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    Request For New PAN Card Or/ and Changes or Correction in

    Uploaded by

    Abhishek Keshari
    1. Balram Gupta is requesting a new PAN card or changes/corrections to his existing PAN card. 2. He provides his personal details like name, date of birth, gender, address, phone number and email. 3. He mentions his father's name as Dwarika Prasad and mother's name and attaches his Aadhaar card and 2 supporting documents for the proposed changes. 4. Balram declares that the information provided is true and signs the form.

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    Request For New PAN Card Or/ and Changes or Correction in

    Uploaded by

    Abhishek Keshari
    51 views2 pages
    1. Balram Gupta is requesting a new PAN card or changes/corrections to his existing PAN card. 2. He provides his personal details like name, date of birth, gender, address, phone number and email. 3. He mentions his father's name as Dwarika Prasad and mother's name and attaches his Aadhaar card and 2 supporting documents for the proposed changes. 4. Balram declares that the information provided is true and signs the form.

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    1. Balram Gupta is requesting a new PAN card or changes/corrections to his existing PAN card. 2. He provides his personal details like name, date of birth, gender, address, phone number and email. 3. He mentions his father's name as Dwarika Prasad and mother's name and attaches his Aadhaar card and 2 supporting documents for the proposed changes. 4. Balram declares that the information provided is true and signs the form.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    51 views2 pages

    Request For New PAN Card Or/ and Changes or Correction in

    Uploaded by

    Abhishek Keshari
    1. Balram Gupta is requesting a new PAN card or changes/corrections to his existing PAN card. 2. He provides his personal details like name, date of birth, gender, address, phone number and email. 3. He mentions his father's name as Dwarika Prasad and mother's name and attaches his Aadhaar card and 2 supporting documents for the proposed changes. 4. Balram declares that the information provided is true and signs the form.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    Acknowledgement Number : N- 881032290941924

    Only ‘Individuals’ to
    affix recent Request For New PAN Card Or/ And Changes Or Correction in Only ‘Individuals’ to
    affix recent
    photograph
    Permanent Account Number (PAN) photograph
    (3.5 cm x
    (3.5 cm x
    2.5 cm)
    AWFPG9743F 2.5 cm)
    Please read Instructions ‘h’ & ‘i’ for selecting boxes on left margin of this form.
    Sign/ Left Thumb impression
    across this photo
    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 Signature / Left Thumb Impression of
    Applicant (inside the box)
    Last Name/Surname GUPTA
    First Name BALRAM
    Middle Name
    Name you would like it printed on the PAN card
    BALRAM GUPTA
    2 Details of Parents (Applicable only for Individual Applicants)
    Whether mother is a single parent and you wish to apply for PAN by furnishing the name of your mother only? Yes No
    If yes,please fill in mother's name in the appropriate space provided below.
    (please tick as applicable)
    Father's Name (Mandatory except where mother is a single parent and PAN is applied by furnishing the name of mother
    Last Name/Surname PRASAD
    First Name DWARIKA
    Middle Name
    Mother's Name (Optional except where mother is a single parent and PAN is applied by furnishing the name of mother
    Last Name/Surname
    First Name
    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 Father's Name. Father's Name Mother's Name
    (In case no option is provided then PAN card will be issued with father's name except where mother is a single parent and you wish to apply
    for PAN by furnishing name of mother only)
    3. Date of Birth/Incorporation/Agreement/Partnership or Trust Deed/ Formation of Body of individuals or association of Persons
    Day Month Year
    27/05/1972
    4. Gender(for individual applicants only) Male Female Transgender
    5. Photo Mismatch 6.Signature Mismatch
    7. Address for Communication Residence Office
    Name of office
    Flat / Room / Door / Block KACHIYA
    Name of Premises / Building / WARD 15
    Road / Street / Lane/Post Office GAVTIYA PARA
    Area / Locality / Taluka/ Sub- CHALGALI KHAS
    Town / City / District BALRAMPUR
    State / Union Territory PIN Code ZIP Code Country
    CHHATISHGARH 497223 null INDIA
    8. If you desire to update your other address also, give required details In additional sheet.
    9. Telephone Number & Email ID details
    Country Area/STD Code Telephone / Mobile
    91 9977198852

    Email ID KESHARI.ASSOCIATES@GMAIL.COM
    10. Please mention your AADHAAR number (if allotted) 564475956615
    Name as per AADHAAR letter/card BALRAM GUPTA
    11. Mention other Permanent Account Numbers (PANs) inadvertently allotted to you
    PAN PAN

    PAN PAN
    12. Verification

    I/We BALRAM GUPTA the applicant, in the capacity Himself/Herself


    do hereby declare that what is stated above is true to the best of my/our information
    belief.
    I/We have enclosed
    changes/corrections. 2 (number of documents) in support of proposed
    Place WADRAFNAGAR
    DD MM YYYY
    Date 26/03/2019 Signature / Left Thumb Impression of
    13. Other Address :

    Name of office
    Flat / Room / Door / Block
    Name of Premises / Building /
    Road / Street / Lane/Post Office
    Area / Locality / Taluka/ Sub-
    Town / City / District

    State / Union Territory PIN Code ZIP Code Country

    Signature / Left Thumb Impression of


    Applicant (inside the box)

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