AcKNowLf,DcEMENT NUMBER: n-

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Form No. 49A

ApplicatioD for Allotment ofPermanent Account Number
Un th case ofltrdian Citizens/hdial CompanieyEtrtities incorporatd in India,/
Unincorporated entities formd in Indial
U.d. sr.lion l39A of the ltrcone Td rct, 196l
Io Noid ni*rke (r), ple.s folow tbe tuconptuying i$truc$ons ..d eirnptB bfon nning up $e form

(AO code)

q-s/ A\s 6S{'d

Sir, UWe hereby request that r permanent account numbea be ellotted to me/us,

I/We give below lece.esary

Pleese selct

title, as applicable

Last Naine./Sumame

SDKH

First Name

HAZRAT

shri Ll smt. E

Kumari

Kumari

M/s

Middle Name

flvesExo
D Shri n

tf yen plers give th.t otlr.r Mme

Plese slect title, rs Nppllcable
Last Name/Sumame
First Name

Middle Name

Last Name/Sumame

First Nam

A}ZAL

Lasr Nam/Sumame

First Name
Middl Name

Psrentnrmewhich k to

be pdnted on the

cffd p

Father,s name

Residence Address
Flal / Room / Door/ Block No.
Name of Premises / Building

/Village

IUNUS ALI PADA

NAJIRPT'R

Road / Strt / Lan/Post Office

SUJA?UR

Area / Locality / Taluka/ Sub-

KALIACIIAK

Town/City/District

MALT'A -

State / Union Tefiitory

West Bengsl

Name of

offce

Flat/ Room / Door / Block No.

Nama of Prmiss / Building / Village

Road / Street / Lane/Post Offce

Area / Loclity / Taluka/ Sub- Division

TJZZOO

Smt.

NI/S

Town/City/District
Stat / Ljnion

Tenitory

pincod

/Zp

code

Counlry Name

Country codo

Email lD

fl
E

E
E

Hindu undivided ramity

Body of Individuats

saury

lncoms from Businss

lncome from House property

Business/profession

Full narno, address of the Reprosentative Assessee, who is assessibto

pafticulals have ben given jn the column 1-13.

Association of Persons
Limitd Liabitity partnership

Capitalcains

l]

lncome from Other sourcas

No incorne

urxieffi;;"p""ffih;;ffiffiffiS

Full Name (Full expanded name : initr'als are not permitted)

n Shri tr Smt n

Kumari

tr

M/s

Flat / Room / Door / Block No.

Nam of Premis6s / Building

Road / Street / Lane/Post Offc

Area / Locality / Taluka/ SuF Division

Town/City/District
Stat / Union Tnitory

Copy of AADHAAR

as proof of addrss and

Crrd

Copy of Elcao.'s photo idntity

issued by the-Unique

of Blrth certi8c.te bsued by the

c.rd

as proof of dato ot birth.

lPleaserefertotheinstru"torycrtifeddocUmentstobe8ubmittedas|
lAnnexurc A, Annexure B & Annexur C are to be used wherever applicabl]
tho applicant, in the cpacity

ot

do hereby declar that what is stated above is bue to the bst ot my/our information and belief.

Chrmrgrrm
DD MM YYYY

R-s/

t:

0247:2016
signafife /

Lefr Thumb lmprssdon

Appllca (nside

the box)

of

-i-"

:;,

To

o aotd_s (ilt
5 HAJRAT SK
;' SUJAP]JR YOUNUS ALI
PARA
'' sujapur
l,4ajdah

*iI,ff:::,",*

$,/i,{flury9'gltffin

qITqIi qEIi qr?firlyour

ffi

Aadhaar No.

8206 2126 9088

qFfR
- rytfrn"r

I
u

HAJRAT SK

fi-o , qr.qlq ffir

r-athef
:

Atat SK

3t'{ !]q/tyear

ryT{tiT

of Birth : 1989

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