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Form 49

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Form No. 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
To avoid mistake (s), please follow the accompanying instructions and examples before filling up the form

Assessing officer (AO code)
Sign/ leftTumb impression across this photo

Area code

AO type

Range code

AO No.

Sir, I/We hereby request that a permanent account number be allotted to me/us. I/We give below necessary particulars:

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 First Name Middle Name

2 Abbreviation of the above name, as you would like it, to be printed on the PAN card

3 Have you ever been known by any other name?
If yes, please give that other name
Please select title, as applicable

Yes

No

(Please tick as applicable)

Shri

Smt.

Kumari

M/s

Last Name / Surname First Name Middle Name

4 Gender (for Individual applicants only)

Male

Female

(Please tick as applicable)

5 Date of Birth/Incorporation/Agreement/Partnership or Trust Deed/ Formation of Body of individuals or Association of Persons
Day Month Year

6 Father's Name (Only 'Individual' applicants: Even married women should fill in father's name only)
Last Name / Surname First Name Middle Name

7 Address Residence Address
Flat/Room/ Door / Block No. Name of Premises/ Building/ Village Road/Street/ Lane/Post Office Area / Locality / Taluka/ Sub‐ Division Town / City / District State / Union Territory Pincode / Zip code Country Name

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

State / Union Territory

Pincode / Zip code Residence

Country Name Office
(Please tick as applicable)

8 Address for Communication 9 Telephone Number & Email ID details
Country code Area/STD Code

Telephone / Mobile number

Email ID

10 Status of applicant
Please select status, Individual Trusts as applicable Hindu undivided family Body of Individuals Company Local Authority Partnership Firm Artificial Juridical Persons Government Association of Persons Limited Liability Partnership

11 Registration Number (for company, firms, LLPs, etc.) 12 In case of a citizen of India, then
Please mention your AADHAAR number (if allotted)

13 Source of Income
Salary Income from Business / Profession Income from House property Business/Profession code
[For Code: Refer instructions]

Please select status, Capital Gains

as applicable

Income from Other sources No income

14 Representative Assessee (RA)
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 the column 1‐13.

Full Name (Full expanded name: initials are not permitted)
Please select title, as applicable

Shri

Smt.

Kumari

M/s

Last Name / Surname First Name Middle Name Address Flat/Room/ Door / Block No. Name of Premises/ Building/ Village Road/Street/ Lane/Post Office Area / Locality / Taluka/ Sub‐ Division Town / City / District State / Union Territory Pincode

15 Documents submitted as Proof of Identity(POI) and Proof of Address (POA)
I/We have enclosed as proof of address. [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 applicable] as proof of identity and

16 I/We do hereby declare that what is stated above is

, the applicant, in the capacity of true to the best of my/our information and belief.

Place D Date D M M Y Y Y Y Signature / Left Thumb Impression of Signature / Left Thumb Impression of Applicant (inside the box)

INSTRUCTIONS FOR FILLING FORM 49A (a) Form to be filled legibly in BLOCK LETTERS and preferably in BLACK INK. Form should be filled in English only (b) Each box, wherever provided, should contain only one character (alphabet /number / punctuation sign) leaving a blank box after each word. (c) 'Individual' applicants should affix two recent colour photographs with white background(size 3.5 cm x 2.5 cm) in the space provided on the form. The photographs should not be stapled or clipped to the form. The clarity of image on PAN card will depend on the quality and clarity of photograph affixed on the form. (d) Signature / Left hand thumb impression should be provided across the photo affixed on the left side of the form in such a manner that portion of signature/impression is on photo as well as on form. (e) Signature /Left hand thumb impression should be within the box provided on the right side of the form. The signature should not be on the photograph affixed on right side of the form. If there is any mark on this photograph such that it hinders the clear visibility of the face of the applicant, the application will not be accepted. (f) Thumb impression, if used, should be attested by a Magistrate or a Notary Public or a Gazetted Officer under official seal and stamp. (g) AO code (Area Code, AO Type, Range Code and AO Number) of the Jurisdictional Assessing Officer must be filled up by the applicant. These details can be obtained from the Income Tax Office or PAN Centre or websites of PAN Service Providers on www.utiitsl.com or www.tin-nsdl.com.

(h) Guidelines for filling the Form 49A: Guidelines for filling the form Ite Item Details m No. 1 Full Name Please select appropriate title. Do not use abbreviations in the First and the Last name/Surname. For example RAVIKANT should be written as :
Last Name/Surname First Name Middle Name

R A

V

I

K

A

N

T

For example SURESH SARDA should be written as :
Last Name/Surname First Name Middle Name

S A S U

R R

D E

A S H

For example POONAM RAVI NARAYAN should be written as:
Last Name/Surname First Name Middle Name

N A P O R A

R

A

Y A

A M

N

O N V I

For example SATYAM VENKAT M. K. RAO should be written as :
Last Name/Surname First Name Middle Name

R A S A V E

O T N Y K A A M T M K

For example M. S. KANDASWAMY(MADURAI SOMASUNDRAM KANDASWAMY) should be written as :
Last Name/Surname First Name Middle Name

K A M A S O

N D

D U

A R S

S A U

W A I N D

M Y

M A

R

A

M

Applicants other than 'Individuals' may ignore above instructions. Non-Individuals should write their full name starting from the first block of Last Name/Surname. If the name is longer than the space provided for the last name, it can be continued in the space provided for First and Middle Name. For example XYZ DATA CORPORATION (INDIA) PRIVATE LIMITED should be written as :
Last Name/Surname First Name Middle Name

X Y I A

Z )

D P

A R

T I

A V A

C T

O R E

P L

O R I

A

T T

I E

O N D

(

I

N

D

M I

For example MANOJ MAFATLAL DAVE (HUF) should be written as :
Last Name/Surname First Name Middle Name

M

A

N

O

J

M A

F

A

T

L

A

L

D

A

V

E

(

H

U

F

)

In case of Company, the name should be provided without any abbreviations. For example, different variations of 'Private Limited' viz. Pvt Ltd, Private Ltd, Pvt Limited, P Ltd, P. Ltd., P. Ltd are not allowed. It should be 'Private Limited' only. In case of sole proprietorship concern, the proprietor should apply for PAN in his/her own name. 2 Abbreviation of the full name to be printed on the PAN card Name should not be prefixed with any title such as Shri, Smt, Kumari, Dr., Major, M/s etc. Individual applicants should provide full/abbreviated name to be printed on the PAN card. Name, if abbreviated, should necessarily contain the last name. For example: SATYAM VENKAT M. K. RAO which is written in the Name field as :
Last Name/Surname First Name Middle Name

R A S A V E

O T N Y K A A M T M K

Can be written as in ‘Name to be printed on the PAN Card’ column as SATYAM VENKAT M. K. RAO or S. V. M. K. RAO or SATYAM V. M. K. RAO 3 Have you ever been known by any other name? Gender Date of Birth/Incorporat ion/ Agreement /Partnership or Trust Deed/Formation of Body of For non individual applicants, this should be same as last name field in item no. 1 above. If applicant selects 'Yes', then it is mandatory to provide details of the other name. Instructions in Item No. 1 with respect to name apply here. Title should be similar to the title mentioned in Item No. 1. This field is mandatory for Individuals. Field should be left blank in case of other applicants. Date cannot be a future date. Date: 2nd August 1975 should be written as: D 0 D 2 M 0 M 8 Y 1 Y 9 Y 7 Y 5

4 5

Individuals/ Association of Persons

Relevant date for different categories of applicants is: Individual: Actual Date of Birth; Company: Date of Incorporation; Association of Persons: Date of formation/creation; Trusts: Date of creation of Trust Deed; Partnership Firms: Date of Partnership Deed; LLPs : Date of Incorporation/Registration; HUFs: Date of creation of HUF and for ancestral HUF date can be 01-01-0001 where the date of creation is not available. Applicable to Individuals only. Instructions in Item No.1 with respect to name apply here. Married woman applicant should give father's name and not husband's name. R - Residence Address: For Individuals, HUF, AOP, BOI or AJP, residential address is mandatory. Other applicants should leave this field blank. O - Office Address: (1) Name of Office and address to be mentioned in case of individuals having source of income as salary or Business/profession[Item No.13]. (2) In case of Firm, LLP, Company, Local Authority and Trust, name of office and complete address of office is mandatory. For all categories of applicants, it is necessary to mention complete address and the details of Town/City/District, State/Union Territory, and PINCODE are mandatory. In case, a foreign address is provided then it is mandatory to provide Country Name along with ZIP Code of the country. Individuals/HUFs/AOP/BOI/AJP may indicate either 'Residence' or 'Office' and other applicants should necessarily indicate 'Office' as the Address for Communication. All communication will be sent at the address indicated in this field. (1) Telephone number should include country code(ISD code) and STD code or Mobile No. should include Country code(ISD Code). For example : (i) Telephone number 23555705 of Delhi should be written as Country code 9 1 STD Code 1 1 Telephone Number / Mobile number 2 3 5 5 5 7 0 5

6 7

Father’s Name Address – Residence and office

8

Address for communication Telephone Number and Email ID

9

Where ‘91’ is the country code of India and 11 is the STD Code of Delhi. (ii) Mobile number 9102511111 of India should be written as Country code 9 1 STD Code Telephone Number / Mobile number 9 1 0 2 5 1 1 1 1 1

Where '91' is the country code of India. (2) It is mandatory for the applicants to mention either their “Telephone number” or valid “e-mail id” so that they can be contacted in case of any discrepancy in the application and/or for receiving PAN through e-mail. (3) Application status updates are sent using the SMS facility on the mobile numbers mentioned in the application form. This field is mandatory for all categories of applicants. In case of ‘Limited Liability Partnership’, the PAN will be allotted in ‘Firm’ status. Not applicable to Individuals and HUFs. Mandatory for 'Company'. Company should mention registration number issued by the Registrar of Companies. Other applicants may mention registration number issued by any State or Central Government Authority. AADHAAR number, if allotted, has to be quoted (supported by copy of AADHAAR letter/card) It is mandatory to indicate at least one of the sources of incomes, as mentioned in the form. In case, the income from Business/profession is selected by the applicant then an appropriate business/ profession code should be mentioned.

10 11 12 13

Status of Applicant Registration number In case of citizen of India Source of Income

Please refer the table given below to select the business/profession code:
Code 01 02 03 04 05 06 07 08 09 10 Business/ Profession Medical Profession and Business Engineering Architecture Chartered Accountant/Accountancy Interior Decoration Technical Consultancy Company Secretary Legal Practitioner and Solicitors Government Contractors Insurance Agency Code 11 12 13 14 15 16 17 18 19 20 Business/ Profession Films, TV and such other entertainment Information Technology Builders and Developers Members of Stock Exchange, Share Brokers and SubBrokers Performing Arts and Yatra Operation of Ships, Hovercraft, Aircrafts or Helicopters Plying Taxis, Lorries, Trucks, Buses or other Commercial Vehicles Ownership of Horses or Jockeys Cinema Halls and Other Theatres Others

14

Name and address of Representative Assessee

Section 160 of Income Tax Act, 1961 provides that any person(assessee) can be represented through Representative Assessee. Therefore, this column should be filled in by representative assessee only as specified in Section 160 of the Income-tax Act, 1961, such as, an agent of the non-resident, guardian or manager of a minor, lunatic or idiot, Court of Wards, Administrator General, Official Trustee, receiver, manager, trustee of a Trust including Wakf. This field will contain particulars of the Representative Assessee. This field is mandatory if applicant is minor, deceased, idiot, lunatic or mentally retarded. Column 1 to 13 will contain details of person on whose behalf this application is submitted.

Proof of Identity and Proof of address is also required for representative assessee. Proof of It is mandatory to attach proof of identity and proof of address with PAN application. Documents should be Identity and the name of applicant. List of documents which will serve as proof of identity and address for each status Proof of applicant is as given below: Address documents Document acceptable as proof of identity and address as per Rule 114 of Income Tax Rules, 1962 For Individuals and HUF Sr. Proof of Identity (Copy of) Proof of address (copy of) No 1 School Leaving Certificate Electricity Bill* 2 Matriculation Certificate Telephone Bill* 3 Degree of recognised educational institution Employer Certificate* 4 Depository Account Statement Depository Account Statement* 5 Bank Account Statement / Passbook Bank Account Statement / Passbook* 6 Credit Card Credit Card Statement* 7 Water Bill Rent Receipt* 8 Ration Card Ration Card 9 Property Tax Assessment Order Property Tax Assessment Order 10 Passport Passport 11 Voter Identity Card Voter Identity Card 12 Driving License Driving License Certificate of address signed by Member of Parliament 13 Certificate of identity signed by Member of Parliament or Member of Member of Legislative Assembly or Municipal Councilor Legislative Assembly or Municipal Councilor or Gazetted Officer in the Gazetted Officer in the prescribed format. prescribed format. 15
Note :1. In case of Minor, any of the above mentioned documents as proof of identity and address of any of parents/guardians of such minor shall be deemed to be the proof of identity and address for the minor applicant. For HUF, an affidavit made by the Karta of Hindu Undivided Family stating name, father’s name and address of all the coparceners on the date of application and copy of any of the above documents in the name of Karta of HUF is required. Note: 1. 2. Proof of Address is required mentioned in item no. 7. for residence

in of

or or

address

2.

In case of an Indian citizen residing outside India, copy of Bank Account Statement in country of residence or copy of Non-resident External(NRE) bank account statements.

Other than Individuals and HUF 1 Company 2 Partnership Firm 3 Limited Liability Partnership

Copy of Certificate of Registration issued by the Registrar of Companies. Copy of Certificate of Registration issued by the Registrar of Firms or Copy of partnership deed. Copy of Certificate of Registration issued by the Registrar of LLPs

4 5

Trust Association of Person, Body of Individuals, Local Authority, or Artificial Juridical Person

Copy of trust deed or copy of certificate of registration number issued by Charity Commissioner. Copy of Agreement or copy of certificate of registration number issued by charity commissioner or registrar of cooperative society or any other competent authority or any other document originating from any Central or State Government Department establishing identity and address of such person.

16

Signature impression

/

Thumb

Application must be signed by (i) the applicant; or (ii) Karta in case of HUF; or (iii) Director of a Company; or (iv) Authorised Signaturee in case of AOP, Body of Individuals, Local Authority and Artificial Juridical Person; or (v) Partner in case of Firm/LLP; or (vi) Trustee; or (vii) Representative Assessee in case of Minor/deceased/idiot/lunatic/mentally retarded. Applications not signed in the given manner and in the space provided are liable to be rejected.

GENERAL INFORMATION FOR PAN APPLICANTS (a) Applicants may obtain the application form for PAN (Form 49A) from any IT PAN Service Centres(managed by UTIITSL) or TIN-Facilitation Centres(TIN-FCs)/PAN Centres (managed by NSDL), or any other stationery vendor providing such forms or download from the Income Tax Department website(www.incometaxindia.gov.in)/UTIITSL website(www.utiitsl.com)/NSDL website (www.tin-nsdl.com). (b) The fee for processing PAN application is Rs. 85/- (plus service tax, as applicable). In case, the PAN card is to be dispatched outside India then additional dispatch charge of Rs 850 will have to be paid by applicant. (c) Those already allotted a ten digit alphanumeric PAN shall not apply again as having or using more than one PAN is illegal. However, request for a new PAN card with the same PAN or/and Changes or Correction in PAN data can be made by filling up 'Request for New PAN Card or/and Changes or Correction in PAN Data' form available from any source mentioned in (a) above. The cost of application and processing fee is same as in the case of Form 49A.

(d) Applicant will receive an acknowledgment containing a unique number on acceptance of this form. This acknowledgment number can be used for tracking the status of the application. (e) For more information / Application status enquiry contact:

Income-tax Department Website Call Center Email ID SMS www.incometaxindia.gov.in 0124-2438000

NSDL www.tin-nsdl.com 020‐27218080

UTIITSL www.utiitsl.com 022-67931300

tininfo@nsdl.co.in SMS NSDLPANAcknowledgement No. & send to 57575 to obtain application status. INCOME TAX PAN SERVICES UNIT (Managed by National Securities Depository Limited), 3rd Floor, Sapphire Chambers, Near Baner Telephone Exchange, Baner, Pune ‐ 411 045.

utiitsl.gsd@utiitsl.com

Address

IT PAN Service Centres(managed by UTIITSL) PB no 20, Plot no 3, Sector- 11, CBDBelapur – Navi Mumbai 400614

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्�प�औ.

�औ पप इारषप�औ��षर ैपक प�ा�ानर�पपक े पर �ा: प . �औ.,पप इारषप�औ.,प्�.�औ, ्�.�औ., रप रप�औखररपकतपबरम�षापर रंप ै रपइ रपकाऔप'प इारषप�औ��षर ै' र रप�औख प

्रपका �र��्ारपा औरपकै्पर�पकप� �औरप�र, का औ��पक पका ुंपकपर �प्ेप्ैरपकप�औ प र र र ू ा आारदरपकेर पा ा र �पकपआहरपश�, श��ा�, क� ेर, ैल.,प�र े, �ै र म रपप पइ्ु ेादपर रंप�औख प ा र पा ा रपपप

2.

्ैरपक ैाप्ेप्ूे प वुहदिष पआारदक पक प्ैरपक ैाप्ेपर �प�ाकापकेररपकप�औ प्ूे प/ र म त्प�माकाप�कु प ह परप र �पक प ंसड़रा प ह प द ेरपकप�औ प: र

्औकपरपके र प ह पुादप ंसड़रा्पत्, बंषा�पर �प�रपबषरा ुपत्प रप � �ािषप ा

ंसड़रा लपत्प



रपहतलैरपर �प�रप ्ुं�पारकषप �.क.े ापप र

पपपपपपपपपपपपपपपपपपपपपपपपपप ्ु“�पा�. �.क.े ाप र हैे-वुपदिषपआारदक पकप�औ , र 3. अु . आ्पका�प �क �पबनु प पक ेप ह पप ्े अा�प�दप ंखु पप1 �र पबंषा�पर �पहतलै प�र प �प

पपपपपपपपपपपपपपपपपपपपपपपपपप

पपपपपपपपपपपपपपपपपपपपपपपपपप ्ु“�पारकषप �.क.े ापबथा प र .ा�. �.क.े ाप र



े ापपपपपपपपपपपपपपपपपपपपपपपपपपपप ्ुप�पपपपपपपपपपपपपपपारकषप �.क. र पपक ेपकलऔ�प�र प�औखप कारप ै प“्ैरपक ैाप्ेपर �प�माकाप�कु प

अं�तमपनाम/पउ्नामपपपपपपपपपप्मपनामपपपपपपपपपपपपपपम ्ापनामप

ह”

ुादपआादर कप “ ं”पक पाुरपकेाप ै पातपबनुेपर �पक पकु् े पबषरा ुपत्प रप र ा

्औकपदपके र प ह परपर �पकप ंतंपप�रप�दप ंखु पप1 कपबरमदरजपु ंपऔ हूप हररप र र

र �प रप 4. ह प व? �औंहप

ररप

ष इषऔप ै रप

�पपक ेप ह पद

पपक ेप�दप ंखु ंप1 �र पष इषऔपक प लऔरपखप�कु पहु प प

ु पड़ररपदवििषद�ु प र ामपबषरा ुप ै रपबनुुपआारदक पकप� �औरप�रपइ रपमेअाषपा ् प ा र ाा रप

5.

कतपषा�थ/ �झ्ार कतपषा�थ/

न�पषा�थ/षरह�रप झरद ेर

षा�थपा ा�पषा�थपर रंप प का�रपादर ंक: ाद 0 हप ाद 2 �. 0 �.

2 बहका प1975 क पइ पपक ेप�औख प ा 1 ा 9 ा 7 ा 5

बथा पनु प प�ाऔरखप

8

कतपषा�थप/वुपदिष�ु प आारदक पकप�ा�ानरंपाहगपकप�औ प ंहापषा�थप ै : र र कपषरक ुपक पत्प र वुददिषर: न�पपकतपा काप�ाकपषा�थ; क्र�: षरह�रपकतपषा�थ; वु ं औरररपकतपषा�थ/ षर� र/ ृ रपकतपषा�थ ;पनु प : नु द� प�ाऔरखपकप ृ रपकतपषा�थ;प ा र वुरदअापु पकप ंघप र झरद ेरप�ाऔरखपकतपषा�थ; औ औ्� : षरह�र/ ्ं �केरपकतपषा�थ, कतपषा�थप ाुू हपकप ृ रपकतपषा�थपाथ प्ूाा प ाुू हपकप�औ प र र ं प कप ृ र

दअा ु पक प ंघ ाुू ह: रपकतप झरद ेरपह��:

6.

�्ा पक पर �प

ा ेरखप ्औकप पर रंप ै पा ंपषा�थप01-01-0001

काऔपवुरदिषपु पकप�औ पऔ हरपर �पकप ंतंपप�रपु ंप�दप ंखु 0 1 �रपाद पबरदरजप र र र ू म औ हप हरपरप�ाा ा ापकर�्पआारदकपब्ररप�्ा पक पर �पाेरह�परप�कपब्ररप्षापक प ू आ-पआवासी्प्ता:प दवििषुु ,

प का�प ै रपपप

7.

्ा -आा

क ु औुप ा

प ांप

र �प

क ु ाऔुपक पर �प ांपक ु ाऔुपक प्े प्ा पदर र पबषरा ुाप ै रप ू

(2) ह�प औप औप्�, क्र�, कथ � र�ुपप �पकेरप ांपनु प पकप� �औरप�र प ा ं र

�र पक ु ाऔुपक पर �प ांप्ा प दलऔेलखाप�कु प

(1) ारारपकपत्प�रपआुपकप र र

काप-पका्ार््पकाप्ता:प

ै रपबनुपआारदकपइ पकथ परपक पमेअा्पा ैरहररप प

ाुू ह,

य्�, त�यआ पबथा प

र्�पकप�औ पआा र

�ुप्ा पबषरा ुप ा

ापु पक े त े/ वुरा

र पा ा

ुपा औरपवु्दिषाु पकप� �औरप र प(�दप खु �रप13)रपप ं

रहे/ज े/द औ , े जुु/ ंघपड़रर, ाथ प�्रपक ैपबषरा ुप ै रपप ा ुादप�ादरजपक प्ा पादु प बषरा ुाप ै रप वुपदिषा/ ाुू ह/

आारदक पकतप ा�पशरलरु पकप�औ प्ेरप्ापक प लऔराखपकेर पबषरा ुप ै प�ेप र र ा ू ा प ै पा पदरजपक पर �पद ्पक ैपकप र र्�पु पा पआा थप�औखर प

8.

्र ा ेपकप�औ प र ्ा प

रपक ु ाऔुपइं�हापकेर हररप

काप वप�ेपबदनुपआारदकप्र ा ेपकप्ापकप�औ पक ु ाऔुपक प्ा पबषरा ुपत्प र र र र ा ंहररपप

य्�/त�यआ प/

पबथा पक ु ाऔुपइं�हापकेप

9.

देा षप खु इपाप (1)ुादपदेा षप ंखु कपक प लऔर खप�कु पहु प ै पा पदरजपक ैप(आ ं ू ू -�रऔपआ ै�प बषरा ुाप ै रप षरै�पक ैपबथा प� त इऔप ंखु पकप� �औरप�र , दरजपक पक ैप(आ र

ा�प्र ा ेपइ प ह प्ेप ू�ााप�क प्ाप्ेपार रप र

पै�पक ै)

ै�पक ै)

�ेप

प द े रपकप�औ प: र

दरजपक पक ैपपपपपप

i)पादलऔरऔपक पषर औरह रपरैतपेप23555705 इ पाे प�औखर प ह

!

षरै�पक ैपपपपपपपपदेा षप ंखु � / � त इऔप ंखु ेप ू

9 1

1

1

2

3 5 5 5 7 0 5 षरै�पक ैप11 ै पर

ii)पपा ेापक प� त इऔपरैतपेप9102511111 इ पाे प�औखर प ह परप दरजपक पक ैपपपपपप 9 1 प'91' ा ेापक पदरजपक ैप ै पर ं

प'91' ा ेापक पदर जपक ैप ै पाथ पादलऔर� पक प ं

षरै�पक ैपपपपपपपपदेा षप ंखु � / � त इऔप ंखु प ू 9 1 0 2 5 1 1 1 1 1

(2) आारदक पकप�औ पब्र प'देा षप खु 1' बथा पाैपप' -�रऔपआ पै�' क प र ं ू � ु �प रपाथ / बथा प्ैरपप राकपकेररप र ामप र रप ं्कप�कु प ा प �प प �ाप पक पपु हपकेाप म पार �प र म ा�प ै र प करप र

लऔर खपकेर पबषरा ुप ै पा �कपआारदरप�रप�क �प�ा ंहषापकप� �औरप�रप -�रऔपकप ा र र

(3) आारदरपकतपबदुारपदकथबषापआारदरपह �ाप�र प दलऔमलखाप� त इऔप ंखु रप्ेप ु पड़ररपआारदकपकतप ा�पशरलरु पकप�औ पबषरा ुप ै रप' ���ापद षु्ापप र ा � �औरप�रप्ैरप'ह�ा' कतप ै � ुाप रपआतंाषाप�कु प क्र�, क्षरु पकप्ं �क ेपदा े प ं ं र ह रप झरद ेर' कप र

10 . 11

आारदकपकतप ै � ुाप

्ं �केरप ंखु दप वु�दिषकपाथ पा नदऔपब�ाा द ाप्मेा े प्ेपऔ हूपर रंपरपप'क्र�' कप�औ पबषरा ुारप ं र ू आारदरप�क �पे जुकपबथा पकनकाप ेक ेपप �पकेरपदा े प र ेरप्ं �केरप ंखु ्पक प लऔररखपकेर हररपबनु�प ेर

12 . 13

ा ेापकपर हमेकप र कप� �औरप�रप र आुपक प ापप

्ं �केरप ंखु लपक प लऔरकखपकेप कारप वरप कतपपषापप� रपकप�औ प ंऔ रऔपकेर) रप र ुादपआारदकपदा े पक े त े/वुपा पक े त े/वुेा केर : कै 01 02 03 04

आप ेप खु , ुादपआंत ाषाप ै पा पइ क प लऔरकखप�कु प ं ं ह �प�रपुथ प दलऔऔलखापआुपक पक�प रपक�प कप ा क े त े/वुेा ुपक ैपक प लऔर खप�कु प ुप रपआुपामर प र

परप(आप ेप्रप/ क ैाप

ा प ै पा प कप ्ुअा( म

ाप �ाापकेर पबषरा ुप ै रप ा ू

ुपक ैपामरररपकप�औ पकृ्ु पषरैरप�औलखापा �औक पक पबाऔ करप र ु कै 11 12 13 14 क े त े/वुेा ुप

क े त े/वुेा केते

�ा�क् पपवुुा इं �षरुमेंहप ा काम्कऔ

ुप�ेप

�हल� , षर और�ा रप�ेप ऐ रपबनुप�र ें र प षर� ाा प ांप�ाक ार पप्दु �हकत ू

रदरपऔरख क े/औरख प�ा�पक े

कषलपकप अ औार पकप र ्-दऔ औ



दकुऔ, जरुेपदऔ औपाथ प

05 06

आंामेकप ज

ाकर�कतप्े �जा



15 16

कऔ प ांपु र पपदजार बेक रषपपबथा प , ाेक रष,

07

क्र�प �ाा ं

17

षैअ � , औलेर, जक, त प ा रपाऔ र प

र औरक रषषेपक प्मेा और

बथा पबनुापा लरजुाकप

08 09 10 14. प्रितिनिध िनधार्रती नाम व पता करका

काननी पेशवर / वकील े ू सरकारी ठे कदार े बीमा एजसी

18 19 20

घोड़ वामी

अथवा

जॉकी

क े

िसनेमा हॉल तथा अ य िथएटर अ य यव था है िक िकसी कर-िनधार्िरती को प्रितिनिध व िकया

िकसी यिक्त (िनधार्िरती)

आयकर अिधिनयम, 1961 की धारा 160 म

वारा प्रितिनिध िनधार्िरती क मा यम से े

जा सकता है । अत: इस कॉलम को आयकर अिधिनयम,1961 की धारा 160 म एजे ट, अवय क का अिवभावक या प्रब धक, पागल अथवा मख, प्रितपा य अिधकरण, ू र् महाप्रशासक, शासकीय इस जगह पर प्रितिनिध कर-िनधार्िरती का िववरण होगा। यह आवेदक अवय क, मत, पागल, मखर् अथवा मंदबिद्ध है । ु ू ृ यासी, प्रा तकतार्, प्रबंघक, वक्फ सिहत यास का यासी िविनिदर् ट कवल प्रितिनिध िनधार्िरती क े े वारा भरा जायेगा । जैसािक अिनवासी का

थान अिनवायर् होगा यिद

िकया जाएगा। अपेिक्षत है ।

कालम 1 से 13 म उस यिक्त का िववरण होगा िजसकी ओर से यह आवेदन प्र तुत

प्रितिनिध कर-िनधार्िरती क िलए पहचान का प्रमाण तथा पते का प्रमाण होना भी े 15. पहचान क प्रमाण पैन आवेदन क साथ पहचान का प्रमाण तथा पते का प्रमाण संलग्न करना अिनवायर् है । े े तथा प्रमाण पते क द तावेज आवेदक क नाम से होने चािहए। प्र यक े े े क तथा पते क प्रमाण क े े े :प म िदए जाने वाले कागज़ातो की सची नीचे िदए अनुसार है ू प म वीकायर् कागजात तर क आवेदक क िलए पहचान े े

द तावेज

आयकर िनयमावली, 1962 क िनयम 114 क अनसार पहचान तथा पते क प्रमाण क े े े े ु क्र. सं 1 2 3 4 5 6 7 8 9 10 11 12 13 यि टय तथा िह द ू अिवभािजत पिरवार क िलए े पहचान का प्रमाण (प्रितिलिप)

पते का प्रमाण (प्रितिलिप) िबजली िबल* टे लीफोन िबल* िनयोक्ता का प्रमाण-पत्र* जमा खाता िववरण* बक खाता िववरण/पासबक* ु क्रिडट काडर् िववरण* े िकराया रसीद* राशन काडर् स पि त कर िनधार्रण आदे श पासपोटर् मतदाता पहचान काडर् ड्राइिवंग लाइसस िकसी राजपित्रत अिधकारी सांसद अथवा िवधायक अथवा िनगम पाषर्द अथवा वारा िनधार्िरत फॉमट

िव यालय छोड़ने का प्रमाण-पत्र मैिट्रक का प्रमाण-पत्र मा यता प्रा त शैिक्षक सं थान की िडग्री जमा खाता िववरण बक खाता िववरण/पासबक ु क्रिडट काडर् े राशन काडर् स पि त कर िनधार्रण आदे श पासपोटर् मतदाता पहचान काडर् ड्राइिवंग लाइसस सांसद अथवा िवधायक अथवा िनगम पाषर्द अथवा िकसी राजपित्रत अिधकारी पहचान का प्रमाण-पत्र पानी का िबल

वारा िनधार्िरत फॉमट म ह ताक्षिरत

म ह ताक्षिरत पते का प्रमाण-पत्र

्रपप

ाषर्कर�:-

1. बाुदककपकप� �औरप�रपऐ रपबाुकक �लपकप र र �क �पब�ाा ाक/ ेंड़कपकप् ा रपाथ प्ाप र र

1.

दका ेार पबाुकक पआारदकपकप�औ प् ा रप र ाथ प्ारपक पप� रप� र प 2. ाुू हपकप�औ , र ह रप

कपप� रपकपत्प�रप ्े अाकप दलऔरलखापक प कतपा ेरखपक पा प� प रप्मे र प र पा ा र र

्ापक पप� रपब्रसड़ाप ै परप र

�दप खु पप7 �रप दलऔपलखापआा ं

ाषर्हर�:-

�ुप्ापकप�औ प र र रपप

ा ेाप रपत ेपे ररपा औरपा ेा�ुपर हमेकपकप र ्मेा ेपक पर �पदर ाप म पका ापकपदा े पतर ु प र र र व हु पप षर -्र, �्ा पक पर �पाथ पआारदरप � �औरप�र, आा पकपदरजप�रपतकपख ा प�ााेरपकतपपषाप बथा पबषरा �पत कुप( रआे ) तवकपख ा प�ााेलरु प कतपा ेरखपक प ा�प झरद े पक प्ा प�ेप दका हार प�रप�क �प कपपषापब्रसड़ाप ै परपपपप क्र�प ं ाुू हपकपका ापकपर �प रपर्ेपाद पह प र र कतपपषापरपप

ा नदपपपब�ाा द ाप ू

व्् िष्् पत्ापेहहदपपअनवभा भतप्तरवार पकपअ्ावापअह्तपप े न 1 2 3

पक्षरु पकप्ं �क ेपदा े प ं र ्रपकतपपषा�औ�्प ह�गपकप्ं �क ेपदा े प र

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