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Request For New PAN Card Or/ And Changes Or Correction In PAN Data

     Permanent Account Number (PAN)
                                                                                                                                 Only 'Individuals'
                                                                                                                                  to affix recent
                                                                                                                                 photograph (3.5
                                                                                                                                   cm x 2.5 cm)
            Please read Instructions 'g' and 'h' for Red Coloured boxes on left margion of this form.




1        Name
                                                                                                                                Signature/ Left Thumb
     Please Tick         as applicable                  Shri         Smt.     Kumari         M/s                                     Impression
         Last Name / Surname                                                                                       First Name


                                                               Middle Name



    Name as you would like it printed on the Card
2        Father's Name (Only 'Individual' applicants : Even married women should give father's name only)
         Last Name / Surname                                                                            First Name


                                                               Middle Name


     Date of Birth / Incorporation / Agreement / Partnership or Trust Deed / Formation
3
     of Body of Individuals/ Associastions of Persons                                                          D      D   M M       Y Y     Y   Y
4        Sex (for individual applicant only)     Male             Female

5        Photo Mismatch

6        Signature Mismatch

7        Address For Communication             Please indicate if this is Residence                or Office
     Office Name (to be filled only in case of office address)


     Flat/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


8 If you desire to update your other address also, give required details in additional sheet.                                      (Indicating PIN is mandatory)
                     STD Code               Tel. No.

9        Tel. No.                                                                      email ID

10        Mention other Permanent Account Numbers (PANs) inadvertently allotted to you

              PAN 1                                                   PAN 3
              PAN 2                                                   PAN 4


     I                                                                                 , the applicant, do hereby declare that what is stated above is

     true to the best of my information and belief. I have enclosed             (number of documents) in support of proposed changes/ corrections.




    Verified today, the                                                                                   Signature/ Left Thumb Impression of
                              D   D      M M     Y Y       Y     Y                                             Applicant (inside the box)


                                                                        Acknowledgment
     Received with thanks from Shri/ Smt./ Kum./ M/s

     CSF Number

     PAN Number

     PAN Service Centre Code

     PAN Service Centre Name

     Enclosures :
                                                       1

                                                       2

                                                       3

                                                       4

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Pan card duplicate 1

  • 1. Request For New PAN Card Or/ And Changes Or Correction In PAN Data Permanent Account Number (PAN) Only 'Individuals' to affix recent photograph (3.5 cm x 2.5 cm) Please read Instructions 'g' and 'h' for Red Coloured boxes on left margion of this form. 1 Name Signature/ Left Thumb Please Tick as applicable Shri Smt. Kumari M/s Impression Last Name / Surname First Name Middle Name Name as you would like it printed on the Card 2 Father's Name (Only 'Individual' applicants : Even married women should give father's name only) Last Name / Surname First Name Middle Name Date of Birth / Incorporation / Agreement / Partnership or Trust Deed / Formation 3 of Body of Individuals/ Associastions of Persons D D M M Y Y Y Y 4 Sex (for individual applicant only) Male Female 5 Photo Mismatch 6 Signature Mismatch 7 Address For Communication Please indicate if this is Residence or Office Office Name (to be filled only in case of office address) Flat/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 8 If you desire to update your other address also, give required details in additional sheet. (Indicating PIN is mandatory) STD Code Tel. No. 9 Tel. No. email ID 10 Mention other Permanent Account Numbers (PANs) inadvertently allotted to you PAN 1 PAN 3 PAN 2 PAN 4 I , the applicant, do hereby declare that what is stated above is true to the best of my information and belief. I have enclosed (number of documents) in support of proposed changes/ corrections. Verified today, the Signature/ Left Thumb Impression of D D M M Y Y Y Y Applicant (inside the box) Acknowledgment Received with thanks from Shri/ Smt./ Kum./ M/s CSF Number PAN Number PAN Service Centre Code PAN Service Centre Name Enclosures : 1 2 3 4