Form No. 49A Application for Allotment of Permanent Account Number ...

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I/We hereby request that a permanent account number be allotted to me/us. I/We give below ... Telephone / Mobile number
FormNo.49A ApplicationforAllotmentofPermanentAccountNumber [InthecaseofIndianCitizens/IndianCompanies/EntitiesincorporatedinIndia/ UnincorporatedentitiesformedinIndia] Undersection139AoftheIncomeTaxAct,1961 Toavoidmistake(s),pleasefollowtheaccompanyinginstructionsandexamplesbeforefillinguptheform

Assessingofficer(AOcode) Areacode

Sign/leftTumbimpressionacross thisphoto

AOtype

Rangecode

AONo.

Sir, I/Weherebyrequestthatapermanentaccountnumberbeallottedtome/us. I/Wegivebelownecessaryparticulars:

1 FullName(Fullexpandednametobementionedasappearinginproofofidentity/addressdocuments:initialsarenotpermitted)

D asapplicable

Pleaseselecttitle,

Shri

Smt.

Kumari

M/s

LastName/Surname FirstName MiddleName

2 Abbreviationoftheabovename,asyouwouldlikeit,tobeprintedonthePANcard

3 Haveyoueverbeenknownbyanyothername?

Yes

No

Smt.

Kumari

Male

Female

(Pleasetickasapplicable)

Ifyes,pleasegivethatothername

D asapplicable

Pleaseselecttitle,

Shri

M/s

LastName/Surname FirstName MiddleName

4 Gender(forIndividualapplicantsonly)

(Pleasetickasapplicable)

5 DateofBirth/Incorporation/Agreement/PartnershiporTrustDeed/FormationofBodyofindividualsorAssociationofPersons Day

Month

Year

6 Father'sName(Only'Individual'applicants:Evenmarriedwomenshouldfillinfather'snameonly) LastName/Surname FirstName MiddleName

7 Address ResidenceAddress Flat/Room/Door/BlockNo. NameofPremises/Building/Village Road/Street/Lane/PostOffice Area/Locality/Taluka/SubDivision Town/City/District State/UnionTerritory

OfficeAddress Nameofoffice Flat/Room/Door/BlockNo. NameofPremises/Building/Village Road/Street/Lane/PostOffice Area/Locality/Taluka/SubDivision Town/City/District

Pincode/Zipcode

CountryName

State/UnionTerritory

Pincode/Zipcode

8 AddressforCommunication

CountryName

Residence

(Pleasetickasapplicable)

Office

9 TelephoneNumber&EmailIDdetails Countrycode

Area/STDCode

Telephone/Mobilenumber

EmailID

10 Statusofapplicant Pleaseselectstatus,

D asapplicable

Government

Individual

Hinduundividedfamily

Company

PartnershipFirm

AssociationofPersons

Trusts

BodyofIndividuals

LocalAuthority

ArtificialJuridicalPersons

LimitedLiabilityPartnership

11 RegistrationNumber(forcompany,firms,LLPs,etc.)

12 IncaseofacitizenofIndia,then PleasementionyourAADHAARnumber(ifallotted) Pleaseselectstatus,

13 SourceofIncome Salary

D asapplicable

CapitalGains

IncomefromBusiness/Profession

Business/Professioncode

[ForCode:Referinstructions]

IncomefromHouseproperty

IncomefromOthersources Noincome

14 RepresentativeAssessee(RA) Fullname,addressoftheRepresentativeAssessee,whoisassessableundertheIncomeTaxActinrespectoftheperson,whoseparticularshavebeengiveninthe column113.

FullName(Fullexpandedname:initialsarenotpermitted) Pleaseselecttitle,

D asapplicable

Shri

Smt.

Kumari

M/s

LastName/Surname FirstName MiddleName Address Flat/Room/Door/BlockNo. NameofPremises/Building/Village Road/Street/Lane/PostOffice Area/Locality/Taluka/SubDivision Town/City/District State/UnionTerritory

Pincode

15 DocumentssubmittedasProofofIdentity(POI)andProofofAddress(POA) I/Wehaveenclosed

asproofofidentityand

asproofofaddress. [Pleaserefertotheinstructions(asspecifiedinRule114ofI.T.Rules,1962)forlistofmandatorycertifieddocumentstobesubmittedasapplicable]

16 I/We doherebydeclarethatwhatisstatedaboveis

,theapplicant,inthecapacityof truetothebestofmy/ourinformationandbelief.

Place D Date

D M M

Y

Y

Y

Y

Signature/LeftThumbImpressionof Signature / Left Thumb Impression of Applicant(insidethebox)