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FormNo.49A

ApplicationforAllotmentofPermanentAccountNumber

[Inthe caseofIndianCitizens/IndianCompanies/EntitiesincorporatedinIndia/

UnincorporatedentitiesformedinIndia]

Undersection139AoftheIncomeTaxAct,1961

Toavoidmistake(s),pleasefollowtheaccompanyinginstructionsandexamplesbeforefillinguptheform

Assessingofficer (AOcode)

Sir,

I/Weherebyrequestthatapermanentaccountnumberbeallottedtome/us.

I/Wegivebelownecessaryparticulars:

1 FullName(Fullexpandednametobementionedasappearinginproofofidentity/addressdocuments:initialsarenotpermitted)

Pleaseselecttitle, asapplicable Shri Smt. Kumari M/sLastName/Surname

FirstName

MiddleName

2 Abbreviationoftheabovename,asyouwouldlikeit,tobeprintedonthePANcard

3 Haveyoueverbeenknownbyanyothername? Yes No (Pleasetickasapplicable)Ifyes,pleasegivethatothername

Pleaseselecttitle, asapplicable Shri Smt. Kumari M/s

AONo.Areacode AOtype RangecodeSign/leftTumbimpressionacrossthisphoto

LastName/Surname

FirstName

MiddleName

4 Gender(forIndividualapplicantsonly) Male Female (Pleasetickasapplicable)5 DateofBirth/Incorporation/Agreement/PartnershiporTrustDeed/FormationofBodyofindividualsorAssociationofPersons

6 Father'sName(Only'Individual'applicants:Evenmarriedwomenshouldfillinfather'snameonly)

LastName/Surname

FirstName

MiddleName

7 Address

ResidenceAddress

Flat/Room/Door/BlockNo.

NameofPremises/Building/Village

Road/Street/Lane/PostOffice

Area/Locality

/Taluka/

Sub

Division

Town/City/District

State/UnionTerritory Pincode/Zipcode CountryName

OfficeAddress

Nameofoffice




Day Month Year

Area/Locality/Taluka/Sub Division

Town/City

/District

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State/UnionTerritory Pincode/Zipcode CountryName

8 AddressforCommunication Residence Office (Pleasetickasapplicable)9 TelephoneNumber&EmailIDdetails

Countrycode Area/STDCode Telephone/Mobilenumber

EmailID

10 Statusofapplicant

Pleaseselectstatus, asapplicable GovernmentIndividual Hinduundividedfamily Company PartnershipFirm AssociationofPersons

Trusts BodyofIndividuals LocalAuthority ArtificialJuridicalPersons LimitedLiabilityPartnership

11 RegistrationNumber(forcompany,firms,LLPs,etc.)

12 IncaseofacitizenofIndia,then

PleasementionyourAADHAARnumber(ifallotted)

13 SourceofIncome Pleaseselectstatus, asapplicableSalary Capital

Gains

IncomefromBusiness/Profession Business/Professioncode [ForCode:Referinstructions] IncomefromOthersources

IncomefromHouseproperty Noincome

14 RepresentativeAssessee(RA)

FullName(Fullexpandedname:initialsarenotpermitted)

Pleaseselecttitle, asapplicable Shri Smt. Kumari M/sLastName/Surname

FirstName

MiddleName

Address




Area/Locality/Taluka/Sub Division

Town/City/District

State/UnionTerritory Pincode

15 DocumentssubmittedasProofofIdentity(POI)andProofofAddress(POA)

I/Wehaveenclosed asproofofidentityand

asproofofaddress.

[Pleaserefertotheinstructions(asspecifiedinRule114ofI.T.Rules,1962)forlistofmandatorycertifieddocumentstobesubmittedasapplicable]

16 I/We ,theapplicant,inthecapacityof

do herebydeclarethatwhatisstatedaboveis truetothebestofmy/ourinformationandbelief.

Place

D D M M Y Y Y Y Si nature Left Thumb Im ression of

Fullname,addressoftheRepresentativeAssessee,whoisassessableundertheIncomeTaxActinrespectoftheperson,whoseparticularshavebeengiveninthe

column113.

Date

Applicant(insidethebox)