Form No. 494, Application for Allotment of Permanent Account Number [in the case of Indian Citizens/indian Companies/Entites incorporated in Indial Unincorporated entities formed in india] oaph ta nod it) ln scanner ne rps be ig Beary Assessing officer (AO code) ‘Area code ‘AO type Range code ‘AO No. LJ Si, We hereby request that a permanent account number be alloted to metus. We give below necessary particulars Sa nero 1 Full Name (Full expanded name to be mentioned as appearing In proof of identtyladdress documents: Initials are not permitted) Please select tle, []as applicable shi sm Kuma [Jaws Last Name I Sumame First Name Midate Name 2. Abbreviations of the above name, as you woul be printed on the PAN card 3 Have you ever been known by any other nam yes, please give tat ther name Prease select tle, [Y]as applicable Shei sm Kuma [Tw Yes No (please tick as applica Last Name I Sumame First Name. Middle Name 4 Gender (for Individual applicants only) Mat Female (please tick as applica 5 Date of BirthiIncorporation/AgreementiPartnership or Trust D J Formation of Body of individuals or association of Persons 6 Fathor's Name (Only ‘individual’ applicants Last Name Sumame ven married women should fil in father's name only) First Name. Midate Name Mother's Name (optional) Last Name Sumame First Name Middle Name ‘Select the namo of either father or mother which you may ike to be printed on PAN card iat aw ant) (tn case no option is provided then PAN card willbe Issued with father’s name) Father's name Mother's Name (Pa fk 7 Address Residence Address Flat Room / Door Block No. Name of Premises / Building / Vilage Road / Street LaneiPost Office ‘Area / Locality Taluka! Sub- Division Town | Gity /Distct Slate / Union Teeiory Pincode /Zin Country Name Office Address Name of ofee Flat Room / Door lock No, Name of Premises / Building / Vilage Road / Steet /Lane/Post Office ‘rea / Locally /Talukal Sub- Division Town | City District ‘State / Union Teetory Pincode /Zip code Country Name8 Address for Communication Residence Office (Please tick as applicable) 8 Telephone Number & Email ID details County code Telephone / Mobile number Email ID 410 Status of applicant Prease eolect status, [7 ]as applicable Government Individual Hindu undivided family Company Partnership Firm Association of Persons Trusts Body of Individuals Local Authority Atal Jurisical Persons Limited Liabtty Partnership ‘41. Registration Number (for company, firms, LLPs etc.) 12 Please mention your AADHAAR number (if allotted) 13° Source of income Please select, [7] as applicable Salary Caria Gains Income fom Business Profession BusinessProfession code {For Code: Refer instructions) [_] Income trom othr sources Inco fom House propery No income 14 Representative Assessee (RA) Full name, address ofthe Representative Assesses, whois assessibie under the Income Tax Actin respect ofthe person, whose particulars have been given in the column 1-13, Full Name (Full expanded name : initials are not permitted) Please selectite, [Y]as applicable Shi sm Kumari] ws Last Name / Sumame Fist Name Middle Name Address Flat Room / Door! Block No. Name of Premises / Building / Vilage Road /Siret / Lane(Post Office ‘Area! Localty/Talukal Sub- Division Town / City District, State Union Teeitory Pincode 15 Documents submitted as Proof of Identity (PO!) Proof of Address (POA) and Proof of Date of Birth (O08) 1WWe have enclosed as proof of ident, 1s proof of address and ‘a proof of date of bith, [Ptoase refer to the instructions (as speciied in Rule 114 af LT, Rules, 1962) for Ist of mandatory cerified documents lo be submited as applicable [Annexure A, Annexute & & Annexure C are o.be used wherever applicable) 16 We the applicant, n the capacity of do hereby dectare tat what s slated above is tru tothe best of my/our information and bei. Place pomMmyyyy Date ‘Signature Left Thum Impression of Applicant nse the box)INSTRUCTIONS FOR FILLING FORM 498 aca fs En one ch © ea es ste ong wena er ech? cn} rao penne propa Tay 1 Se he nena nt ae ge Pama th AD cote ea Cae Ae are ace ar relies carn Ou mn ed oo wean The eta cane hese Tax fie OF FPAN Seer raat i be sper” ts ae tee) eh pee eaearoiecee Sail > Forenemn —> parse > Fecesampis HANDY HAFATTAT BATE WTOP Theta bs Waa ined on the PAN card ‘Gender [ THs Fea mandatory Tor eas, Fak shou Bo A STKn Ge oT OST SSIES, 5 Dale of Birimncorporaion/Agreement Partnership of Trust Deed/Fonmation of Body of avidual/Aasodaton of eo no. 18) Address for communication 9. Telephone Number and E-mail 1D eTSitus af Appian T[coreany Seow 17g tes are: Bans bs Carre VERE 5 [oe rats 3ST [oars oases eee Pisano ana tel aes ar oreo for presente assessoe etn ene ei ree or cee egos oobi rome of pea Tame "Recreacctanbasse tenses aonssare mare ashlee 2 seis ae een eee ee oe re ay cen taken feneat or See ce Se areelec es ceaumeeray caier peceem creer ee care Boer Sore teers rete a ee Oa caer cere re arc oe eee cose ‘Sampalihe aucng bier) cortanng uy anexingprotog’aprane barxoctovnl rumberot apple ‘s ‘eenge Note | Suv Rees RAN 3Sncd Bache il ty sndaduta ™ ” | Far udaduaes alt he Sacunan staal pea aeaedcaaarcnea] aT ae OT RE Se See ITE Cpe vememencincre marenienonant nc somevaauerad af aaertmnee Smee Oe cen wien av naa ecm ne macros eee Om area S SSS chute ea sgt alsa’ Sahn teks ty eS i { hanwcgriniar Cusrrauny cisceres eoyetaeihcmtiaren | de! ppicaion | Pe ee Naniweamaniclion oo ote [buys core Nowa Eso bk sou [asta oath oop ican Consulate te detec nce (co oe seeker al sacon 2 he Cheers ket "SSHeT e Tass orb Perien Poymer ove’ oe Werrage cet sce aeucdy Regt’ of Una nrsdcovon Asay nia r Dearne Phot tty Crees Prono ery Cad aves by Cano Sovermart tx Stats Govonenrdocoraalposte schon urdeting plc geri Coal earns Schr ra errr Cosy le Sebo pene ABest ear a 1 [oorpeny Gopyat Crteaa o Ragan ascedby a RegivarofConparies 3 [Gd uabiy Pama apy of Cortese of Region ssc wy te Rope oTLLPs 4 [Besssator Persons (rus Copy otf oe0d Orbs con tes TTeTTATON Rb AOST CRAY CARESS = |Rasccalorer Powis Bay RINE] Cons area teaiAahosty Cop of earfeateo relation number saves by Gharty Commissioner or regsvar & cosperatve practi Judea Parson cist anyater competent aut) Amy ctor Gocame: egneing rom ary Ceneal Goverment or Sate overent Doparmant ibang ery on sutessol suchen 76._ Signature Thumb impression: Tapieaon musts saned by (alert Or) Kara ce of UF Or fi redar Ta Carpany OF vy Arr Signature casa TROP Body oP ce Coca Aalto ene Atel lnsea Porn Sa) Pav noone Faro? Gro) tree Orta) Repeenrinte Aarons asd of ivordocsacacieatumaicinniaty des Appatarsel=gned.thagen anne ansintteenece provided reales rjcad “Apsara may abla eosin arm ot PAN (Fam 4) Far ty I PAN Seve eres jranagedby UTITSL) or any aerator vendor para ‘Stoners downcosnorrne neu ne Separretuatat wey iretasnsaga in UtetS asia wai »b, Thefe forrocesing PAN apicabon = € 107 frelang sons a Inease he PAN card isto be epee ote he selorl pach charge of hz" yithavtbo pay arpa fount penetapes cota teen cumianatndeictetunmmcmgranme™e mm 4. Appeal wl eotvaan acknowledgement contaning 29 digh niquc number on accaptance os form, The acknowledgement number can be used for {eking ti tau the eppreain ACKNOWLEDGEMENT Fecoved € 107/- {inclusive of appicabre taxes)- ‘Application Form 49A Sr. no. 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