Form NO.
Only Individuals
to affix recent
photograph
(3.5 cm x
2.5 cm)
49A
Only Individuals
to affix recent
photograph
(3.5 cm x
2.5 cm)
AO TYPE
AREA CODE
BPL
Range Code
AO NO
93
13
Sir, I/We hereby request that a permanent account number be allotted to me/us.
Shri
Smt
Kumari
M/S
Kumari
M/S
SHARMA
KEWAL
Middle Name
2. Abbreviations of the above name, as you would like it, to be printed on the PAN card
KEWAL SHARMA
3. Have you ever been known by other name?
If yes, please give that other name
Please select title, as applicable
Yes
Shri
No
Smt.
Last Name/Surname
First Name
Middle Name
4. Gender(for individual applicants only)
Male
Female
Month
Year
27/10/1992
6. Details of Parents (applicable only for individual applicants)
Fathers Name (Mandatory - Even married women should fill in fathers name only)
Last Name/Surname
SHARMA
First Name
SURESH
Middle Name
CHANDRA
SHARMA
First Name
VANDANA
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 fathers name)
Father's Name
Mother's Name
(Please tick as applicable)
7.
Address
Residence Address
Flat / Room / Door / Block
11/2
THANDLA
BHRAHMAN MOHALLA
JHABUA
MADHYA PRADESH
Office Address
Name of office
Flat / Room / Door / Block
Name of Premises / Building /
Road / Street / Lane/Post Office
Area / Locality / Taluka/ Sub-
Country Name
INDIA
8.
9.
Country code
Country Name
Office
Residence
Area/STD Code
91
9179725959
Email ID
KEWAL.SHARMA743@GMAIL.COM
Company
Partnership Firm
Association of Persons
Trusts
Body of Individuals
Local Authority
Capital Gains
Business/Profession
No income
as applicable
Shri
Smt
Kumari
M/s
Last Name/Surname
First Name
Middle Name
Address
Flat / Room / Door / Block
Name of Premises / Building /
Road / Street / Lane/Post Office
Area / Locality / Taluka/ SubTown / City / District
State / Union Territory
Pincode
Country Name
15. Documents submitted as Proof of Identity (POI), Proof of Address (POA) and Proof of Date of Birth (DOB)
I/We have enclosed
as proof of identity
Driving License
[Please refer to the instructions (as specified in Rule 114 of I.T. Rules, 1962) for list of mandatory certified documents to be submitted as
applicable
[Annexure A, Annexure B & Annexure C are to be used wherever applicable]
16 I/We
KEWAL SHARMA
Himself/Herself
do hereby declare that what is stated above is true to the best of my/our information and
belief.
Place
INDORE
DD
Date
22/08/2016
MM
YYYY
Signature / Left Thumb Impression of
Applicant (inside the box)