ADV.
JITENDRA KUMAR PORWAL 807, ALKA PURI - ETAWAH 6:55 AM Contact Number - 09410078650 Status of Applicant Ward / Circle Area Code Ao Type Range Code Ao No.
ASSESSEE NAME
Prefix First Name Middle Name Last Name/Surmane Name of printed on Pan card
DETAIL OF OTHER NAME Give that other name
First Name Middle Name Last Name/Surmane
FATHER'S NAME
First Name Middle Name Last Name/Surmane
REDIDENTIAL ADDRESS
Flate/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
OFFICE ADDRESS Office Name
Flate/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 Adress for communication S.T.D. Code Mobile Phone & Telephone Number Email ID
OTHER INFORMATION
Sex Date of Birth / Incorporation /Agreement / Partnership or Trust Deed / Formation Body of Individual/ Association of Persons Registration Number (In case of Firms,Companies etc. Whether citizen of India Are you a salaried employee ? If yes, Indicate Government Name of Organisation where working If Business, Indicate Nature of Business Indicate Sources of Income
FULL NAME ADDRESS OF THE REPRESENTATIVE ASSESSEE (COLUMN 14)
First Name Middle Name Last Name/Surmane Flate/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
PROOF OF IDENTITY & ADDRESS
Proof of Identity Proof of Address
Click here Pan 49A Form
ITENDRA KUMAR PORWAL , ALKA PURI - ETAWAH 10 - 08 - 2011
ct Number - 09410078650 Individual
ASSESSEE NAME
Shri
TAIL OF OTHER NAME No
FATHER'S NAME
DIDENTIAL ADDRESS
OFFICE ADDRESS
Office Address
THER INFORMATION
Male
Yes Yes
HE REPRESENTATIVE ASSESSEE (COLUMN 14)
Rajendra P Ghuge
OF IDENTITY & ADDRESS
Driving License Driving License
k here Pan 49A Form
Form No. 49A
Application for Allotment of Permanent Account Number Under Section 139A of Income Tax Act, 1961
(To avoid mistake(S) ,Please follow the accompanying instructions and examples carefilly before filling up to the form)
To, The Assessing Office Ward/Circle Range Commmissioner Sir,
1 1
1 Area Code AO Type Range Code Ao No
I/We hereby Request that a permanent account number be allotted to me/us I/We give below necessary particulars :
Full Name ( Full expanded name : initials are not permitted ) Please Tick as applicable Shri Smt. Kumari First Name Middle Name M/s
Signatu Im
Last Name/Surmane
2 3
Name you would like printed on card Have you ever been know by any other name ? If yes, please give that other name (Full expanded name : initials are not permitted) Last Name/Surmane Middle Name Shri Smt. Kumari Please Tick as applicable Yes
First Name
Father's Name (Only Individual applicants : Even married women should give father's name only) Last Name/Surmane Middle Name First Name
Address R Residential Address Flate/Door/Block No. Name of Premises/Building/Village Road/Street/Lane/Post Office Area/Locality/Taluka/Sub - Division Town/City/District State / Union Territory
Office Address ( Name Of Office )
Flate/Door/Block No. Name of Premises/Building/Village Road/Street/Lane/Post Office Area/Locality/Taluka/Sub - Division Town/City/District State / Union Territory
6 7
Adress for communication Tel. No. Email ID + 9 1
Please Tick
as applicable
or
8 9
Sex (For Individual Applicant Only) Status of Applicant Individual P Hindu Undivided Family H Company C
Please Tick Please Tick
as applicable as applicable Firm F
Male
Body of In Local
Association of Persons A Association of Person (Trusts) T
Artificial Juridic -
10
Date of Birth / Incorporation /Agreement / Partnership or Trust Deed / Formation Body of Individual/ Association of Persons Registration Number (In case of Firms,Companies etc. Whether citizen of India Please Tick as applicable Yes Other No
11 12 13
(A) Are you a salaried employee ? If yes, Indicate Government
Name of Organisation where working (B) If you are engaged in a business/profession indicate nature of business or profession and fill the relevant code. (C) If you are note covered by (a) or (b) above indicate sources of income, if any
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 column 1 to 3 Last Name/Surmane First Name A J E N D R A P G H U G E R A J E N D R A P Middle Name Address R Residential Address Flate/Door/Block No. Name of Premises/Building/Village Road/Street/Lane/Post Office Area/Locality/Taluka/Sub - Division Town/City/District State / Union Territory
15
I/We have enclosed as proof of address
Driving License
as proof of identity and
Driving
I/We above is true to the best of my / our information and belief.
the applicant do hereby declare that what is s
Venfied today the
10 - 08 - 2011
Signature / Left of Applicant
Adv. JKP - 09410078650
Signature / Left of Applicant
Form No. ITS 4
Only 'Individuals' to affix recent photograph (3.5 cm 2.5 cm)
Signature/Left Thunb Impression
No
M/s
tory
Pin Code
tory
Pin Code
Female
Body of Individuals B Local Authority L Artificial Juridical person J -
levant code.
pect of the person,
tory
Pin Code
Driving License
clare that what is stated
Signature / Left Thumb Impression of Applicant (Inside the box)
Signature / Left Thumb Impression of Applicant (Inside the box)
