881020132449461

Affix recentphotograph(3.5cm x 2.5cm)

Affix recentphotograph(3.5cm x 2.5cm)

Signature/ Left ThumbImpression across this photo

ACKNOWLEDGEMENT NUMBER:

Citizen of India

Category

Name to beprinted on card

Father's Name

Name

Office Address

Address forCommunication

ResidentialAddress

Date of Birth

Telephone No.

AADHAAR No.

Email ID

Y

Individual

Shri RANJITH VENKATACHALA

RANJITH VENKATACHALA

Shri VENKATACHALA GUDATHIMMIAH

04-09-1989

6677TH MAIN 11TH CROSSBEL LAYOUT 1ST STAGEBANGALORE - 560091Karnataka

EAST WEST POLYTECHNICSY67ANJANAGARBEL LAYOUTBANGALORE - 560091Karnataka

881020132449461

[email protected] 9483232345

RESIDENTIAL

Payment Mode

Credit Card: Your Payment of ` 106 against transaction number 400-2224875 has been successfully processed.

The following documents are enclosed as:Proof of Identity:

Proof of Address:

Proof of Identity of representative assessee:

Proof of Address of representative assessee:

Any other document:

Date:

Copy of Elector's photo identity card

Copy of Elector's photo identity card

23-06-2015

Signature/ Left Thumb Impression of Applicant(inside the box without touching the sides and in BLACK INK ONLY)

Service Tax Code (Registration Number): AAACN2082NST001Service Tax Registration Category: BUSINESS AUXILIARY SERVICES

I/We, Ranjith.v the applicant, do hereby declare that what is stated above is true to the best of my/our information and belief.

Proof of Date of birth: Copy of Matriculation certificate

CIN U72900MH1995PLC095642

(PLEASE READ INSTRUCTIONS GIVEN ON NEXT PAGE)

Acknowledgement for request for new PAN card (Form 49A)

Instructions:

The acknowledgement number above is your unique reference number for PAN application. Kindly quote this number for trackingthe status of your PAN application on https://tin-nsdl.com or any queries relating thereto.

Save and print this acknowledgement.

Application fee and mode of payment: Payment favouring 'NSDL-PAN' can be made as follows:Sr. No. Address for

CommunicationAmount payable

( ) Mode of payment

1 Indian 106 Credit card / Debit card/ Net Banking / Demand Draft (DD) payable at Mumbai/Cheque to bedeposited in any HDFC bank branch across the country (except Dahej).2 Foreign 985 Credit card / Debit card / Demand Draft (DD) payable at Mumbai

Please mention name of applicant and acknowledgement number on the reverse of cheque/DD.

Individual applicants affix your recent colour photograph (3.5 cm x 2.5 cm), sign the acknowledgement (inside the box providedwithout touching the sides and in BLACK INK only) and enclose a Demand Draft (DD), if any, alongwith Proof of Identity, Proofof Address and Proof of Date of Birth as specified in the application form.

Superscribe the envelope with 'APPLICATION FOR PAN - Acknowledgement Number' (e.g. 'APPLICATION FOR PAN -881010100000973').Send the documents as specified in point no. 4 above to Income Tax PAN Services Unit, NSDL e-Governance InfrastructureLimited, 5th floor, Mantri Sterling, Plot No. 341, Survey No. 997/8, Model Colony, Near Deep Bungalow Chowk, Pune -411016 Tel: 020-27218080; Fax: 020-27218081.

Your acknowledgement, Demand Draft if any, and proofs, should reach NSDL within 15 days from the date of online application.

Application will be processed only on receipt of relevant proofs and realisation of payment.

PAN card will be dispatched only to the communication address provided in your PAN application. Wherever theRepresentative Assessee (RA) details ( item no.14 in Form 49A ) are mentioned in the application, PAN card will be dispatched tothe RA's address.

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881020132449461

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