Form 49A

Form No. 49A Application for Allotment of Permanent Account Number Only 'Individuals' Only 'Individuals' [In the case of Indian Citizens/Indian Companies/Entities incorporated in India/ to affix recent to affix recent Unincorporated entities formed in India] photograph photograph Under section 139a of the Income Tax Act,1961 (3.5 cm * 2.5 cm) (3.5 cm * 2.5 cm) To avoid mistake(s),please follow the accompanying instructions and examples before filling up the form Assessing officer (AO Code) Area Code AO type Range Code AO No. Sign/left Thumb impression GUJ W * across the photo Sir, Sign/left Thumb impression I/W e hereby request that a permanent account number be allotted to me/us. I/W e 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 Abbreviations of the above name , as you would like it, to be printed in the PAN card 3 Have you ever been known by any other name ? Yes √ No (Please tick as applicable) If yes, please give that other name Please select title, √ 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' applicant: Even married women should fill in father's name only) Last Name / Surname First Name 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 applicable) 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 Pin code/Zip code Country Name INDIA 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 Pin code/Zip code Country Name Agent Name & Mobile Number :- 8 Address for Communication √ Residence Office (Please tick as applicable) 9 Telephone Number & Email ID Details Country Code Area/STD Code Telephone/Mobile Number 91 Email ID 10 Status of Applicant Please select status √ as applicable Government √ Individual Hindu undivided family Company Partnership Firm Association of Persons Trusts Body of Individuals Local Authority Artificial Juridical 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 Please select status as applicable Salary Capital Gains Income from Business/Profession Business/Profession Code (for Code:Refer Instructions) √ Income from other sources Income from House property 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 Pin code/Zip code 15 Documents submitted as Proof of Identity (POI) and Proof of Address (POA) I/W e have enclosed as proof of identity and as proof of address. as proof of date of birth. [Please refer to the instructions (as specified in Rule 114 of I.T. Rules,1962) for list if mandatory certified documents to be submitted as applicable] [Annexure A, Annxure B & Annexure C are to be used wherever applicable] 16 I/W e , the applicant,in the capacity of SELF do hereby declare that what is stated above is true to the best of my/our information and belief. Place VADODARA * D D M M Y Y Y Y Signature / Left Thumb Impression of Date Applicant(Inside the box) → Signature in Black Ink and with in the given proper Box(without any touching any line)(One Sign on Left Side Photograph) → Thumb Impression, if used,then PAN Application (Thumb Impression) should be attested by a Magistrate or Notary Public or a Gazetted Officer under Seal & Stamp → ID Proof, Address Proof and Date of Birth Proof Compulsary Req. for Individuals (Proof should be applicant's name only) → ID Proof List... (1) Passport, (2) Driving License, (3) Aadhar Card, (4) Election Card, (5) Ration Card having Photograph (6) Certificated issued by Member of Parliament or Member of MLA or Municipal Councilor or Gazetted Officer etc…..As per Income Tax Rule → Add Proof List... (1) Passport, (2) Driving Licence, (3) Aadhar Card, (4) Election Card, (5) Bank A/C with Latest Entry, (6) Post Office Bank A/C, (7) Electricity Bill,(8) Water Bill, (9) Telephone Bill, (10) GAS Bill or Card, (11) Propety Tax Assessment Order (12) Credit Card Statement (12) Certificated issued by Member of Parliament or Member of MLA or Municipal Councilor or Gazetted Officer etc…..As per Income Tax Rule → Date of Birth Proof List... (1) Election Card (2) Passport, (3) Driving Licence, (4) Aadhar Card, (5) Marksheet of Recognised Board (6) Domicile Certi issued by the Government, (7) Date of Birth Affidavait form Magistrate, (8) Pension Payment Order (9) Marriage Cert. (10) Photo ID Card issued by Central or State Govt. or Central or State Public Sector Undertaking (11) Central Govt Health Service Scheme Photo Card or Ex-Servicemen Photo Card → In Case of Minor Applicant Birth Cert. of Minor and any of the above ID, ADD. Proof of Parents / Guardians Req. → For HUF, An affidavit made by the Karta of HUF stating name,father's name & add. And Karta ID,ADD. & DOB Proof form above list Req.