11 have encoses [ AADHAAR Card Issued by as prool ct denuy, (PADHAAR Card 'ssued by UIDAT™] as proof of address and ard Tesue\ lAnnexure A, Annexure B & Annexure C ae to be used wherever applicabie) fa alee ener | te spon, inthe capac of REPRESENTATIVE ASSESSEE] ‘so hereby declare that whats stated above i rue tothe best of my/our information and belie. Ploce: (CHHATARPUR 28 proof of date of bith (Please ror tothe instructions (as specied in Rule 114 of LT, Rules, 1962) for lst of mandatory cetiied documents to be submited a8 applicable} kW aATA ta |aretha Afar wr g “Unique identiication Autmonty of nia 570 we wy até 11, Rage MEA, EE, 471001 I un wr stem 1 feMadnye “eno. 4239 0630 0025 Far sens, a Tear 4239 0630 0025 Lye vaa ii IRE Sh Coc Government of India BIRGIDMCIO MSI MC Ct Unique Identification Authority of India ‘atari 2p5/ Enrolment No.: 0620/03160/24202 To I Muskan 1)0: Raman Khan wardno-O-narayanpra-road Sidesnar-clonrcthatarpa Chhatarpe Chhatarpur Mocha Pradesh - 471001, 7969196772 we SHTeeT STU wat / Your Aadhaar No. 9088 5148 6832 Vib : 9116 1393 0525 9155 gen Muslan ‘a Rf4/o08: 20/05/2008, fey FEMALE 9088 5148 6832 VD : 9116 1393 0525 91° zg — Aw. tee AADHAAR ‘WET / INFORMATION ie sere agar wr wee, ates AT paenmenanl . ie CARTER SOTO Sarre cram etre se sour go oS ome, eh we, fore ah oH Sen srg Hae B12 se & are oa Fa Snr ed are Sew (0) ww 9 et st eect fo ana A af a ww a tre ete eet 1 sour areata weet ate ARTA ats Pet remem A ace weer are 3S srg see te Eh ang abe wh 1m arene sera ar a got & fa sare ait mAadhoar be ‘orets 8 gravariaties at strate wet Pteor as sector Su i ee 8 sour (GH ae) EA at afta wea Frewee fear rarer ™ Aadhaaris a proof ofidentity, notof citizenship. ‘Aadhaaris unique and secure, "= Al forms of Aadhaar like Aadhaar letter, PVC Cards, eAadhaar and mAadhaar are equally valid. Virtual ‘Aadhaar Identity (VID) can also be used in place of 12 ‘digit Aadhaar numb ™ Update Aadhaar at "= Aadhaar helps you avail various Government and Non-Government benefits/services. ‘= Keep your mobile number and email id updated in ‘Aadhaar. Download mAadhaar app on smart phones to avail ‘Aadhaar Services. 1 Use the feature of lock/unlock Aadhaar/biometrics to nsure security, ' Eniiies seeking Aadhaar are obligated to seek due consent. = Sire ee nol-rem a, aa rss [SS noe wagers joann, 9088 5148 6832 AT Sree, A Teast a AIA gar Vib: 9116 13930525 9155 __|