Pan Correction Form
Pan Correction Form
in proof of identityladdress
Trull Name (Full expanded name fo be mentioned as appearing
documents: initials are not permitted) Kumari M/s
Please select title. Shri Smt Signature/Lef thumb impression
as applicable
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 applicabie)
Day Month Year
3 Date of Birth/ncorporation/AgreementPartnership/Trust Deed/
Formation of Body of individuals or Association of Persons
4 Gender (for Individual' applicant only) Male Female Transgender (Please tick as appl1cable) 5 Photo Mismatch
6 Signature Mismatch 7Address for Communication Residence Office (Please tick as applicable)
8 If you desire to update your other address also,give required details In additional sheet.
Country code Area/STD/Code Telephone / Mobile number
9 Telephone Number & Email ID details
Email ID
12 Verification
IWe the applicant, in the capacity of
do hereby declare that what is stated above is true to the best of mylour information and belief.
IWe have enclosed (number of documents) in support of proposed changes/corrections.
Place
DD M MY Y Y Y
Date
Signature/Left Thumb Impression of Applicant (inside the box)