INCOME-TAX RULES , 1962

Form No. 49A

Application for A llotment of Permanent Acco unt Number
[In the case of Indian Ci tizens/Indian Companies/Entities incorporated in Ind ia!
00' 00'
'Individuals' Unincorporated entities formed in India] 'Individuals'
to affix recent See Ru le 114 to affix rec ent
photograph photograph
To avoid mistake (5), please loIIowthe acc~nyiog nstru:lIons and exafl1lles before filing up the loon (3_5 cmx
(3.5 em x
2.5cm) 2.5 em )
Assessing officer (AO code)

Area code AO type Range code AO No.

Sign I Left Thum~: t " s. iOll

ocros. this 010 I I I I I I I I I I I
Sir,
If\Ne hereby request that a permanent account number be allotted to me/us_
If\Ne gi ve below necessary particulars: Signalure , Left Thumb Impression

1 Full Name (Full expanded name to be mentioned as appearing in proof of identity/date of birth/address documents: initials are not permitted)

Please select title, 0 as applicable O Shri Osmt o Kumari o Mis

last Name I Surname

First Name
Middle Name I I I I I I I I I I I I I I I I I I I I I I I I I I
2 Abbreviations of the abov e name, as you would like it, to be printed on the PAN card

I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I
I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I
3 Have you ever been known by any other name? o D NO Yes (please tick as applicable)
If yes, please gIVe that other flame
Please select tille, 0 as applicable O Shri O smt o Kumari o Mis

last Name I Surname

First Name
Middle Name I I I I I I I I I I I I I I I I I I I I
4 Gender (for Individual applicants only) (please tick as applicable)
I I I
O
I
Maie
I
O Female o Transgender
I

5 Date of BirthllncorporationlAgreementJPartnersh ip or Trust Deedl Formation of Body of individuals or Association of Persons

6
rn Moo,,"

IT]
Ye ar

I I I I I
Details of Parents (applicable only for individual applicants)
lIrfIether mother is a single parent and you wish to apply for PAN by furnishing the name of your mother only?
vesO NO (please tick as applicable)
If yes, please fill in mothers name in the appropriate space provide below
Father's Name (Mandatory except w here mother is a single parent and PAN is applied by furnishing the name of mother only)

Last Name/Surname
First Name
Middle Name I I I I I I I I I I I I
Mothers Name (optional except where mother is a single parent and PAN is applied by furnishing the name of mother only)
I I I I I I I I I I I I I I

Last Name/Surname
First Name
Middle Name I I I I I I I I I I I I I I I I I I I I I I I I I I
o
Select the name of either father or mother which you may like
Father's name 0 Mother's name
{o be printed on PAN card (Select one only)
(Please tick as applicable)
(In case no option is provided then PA N card will be issued with fathers name except where mother is a single parent and you wish to apply
for PAN by furnishing name of the mother only)
7 Address
Residence Address
Flat I Room I Door I Block No
Name of Premises I Building I Village
Road I Street I LanelPost Office I I I I I I I I I I I I I I I I I I I I I I I I I
Area I Locality I Talukal Sub- Division
Town I City I District I I I I I I I I I I I I I I I I I I I I I I I I I
State I Union Territory Pincode Zip code Country Name

I I I I I I I I I I
 Office Address
Name of office
Flat I Room I Door I Block No_
Name of Premises I Building I Village I I I I I I I I I I I I I I I I
Road I Street I Lane/Post Office
Area I Locality I Talukal Sub-- Division
Town I City I District
State / Union Terri tory
I I P ncode
I /IZijIcodeI I I
Country Name
I I I I I I I I
I I I I I I I
8 Address for Communication D Residence D Office (Pl ease tick as applicable)

9 Telephone Number & Email ID details

Count~ code Area/STD Code Telephone I Mobile number

I I I I I I I I I I I I I I I I I I I I I I I I I I
EmailiD
I I
10 Status of applicant
Please select status, ~ as applicable D Government
D Individual Hindu undivided family Dcompany D Partnership Firm D Association of Person s
D Trusts D Body of Individuals D Local Authority D Artificial Juridical Persons D Limi ted Liability Partnership
11 Registration Number (for company, firms , LLPs etc.)

I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I
12. In case af a person, wha is required ta quote Aadhaar number or the Enrolment ID of Aadhaor application form as per sectian 139M,-
Please m ention your AADHAAR number (if allotted):
I I I I I I I I I I I I I
If AADHAAR number is not allotted, please mention the Enrolm ent ID of Aadhaar application form:

I I I I I I I I I I I I
Name as per AADHAAR letter or card or as per the Enrolment ID of Aadhaar application form:
I I I I I I I I I I I I I I
I

13
I I I I I I I I I I I
Source of Income
II I I I I I I I I I I I I I I I I I I
Please select, [{] as applicable

0 Salary 0 Capital Gains

0 Income from Business I Profession Business/Profession code IT] [For Code: Refer instructions] 0 Income from Other sources

0 Income from House property

14 Representative Assessee (RA)
0 No income

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 col umn 1-13_
Full Name (Full expanded name: initials are not permitted)

Please select title, [{] as applicable DShri D smt D Kumari OM"

Last Name / Surname
First Name
Middle Name I I I I I I I I I I I I I I I I I I I I I I I I I I
Address
Flat / Room ! Door ! Block No_
Name of Premises ! Building I Village
Road / Street ! Lane/Post Office
Area ! Locality I Taluka/ Sub- Division
Town / City I District
State / Union Territory Pincode

I I I I I I I I I
15 Documents submitted as Proof of Identity (POI), Proof of Address (POA) and Proof of date of Birth (POB)

IlWe have enclosed I I as proof of identity, I I

as proof of address and I I
as proof of date of birth
[Please refer to the instructions (as specified in Rule 114 of IT Ru les, 19(2) for list of mandatory certified documents to be submitted as applicable]
16 IlWe l I, the applicant, in the capacity of I I
do hereby declare that what is stated above is true to the best of my/our information and belief.
Place I I
D D MMY Y Y Y
Date
I I I I I I I I I Signature I Left Thumb ImpresSion of
Applicant (inside the box)