Professional Documents
Culture Documents
881060224386252
Request For New PAN Card Or/ And Changes Or Correction in PAN
Only Individuals to
affix recent
photograph
(3.5 cm x
2.5 cm)
Only Individuals to
affix recent
photograph
(3.5 cm x
2.5 cm)
Please read Instructions h & i for selecting boxes on left margin of this form.
Shri
Smt.
Kumar
M/S
Signature/Left Thumb Impression
Last Name/Surname
First Name
SURYADEVARA
Middle Name
SAINADH
BUJJI
2 Fathers Name (Only individual applicants : Even married women should fill in fathers name only)
Last Name/Surname
SURYADEVARA
First Name
SUBBARAO
Middle Name
Mothers Name
Last Name/Surname
SURYADEVARA
First Name
Middle Name
Parent name which is to be printed on the card
Father's name
Mother's name
3. Date of Birth/Incorporation/Agreement/Partnership or Trust Deed/ Formation of Body of individuals or association of Persons
Day
Month
Year
21-08-1986
Male
Female
5. Photo Mismatch
6.Signature Mismatch
Residence
Office
Name of office
Flat / Room / Door / Block No.
21-14-12/30
Ramalingeswara Peta
Guntur
Pincode / Zip code
522201
Country Name
8. If you desire to update your other address also, give required details In additional sheet.
9. Telephone Number & Email ID details
Country code
Area/STD Code
91
Email ID
9490193011
SURYADEVARABUJJI@YAHOO.CO.IN
437330983491
11. Mention other Permanent Account Numbers (PANs) inadvertently allotted to you
PAN
PAN
PAN
PAN
12. Verification
I/We
Himself/herself
do hereby declare that what is stated above is true to the best of my/our information and belief.
I/We have enclosed 4
Place
Tenali
DD MM YYYY
Date
17-09-2016
ACKNOWLEDGEMENT NUMBER:
Category
Permanent
Account No.
Name
N-
881060224386252
Individual
BYKPS7751R
Shri BUJJI SAINADH SURYADEVARA
Name to be
SURYADEVARA B SAINADH
printed on card
Father's Name Shri SUBBARAO SURYADEVARA
Date of Birth
21-08-1986
Address for
21-14-12/30
Communication THOTA VARI STREET 2ND LIN
RAMALINGESWARA PETA
TENALI
GUNTUR - 522201
Andhra Pradesh
Other Address
Telephone No. 91 9490193011
Email ID
SURYADEVARABUJJI@YAHOO.CO.IN
AADHAAR No. 437330983491
Photo Mismatch
Signature Mismatch
Sex
PAN3:
PAN4:
Payment Mode
e-Wallet: Your Payment of ` 107 (inclusive of service tax , SBC & KKC as applicable(#)) through CSC Portal against transaction number 401-1969117 has been successfully
Date: 17-09-2016
(#)includes Swachh Bharat Cess @0.5% (i.e ` 0.47) & Krishi Kalyan Cess @0.5% (i.e ` 0.47)
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, NSDL e-Governance Infrastructure
Limited, 5th floor, Mantri Sterling, Plot No. 341, Survey No. 997/8, Model Colony, Near Deep Bungalow Chowk, Pune 411016 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.