Acknowledgment for request for new PAN card

ACKNOWLEDGMENT NUMBER: 881020110530932

Citizen of India Category Name Name to be printed on card Father's Name Date of Birth Residential Address Y Indiv idual Shri Siv aram Siv aram Shri Manickam 17 - 03 - 1989 3a Thirunagar 5th cross Manachanallur Tiruchirappalli - 621005 Tamil Nadu Residential 0431 - 2560145 parcome@hotmail.com

Affix recent photograph (3.5cm x 2.5cm)

Office Address Address for Communication Telephone No Email Id

Paym ent Mode

Credit Card / Debit Card: Your Payment of 94.00 against transaction number 400-209512 has been successfully processed.

I/We, the applicant, do hereby declare that what is stated above is true to the best of my/our information and belief. The following documents are enclosed as: Proof of Identity: Copy of v oter's identity card Proof of Address: Copy of v oter's identity card Proof of Identity of representative assessee: Proof of Address of representative assessee: Any other document: Signature/Left Thumb Impression of Applicant (inside the box without touching the sides & in BLACK INK ONLY) Date: 17 - 10 - 2011

Preview Application Form

Service Tax Registration No.: M-III/ST/BAS/2847

Print Acknowledgment

New Application

Instructions:
1. The acknowledgement number abov e is y our unique ref erence number f or PAN application. Kindly quote this number f or tracking the status of y our PAN application on http://tin-nsdl.com or any queries relating thereto. 2. Save and print this acknowledgment. 3. Application fee and mode of payment: Pay ment f av ouring 'NSDL-PAN' can be made as f ollows: Sr. No. 1 Address for Communication Indian Amount payable ( ) 94 Mode of payment Credit card / Debit card/ Net Banking / Demand Draf t (DD) pay able at Mumbai/Cheque to be deposited in any HDFC bank branch across the country (except Dahej). DD pay able at Mumbai

Foreign

944

Please mention name of applicant and acknowledgment number on the reverse of cheque/DD. 4. Indiv idual applicants af f ix y our recent colour photograph (3.5 cm x 2.5 cm), sign the acknowledgment (inside the box prov ided without touching the sides and in BLACK INK only ) and enclose a DD, if any , alongwith Proof of Identity & Proof of Address as specif ied in the application f orm. 5. Superscribe the env elope with 'APPLICATION FOR PAN - Acknowledgment Number' (e.g. 'APPLICATION FOR PAN - 881010100000973'). 6. Send the documents as specif ied in point no. 4 abov e to Income Tax PAN Services Unit, National Securities Depository Limited, 3rd floor, Sapphire Chambers, Near Baner Telephone Exchange, Baner Pune -411045 Tel: 020-27218080; Fax: 020-27218081. 7. Y our acknowledgment, Demand Draf t if any , and proof s, should reach NSDL within 15 day s f rom the date of online application. 8. Application will be processed only on receipt of relev ant proof s and realisation of pay ment. 9. PAN card will be despatched only to the communication address prov ided in y our PAN application. Wherev er the Representativ e Assessee (RA)