Area code AO type Range code AO No. Signature/Left Thumb Impression

Transcription

1 Only 'Individuals' to affix recent photograph [3.5 cm x 2.5 cm) to affix recent photograph [3.5 cm x 2.5 cm) Signature/Left Thumb Impression across the photo 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) Only 'Individuals' Area code AO type Range code AO No. Signature/Left Thumb Impression 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/Mr. Smt./Mrs. Kumari /Ms. M/s 2. Abbrevation 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 Yes No (please tick) as applicable. If yes, please give the other name Please select title, as applicable Shri/Mr. Smt./Mrs. Kumari /Ms. M/s 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) 7. Address Residence Address

2 State / Union Territory Pin code/zip code Country Name Office Address Name of office State / Union Territory Pincode/Zip code Country Name 8. Address for Communication Residence office (please tick) as applicable. 9. Telephone Number & ID details Country code Area/STD Code Telephone/Mobile number id 10 Status of applicant Please select status, as applicable Government Individual Hindu undivided Company Partnership Firm Association of family Persons Trusts Body of Individuals Local Artificial Juridical United Liability Authority Persons 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/ Business/Profession (For Code:Refer Income from Profession code Instructions) other sources Income from House property 14. Representative Assessee (RA) No income Full name, address of the Representative Assessee, who is assessible under the Income Tax Act in respect of the person, whose particulars have been given in the column Full Name (Full expanded name: initials are not permitted)

3 Please select title, as applicable Shri Smt. Kumari M/s Address State / Union Territory Pin code 15. Documents submitted as Proof of Identity (POI), Proof of Address (POA) and Proof of Date of Birth I/We have enclosed as proof of identity, as proof of address and as proof of date of birth [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] [Annexure A, Annexure B & Annexure C are to be used wherever applicable] 16. I/We, the applicant, in the capacity of do hereby declare that what is stated above is true to the best of my/our information and belief Place D D M M Y Y Y Y Signature/Left Thumb impression of Date Applicant (Inside the box)

4 Annexure -A (Certificate to be used by a Member of Parliament/Member of Legislative Assembly/Municipal Councillor or Gazetted Officer under sub-rule (4) of rule 114 of the Income-tax Rules, 1962) photograph as affixed on PAN application form appearing half on the photograph and half on the certificate) I hereby certify that I know Sh./Smt/Kum. son/daughter of...and his/her personal particulars as given below are correct to the best of my knowledge and belief. I recommend issue of PAN card by the Income-tax Department to him/her. Name Father s Name (even in case of married ladies father s name is to be provided) Date of Birth Residence Address (if applicant has resided at more than one place during last one year then all such address with dates should be mentioned) Office Address Previous Name (in case of change in name) Details of issuer of certificate Office address with location Date : Place: Full Name: Designation: Department/Organisation/Constituency: Identity card No: (Enclose a photocopy of I-card) Telephone: Mobile: Annexure -B (Certificate to be used by the employer on the letter head of the organisation/ institution under sub-rule (4) of rule 114 of the Income-tax Rules, 1962) photograph as affixed on PAN application form) appearing half on the photograph and half on the certificate) It is hereby certified that Sh./Smt/Kum. son/daughter of... is employed with us since.. He/She is presently working at the following address of the organisation:- Office Address The residential address of the applicant as verified by us is given below: Residential Address... Registration Number of the Company/Institution etc. PAN of the Company/Institution:

5 Details of the Individual issuing the certificate Full Name: Designation: PAN of the Individual: Office address with location: Telephone: Mobile: Date: Place: Annexure -C (Certificate of identification by Bank on the letter head of the bank under sub-rule (4) of rule 114 of the Income-tax Rules, 1962) photograph as affixed on PAN application form) appearing half on the photograph and half on the certificate) This is to certify that Sh./Smt/Kum son/daughter of..whose photograph is attested above is holding an account having account number.with this branch of the bank. Details of the Individual issuing the certificate Full Name: Designation: PAN of the Individual: Office address with location: Telephone: Mobile: Date: Place: