Request For New PAN Card Or / And Changes Or Correction in PAN Data

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Application Number:U-Q000584258
Coupon Number:U-Q000584258
Permanent Account Number(PAN)
ABSPJ8489M

AADHAAR not matched using Demographic details - will not be linked with PAN.

Payment Status: Success

Your Payment of Rs.110.00/- for one PAN Application has been accepted subject to realization
and final settlement confirmation from your Banker.
Please quote Reference No. LSBI5957224333 for any future correspondence.

1. Full Name (Full expanded name to be mentioned as appearing in proof identity/address

documents initials are not permitted):-()
Title:- First Name:- Middle Name:-
Last Name/Surname:- JHA
SHRI DURGANAND NAVIKANT
Name you would like it printed on the PAN card:- DURGANAND NAVIKANT JHA

2. Details of Parents(applicable only for Individual applicants) :-

Father's Name(Mandatory - Even married woman should fill in father's name only)
First Name:- Middle Name:-
Last Name/Surname:- JHA
NAVIKANT ANIRUDH
Mother's Name (optional)
Last Name/Surname:- First Name:- Middle Name:-
The name of either father or mother which you may like to be
FATHER'S NAME
printed on PAN card :-

3. Date of Birth / Incorporation/Agreement/Partnership or

Trust Deed/Formation of Body of Individuals/Association of 05/01/1948
Persons:-

4. Gender (for 'Individual' applicant only):- MALE

 5. Photo Mismatch:-

6. Signature Mismatch:-

7. Address of Communication:- RESIDENCE

Name of Office (to be filled only in case of
office address):-
Flat/Room/Door/Block No.:- 201
Name of Premises/Building/Village:- SHILP AVENUE
Road/Street/Lane/Post Office:- NAVA VADAJ
Area/Locality/Taluka/Sub-Division:- NARANPURA
Town/City/District:- State/Union Territory:- PIN Code:- Country:-
ZIP:-
AHMEDABAD GUJARAT 380013 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 Email ID:-
91 079 Number:- 9662761138 JHA.SOFCON@GMAIL.COM

10. AADHAAR Number(if 608180423835

allotted) :-
Name as per AADHAAR
DURGANAND NAVIKANT JHA
letter/card :-

11. Mention Other Permanent Account Numbers (PANs) inadvertently alloted to you:-
PAN 1:- PAN 2:- PAN 3:- PAN 4:-
12. I/We DURGANAND NAVIKANT JHA ,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. I/We have enclosed 4 (number of documents) in support of
proposed changes/corrections.

AHMEDABAD

Place Date Signature/Left thumb impression of the applicant