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applNo=G021317234&applType=R

Form 49A Application for Allotment of Permanent Account Number

[In the case of Indian Citizens/Indian Companies/Entities incorporated in India/
Unincorporated entities formed in India]
Under section 139A of the Income Tax Act, 1961

Date: 04/07/2019
VleID:-EZEEE68C616300
Print

Application Number: G021317234

Coupon Number: G021317234

Assessing Officer(AO Code)

Area Code AO Type Range Code AO No

1. Full Name (Full expanded name: initials are not permitted):

First Name:-
Title:- SMT Last Name:- KUMARI Middle Name:-
SMITA
2. Abbreviation of the above name, as you would like it, to be printed on the PAN card:- SMITA KUMARI
3. Have you been known by any other name? N
Last Name:- Middle Name:- First Name:-
4. Gender:- F
5.Date of Birth / Incorporation/Agreement/Partnership or Trust Deed/Formation of Body of
01/03/1985
Individuals/Association of Persons:-
6. Father's Name :
Last Name:- Middle Name:- N/A First Name:- N/A

7. Address:-
Residential Address:-
Flat/Door/Block No.:- FALKA
Name of Premises/Building/Village:- CHANDWA
Road/Street/Lane/Post Office:- PIRMOKAM
Area/Locality/Taluka/Sub-Division:- RUPASPUR CHANDWA
Town/City/District:- KATIHAR State/Union Territory:- BIHAR PIN Code:- 854114 Country:- INDIA
Official Address:-
Office Name:- ABHISHEK KUMAR SINGH
Flat/Door/Block No.:- FALKA

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Name of Premises/Building/Village:- CHANDWA
Road/Street/Lane/Post Office:- PIRMOKAM
Area/Locality/Taluka/Sub-Division:- RUPASPUR CHANDWA
Town/City/District:- KATIHAR State/Union Territory:- BIHAR PIN Code:- 854114 Country:- INDIA
8. Address for Communication:- RESIDENCE

9. Telephone Number & Email ID Details :-

Country Area/STD Telephone/Mobile Email
91 76672 9661922044 [email protected]
Code:- Code:- Number:- Address:-
10. Status of the Applicant:- Individual
11. Registration Number(for
Company,firms,LLP's etc):-
12. Please Mention your AADHAAR
906002432593
Number(if allotted) :-

13.Source of Income

Business/Profession code:-

14. Full Name, address of the Representative Assessee, who is assessable under the Income Tax Act in respect of the
person, whose particulars have been given in colmns 1 to 13.
SMT Last Name:- KUMARI Middle Name:- First Name:- SMITA
Flat/Door/Block No.:- FALKA
Name of Premises/Building/Village:- CHANDWA
Road/Street/Lane/Post Office:- PIRMOKAM
Area/Locality/Taluka/Sub-Division:- RUPASPUR CHANDWA
Town/City/District:- KATIHAR State/Union Territory:- BIHAR PIN Code:- 854114

15. I/We have enclosed AADHAAR Card issued by UIDAI (In Copy) as Proof of Identity ,
AADHAAR Card issued by UIDAI (In Copy) as Proof of Address and AADHAAR Card issued by
UIDAI (In Copy) as Proof of DOB.
16. I/We SMITA KUMARI ,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.

R K P MOBILE CARE MIRGANJ

Signature/Left thumb
Place Date impression of the
applicant

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