Form No. 49AA. Application for Allotment of Permanent Account Number ... 2
Abbreviation of the above name, as you would like it, to be printed on the PAN
card.
FormNo.49AA ApplicationforAllotmentofPermanentAccountNumber [IndividualsnotbeingaCitizenofIndia/EntitiesincorporatedoutsideIndia/ UnincorporatedentitiesformedoutsideIndia] Undersection139AoftheIncomeTaxAct,1961 Toavoidmistake(s),pleasefollowtheaccompanyinginstructionsandexamplesbeforefillinguptheform
Assessingofficer(AOcode) Sign/LeftThumbimpressionacross thisphoto
Areacode
AOtype
Rangecode
AONo.
Sir, I/Weherebyrequestthatapermanentaccountnumberbeallottedtome/us. I/Wegivebelownecessaryparticulars:
1 FullName(Fullexpandednametobementionedasappearinginproofofidentity/addressdocuments:initialsarenotpermitted)
D asapplicable
Pleaseselecttitle,
Shri/Mr
Smt/Mrs
Kumari/Ms
M/s
LastName/Surname FirstName MiddleName
2 Abbreviationoftheabovename,asyouwouldlikeit,tobeprintedonthePANcard
3 Haveyoueverbeenknownbyanyothername?
(Pleasetickasapplicable)
Yes
No
Smt/Mrs
Kumari/Ms
Male
Female
Ifyes,pleasegivethatothername
D asapplicable
Pleaseselecttitle,
Shri/Mr
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
Pincode/Zipcode
CountryName
Pincode/Zipcode
CountryName
OfficeAddress Nameofoffice Flat/Room/Door/BlockNo. NameofPremises/Building/Village Road/Street/Lane/PostOffice Area/Locality/Taluka/SubDivision Town/City/District State/UnionTerritory
8 AddressforCommunication
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.CountryofCitizenshipISDCodeoftheCountryofCitizenship Pleaseselectstatus,
13 SourceofIncome Salary
D asapplicable
CapitalGains
IncomefromBusiness/Profession
Business/Professioncode
IncomefromOthersources
[ForCode:Referinstructions]
IncomefromHouseproperty
Noincome
14 RepresentativeorAgentoftheApplicantinIndia Fullname,addressoftheRepresentativeorAgent
FullName(Fullexpandedname:initialsarenotpermitted) Pleaseselecttitle,
D asapplicable
Shri/Mr
Smt/Mrs
Kumari/Ms
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/Zipcode
15 DocumentssubmittedasProofofIdentity(POI)andProofofAddress(POA) I/Wehaveenclosed
asproofofidentity,
proofofaddress,and
asmandatorycertifieddocuments
as
[Pleaserefertotheinstructions(asspecifiedinRule114ofI.T.Rules,1962)forlistofmandatorycertifieddocumentstobesubmittedasapplicable]
16 KYCdetails*[TobefilledinbyForeignInstitutionalInvestororaQualifiedForeignInvestor,asprescribedundertheregulationsissuedby theSecuritiesandExchangeBoardofIndia(SEBI)] [ "Control" asdefinedunderSEBI(SubstantialAcquisitionofSharesandTakeovers)Regulations,1997 " Beneficial owner" as defined in the para 5.1 of SEBI circular dated December 31, 2010 on Anti Money Laundering.] Pleaseselect
(a) IncaseofIndividuals MaritalStatus CitizenshipStatus
Single
Married I Foreigner
Divorced
D asapplicable
Widow/Widower
P PersonofIndianorigin
O OverseascitizenofIndia
IncaseofForeigner,countryofCitizenship Occupationdetails
Privatesectorservice
Publicsector/Govt.service
Business
Professional
Agriculturist
Retired
Housewife
Student
Others
D asapplicable
Pleaseselect
(b) Incaseofnonindividuals R PrivateCompany
U PublicCompany
D BodyCorporate
S FinancialInstitution
N NonGovernmentOrganization
C CharitableOrganization
(c) GrossAnnualIncomeINR Netwoth(Assetslessliabilities)inINR
(d) IncaseofaPublicCompany,whetherlistedonastockexchange
Yes
No
D asapplicable
Pleaseselect
Ifyes,thenindicatenameofthestockexchange (e) IncaseofNonindividuals
Doesithavefewpersonsorpersonsofthesamefamilyholdingbeneficialownershipandcontrol. Yes
No
Pleaseselect
D asapplicable
["Control":Controlshallincludetherighttoappointmajorityofthedirectorsortocontrolthemanagementorpolicydecisonsexercisable byapersonorpersonsactingindividuallyorinconcert,directlyorindirectly,includingbyvirtueoftheirshareholdingormanagement rigthsorshareholdersagreementsorvotingagreementsorinanyothermanner. "Beneficialowner"meansthenaturalpersonwhoultimatelyownsorcontrolsthe isbeingconducted,and
applicantand/orthepersononwhosebehalfatransaction
includesapersonwhoexercisesultimateeffectivecontroloverajuridicalperson] Pl Please select l t
(f) Istheentityinvolve th tit i l d/providinganyofthefollow th f ll ingservices Foreignexchange,MoneyChangerServices
Yes
No
Gaming/Gambling/Lotteryservices(CasinosandBettingSyndicates)
Yes
No
MoneyLending,Pawning
Yes
No
D asapplicable li bl
(g) Whethertheapplicantortheapplicant'sauthorisedsignatories/trustees/officebearersis
(i) apoliticallyexposedperson
Yes
No
(ii) relatedtoapoliticallyexposedperson
Yes
No
[FordefinitionofpoliticallyexposedpersonrefertoguidelinesissuedunderthePreventionofMoneyLaunderingAct(PMLA)] (h) TaxpayeridentificationNumberinthecountryofresidence
17 I/We doherebydeclarethatwhatisstatedaboveis
,theapplicant,inthecapacityof truetothebestofmy/ourinformationandbelief.
Place D Date
D
M M Y
Y
Y
Y
Signature/LeftThumbImpressionof Applicant(insidethebox)
