Assessing Officer (AO Code) : Last Name/Surname First Name Middle Name
Assessing Officer (AO Code) : Last Name/Surname First Name Middle Name
Assessing Officer (AO Code) : Last Name/Surname First Name Middle Name
Sir, I/We hereby request that a permanent account number be allotted to me/us.
I/We give below necessary Signature/Left Thumb Impression
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 GUPTA
First Name ADITYA
Middle Name
2. Abbreviations of the above name, as you would like it, to be printed on the PAN card
ADITYA GUPTA
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
Parent name which is to be printed on the card Father's name Mother's name
7. Address
Residence Address
Flat / Room / Door / Block No. 294/12 BAZAAR KHALA
Name of Premises / Building / Village NAUBASTA ROAD
Road / Street / Lane/Post Office CHOWK
Area / Locality / Taluka/ Sub- UTTAR PRADESH
Town / City / District LUCKNOW - 226003
Office Address
Name of office
Flat / Room / Door / Block No.
Name of Premises / Building / Village
Road / Street / Lane/Post Office
Area / Locality / Taluka/ Sub- Division
Town / City / District
91 7619992526
Email ID ADIGUPTA510.AG@GMAIL.COM
Trusts Body of Individuals Local Authority Artificial Juridical Persons Limited Liability Partnership
12. In case of a person, who is required to quote Aadhaar number/ the Enrolment ID of Aadhaar application form as per section 139AA.
Please mention your AADHAAR number (if allotted) 3021 4569 7979
If AADHAAR number is not allotted, please mention the enrolment ID of Aadhaar application
Last Name/Surname
First Name
Middle Name
Address
Flat / Room / Door / Block No.
Name of Premises / Building /
Road / Street / Lane/Post Office
Area / Locality / Taluka/ Sub- Division
Town / City / District
15. Documents submitted as Proof of Identity (POI), Proof of Address (POA) and Proof of Date of Birth (DOB)
I/We have Copy of AADHAAR Card issued by the Unique as proof of identity Copy of AADHAAR Card issued by the Unique
as proof of address and Copy of Aadhaar Card issued by the Unique Identification 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
do hereby declare that what is stated above is true to the best of my/our information and belief.
Place LUCKNOW
DD MM YYYY
Date 31-10-2017
Signature / Left Thumb Impression of
Applicant (inside the box)
ACKNOWLEDGEMENT NUMBER: N- 881060182181130
Citizen of India Y
Category Individual
Name Shri ADITYA GUPTA
Name to be
ADITYA GUPTA
printed on card
Father's Name Shri KUMAR PRADEEP GUPTA
Payment Mode
e-Wallet: Your Payment of ` 110 (inclusive of Goods & Services Tax) through CSC Portal against transaction number 400-6992244 has been successfully processed.
Date: 31-10-2017
Instructions:
1. The acknowledgement number above is your unique reference number for PAN application. Kindly quote this number for tracking
the status of your PAN application on https://tin-nsdl.com or any queries relating thereto.
2 Save and print this acknowledgement.
3 Individual applicants affix your recent colour photograph (3.5 cm x 2.5 cm), sign the acknowledgement (inside the box provided
without touching the sides and in BLACK INK only) and enclose a Demand Draft (DD), if any, alongwith Proof of Identity, Proof
of Address and Proof of Date of Birth as specified in the application form.
4 Superscribe the envelope with 'APPLICATION FOR PAN -N - Acknowledgement Number' (e.g. 'APPLICATION FOR
PAN -N - 881010100000973').
5 Send the documents as specified in point no. 4 above to INCOME TAX PAN SERVICES UNIT (Managed By NSDL e-
Governance Infrastructure Limited) 13/D Kurla Industrial Estate, Nari Seva Sadan Road, Narayan Nagar, Ghatkopar
(West), Mumbai – 400 086 Tel: 020-27218080; Fax: 020-27218081.
6 Your acknowledgement, Demand Draft if any, and proofs, should reach NSDL within 15 days from the date of online application.
7 Application will be processed only on receipt of relevant proofs and realisation of payment.
8 PAN card will be dispatched only to the communication address provided in your PAN application. Wherever the
Representative Assessee (RA) details ( item no.14 in Form 49A ) are mentioned in the application, PAN card will be dispatched to
the RA's address.