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    Form 49A - ThePanCard PDF

    Uploaded by

    Ranjan Roy Jacob
    Ranjan Roy Jacob has submitted an application for an allotment of a Permanent Account Number (PAN). He has provided personal details like name, gender, date of birth, address, father and mother's name. He has also submitted documents like a driving license as proof of identity and address and a birth certificate as proof of date of birth. Ranjan Roy Jacob has declared that the information provided is true and correct.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Form 49A - ThePanCard PDF

    Uploaded by

    Ranjan Roy Jacob
    50 views3 pages
    Ranjan Roy Jacob has submitted an application for an allotment of a Permanent Account Number (PAN). He has provided personal details like name, gender, date of birth, address, father and mother's name. He has also submitted documents like a driving license as proof of identity and address and a birth certificate as proof of date of birth. Ranjan Roy Jacob has declared that the information provided is true and correct.

    Original Title

    Form 49A _ ThePanCard.pdf

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    © © All Rights Reserved

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    Ranjan Roy Jacob has submitted an application for an allotment of a Permanent Account Number (PAN). He has provided personal details like name, gender, date of birth, address, father and mother's name. He has also submitted documents like a driving license as proof of identity and address and a birth certificate as proof of date of birth. Ranjan Roy Jacob has declared that the information provided is true and correct.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    50 views3 pages

    Form 49A - ThePanCard PDF

    Uploaded by

    Ranjan Roy Jacob
    Ranjan Roy Jacob has submitted an application for an allotment of a Permanent Account Number (PAN). He has provided personal details like name, gender, date of birth, address, father and mother's name. He has also submitted documents like a driving license as proof of identity and address and a birth certificate as proof of date of birth. Ranjan Roy Jacob has declared that the information provided is true and correct.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    Form No.

    49A Only 'Individuals'


    Only 'Individuals'
    to affix recent Application for Allotment of Permanent Account Number to affix recent
    colour colour
    [In the case of Indian Citizens/Indian Companies/Entities
    photograph photograph
    incorporated in India/Unincorporated entities formed in India] (3.5 cm x 2.5 cm)
    (3.5 cm x 2.5 cm)
    Under section 139A of the Income Tax Act, 1961

    Assessing Officer (AO code)

    Signature of applicant across Area Code AO Type Range Code AO No.


    this photo
    K R L W 5 3 2

    Sir, I/We hereby request that a permanent account number be allotted to me/us.
    I/We give below necessary particulars: Signature of applicant (inside the box)

    1 Full Name (Full expanded name to be mentioned as appearing in proof of identity/address documents: initials are not permitted)
    Please select title, as applicable Shri Smt. Kumari M/s

    Last Name / Surname J A C O B


    First Name R A N J A N
    Middle Name R O Y
    2 Abbreviations of the above name, as you would like it, to be printed on the PAN card
    R A N J A N R O Y J A C O B

    3 Have you ever been known by any other name? Yes No (Please tick as applicable)
    If yes, please give that other name. Please select title, as applicable Shri Smt. Kumari M/s

    Last Name / Surname


    First Name
    Middle Name
    4 Gender (for Individual applicants only) Male Female (Please tick as applicable)
    5 Date of Birth/Incorporation/Agreement/Partnership or Trust Deed/Formation of Body of individuals or Association of
    Persons
    Day Month Year
    3 1 0 5 1 9 9 0
    6 Details of Parents (Applicable only for Individual applicants)
    Father's Name (Mandatory: Even married women should fill in father's name only)
    Last Name / Surname J A C O B
    First Name R O Y
    Middle Name
    Mother's Name (Optional)
    Last Name / Surname M A T H E W
    First Name J A C O B
    Middle Name B E T T Y
    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
    7 Address
    Residence Address
    Flat/Room/Door/Block No. M R A 6 A
    Name of Premises/Building/Village E L D O R A D O
    Road/Street/Lane/Post Office M U N D A K K A L
    Area/Locality/Taluka/Sub-Division K O L L A M
    Town/City/District K O L L A M
    State/Union Territory Pincode/Zipcode Country Name
    KERALA 6 9 1 0 0 1 INDIA

    Page 1 of 3 / A0974443
    Office 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 Pincode/Zipcode Country Name

    8 Address for Communication Residence Office (Please tick as applicable)

    9 Telephone Number & Email ID details


    Country Code Area/STD Code Telephone/Mobile Number
    9 1 7 7 3 6 2 7 2 2 0 6

    Email ID RRANJJAN@GMAIL.COM

    10 Status of Applicant
    Please select status, as applicable Government
    Individual Hindu Undivided Family Company Partnership Firm Association of Persons
    Trusts Body of Individuals Local Authority Artificial Juridical Persons Limited Liability Partnership

    11 Registration Number (for company, firms, LLPs, etc.)

    12 Please mention your AADHAAR number (if allotted)

    13 Source of Income
    Please select, as applicable
    Salary Capital Gains
    Income from Business/Profession Business/Profession Code Income from Other sources
    Income from House property No income

    14 Representative Assessee (RA)


    Full name, address of the Representative Assessee, who is assessable under the Income Tax Act in respect of the person, whose particulars have been
    given in the column 1-13.

    Full Name (Full expanded name: initials are not permitted)


    Please select title, as applicable Shri Smt. Kumari M/s

    Last Name / Surname


    First Name
    Middle Name

    Address
    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 Pincode/Zipcode Country Name

    Page 2 of 3 / A0974443
    15 Documents submitted as Proof of Identity (POI), Proof of Address (POA) and as Proof of Date of Birth (DOB)
    I/We have enclosed DRIVING LICENSE as proof of identity,

    DRIVING LICENSE as proof of address and

    BIRTH CERTIFICATE as proof of date of birth.

    16 I/We RANJAN ROY JACOB , the applicant, in the capacity of HIMSELF


    do hereby declare that what is stated above is true to the best of my/our information and belief.

    Place KOLLAM

    D D M M Y Y Y Y
    Date 2 1 1 2 2 0 1 6

    Signature of applicant (inside the box)

    Page 3 of 3 / A0974443

    --------------------------------------------------------------------------------- Cut here & Paste on the envelope -------------------------------------------------------------------------------

    FROM: | TO:
    RANJAN JACOB | SAMANTA COMMUNICATIONS PVT. LTD.
    CUSTOMER CODE: A0974443 | (PAN SERVICE DEPARTMENT)
    MRA 6 A ELDORADO | DOOR NO. 41, 4TH FLOOR, TOWER I,
    MUNDAKKAL KOLLAM | SHAKTHI TOWERS,
    KOLLAM | #766, ANNA SALAI, CHENNAI,
    KERALA - 691001. | TAMIL NADU - 600002.

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