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    Assessing Officer (AO Code)

    Uploaded by

    GOWTHAM
    1. The document is an application for an Individual Permanent Account Number (PAN) card submitted by Indumathi Kuppusamy. 2. It contains details such as name, date of birth, address, father's name, contact information, income sources, and documents submitted as proof of identity, address, and date of birth. 3. The applicant declares that the information provided is true and signs the application.

    Copyright:

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

    Assessing Officer (AO Code)

    Uploaded by

    GOWTHAM
    51 views2 pages
    1. The document is an application for an Individual Permanent Account Number (PAN) card submitted by Indumathi Kuppusamy. 2. It contains details such as name, date of birth, address, father's name, contact information, income sources, and documents submitted as proof of identity, address, and date of birth. 3. The applicant declares that the information provided is true and signs the application.

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    881031143493222.pdf

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    1. The document is an application for an Individual Permanent Account Number (PAN) card submitted by Indumathi Kuppusamy. 2. It contains details such as name, date of birth, address, father's name, contact information, income sources, and documents submitted as proof of identity, address, and date of birth. 3. The applicant declares that the information provided is true and signs the application.

    Copyright:

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

    Assessing Officer (AO Code)

    Uploaded by

    GOWTHAM
    1. The document is an application for an Individual Permanent Account Number (PAN) card submitted by Indumathi Kuppusamy. 2. It contains details such as name, date of birth, address, father's name, contact information, income sources, and documents submitted as proof of identity, address, and date of birth. 3. The applicant declares that the information provided is true and signs the application.

    Copyright:

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

    Acknowledgement Number: N- 881031143493222

    Form NO. 49A


    Only ‘Individuals’ Application for Allotment of Permanent Account Only ‘Individuals’
    to affix recent to affix recent
    photograph [In the case of Indian Citizens/lndian Companies/Entities incorporated in India/ photograph
    (3.5 cm x Unincorporated entities formed in India] (3.5 cm x
    2.5 cm) Under section 139A of the Income Tax act, 1961 2.5 cm)
    To avoid mistake (s), please follow the accompanying instructions and examples before filling

    Assessing officer (AO code)

    Sign/ Left Thumb impression AREA CODE AO TYPE Range Code AO NO

    CHE W 233 13

    Sir, I/We hereby request that a permanent account number be allotted to me/us.
    Signature / Left Thumb Impression of
    I/We give below necessary particulars: 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 KUPPUSAMY
    First Name
    INDUMATHI
    Middle Name

    2. Abbreviations of the above name, as you would like it, to be printed on the PAN card

    INDUMATHI KUPPUSAMY
    3. Have you ever been known by other name?
    If yes, please give that other name Yes No
    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

    5. Date of Birth/Incorporation/Agreement/Partnership or Trust Deed/ Formation of Body of individuals or association of Persons


    Day Month Year
    19/11/1990
    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 VENKATARAMA


    First Name KUPPUSAMY
    Middle Name
    Mother's Name (Optional)
    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 (Please tick as applicable)
    7. Address
    Residence Address
    Flat / Room / Door / Block 17/34

    Name of Premises / Building / SHANTHI ILLAM

    Road / Street / Lane/Post Office PILLAYAR KOVIL STREET


    Area / Locality / Taluka/ Sub- KAVERIPATTINAM
    Town / City / District KRISHNAGIRI
    State / Union Territory Pincode / Zip code Country Name
    TAMILNADU 635112 INDIA
    Office Address
    Name of office ASHOK INTERNATIONAL SCHOOL
    Flat / Room / Door / Block 42
    Name of Premises / Building / ASHOK SCHOOL
    Road / Street / Lane/Post Office 100FT ROAD
    Area / Locality / Taluka/ Sub- KAMMAGONDANAHALLI
    Town / City / District BANGALORE

    State / Union Territory Pincode / Zip code Country Name


    KARNATAKA 560015 INDIA

    8. Address for Communication Residence Office Please tick as applicable


    9. Telephone Number & Email ID details

    Country code Area/STD Code Telephone / Mobile number

    91 04343 8904638720

    Email ID INDUECE001@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. In case of a person, who is required to quote Aadhaar number/ the Enrolment ID of Aadhaar application form as per section
    Please mention your AADHAAR number (if 972979251239
    If AADHAAR number is not allotted, please mention the enrolment ID of Aadhaar application
    Name as per AADHAAR letter/card or as per the Enrolment ID of Aadhaar application
    INDUMATHI KUPPUSAMY
    13. Source of Income
    Salary Capital Gains
    Business/Profession [For Code: Refer instructions]
    Income from Business / Income from Other sources

    Income from House property No income


    14. Representative Assessee (RA)
    Full name, address of the Representative Assessee, who is assessible 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
    Name of Premises / Building /

    Road / Street / Lane/Post Office

    Area / Locality / Taluka/ Sub-


    Town / City / District
    State / Union Territory Pincode Country Name

    15. Documents submitted as Proof of Identity (POI), Proof of Address (POA) and Proof of Date of Birth (DOB)
    I/We have enclosed AADHAAR Card issued by the Unique Identification Authority of India as proof of identity

    AADHAAR Card issued by the Unique Identification Authority of India as proof of address and

    AADHAAR Card issued by the Unique Identification Authority of India as proof of date of birth.

    [Please refer to the instructions (as specified in Rule 114 of I.T. Rules, 1962) for list of mandatory certified documents to be submitted as
    applicable
    [Annexure A, Annexure B & Annexure C are to be used wherever applicable]
    16 I/We INDUMATHI KUPPUSAMY the applicant, in the capacity of Himself/Herself
    do hereby declare that what is stated above is true to the best of my/our information and
    belief.
    Place KRISHNAGIRI
    DD MM YYYY
    Date 09/07/2017 Signature / Left Thumb Impression of
    Applicant (inside the box)

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