ital com/panoslineservices/addPanAp) Form 49A Application for Allotment of Permanent Account Number [in the case of Indian Citizens/Indian Companies/Entities incorporated in Indial Unincorporated entities formed in india] Under section 139A of the Income Tax Act, 1961 Application Number: A006210640 Coupon Number: A006210640 [1. Full Name (Full expanded name: initials are not permitted): [Tite:- SHRI [LastName:- KESHARWANI [Middle Namei= [First Name:- ANMOL [2. Abbreviation of the above name, as you would like it, to be printed on the PAN card:- ANMOL KESHARWANI [3 Have you Beon known by any other name? N [ [Last Name: iddle Name: — [First Name:- [a Gender- IMALE [at of Birth incorpration/AgreementParinership or Trust DeedFormation of |s ye59 [Body of individuals/Association of Person Fathers ame | aetname:- KESHARWAN! [wide Name:- PRASAD frist Name:- BADR [ Momer=ame fat ame:- | name: frst Name: [The name of ether father or mother which you [yh tbe pane on a cad framers name [S/O BADRI PRASAD KESHARWA [Name of Premises/BulldingVilage:-_____ PASHCHIM SHARIRA RoadiStreetLane /Post Offi [PASHCHIM SHARIRA ‘Areal ocalty/Taluka/Sub-Division:= [MANJHANPUR Te TTown/CityDistrict-_[State/Union Tertory:= a : eanra es lpm code:- 212214 [country:- INDIA Official Address: maz Office Nam I Fiatibeorifiock Nohtps://www.myutitsl.com/pan.. [Country \Code:- ita see = SS | _eeRrem acne ERS anemantte@gnaton [10. status of the Applicant [individual |11. Registration Number(for Company, frme,LLP's et) | [12. Incase of a person, who is required to quote Aadhaar Number the [Enrolment ID of Aadhaar Application form as per section 139A Es ‘Mention your AADHAAR | jnumbertif alloted) ea j i Aadhaar number is not alloted, please |mention the enrolment ID of Aadhaar application form [Name As per AADHAAR lettericard or las per the Enrolment ID of Aadhaar —_ |ANMOL KESHARWANI lapplication form [Source ofincome SALARIED [capital Caine Tnoome from Other sourses Income from House property No income |[14. Full Name, address of the Representative Assessee, who is assessable under the Income Tax Act in respect [ofthe person, whose particulars have been given in colmns 4 = ae |FlatDooriBIock No. | Name of Premises/Building/Village: i [15. vWe have enclosed AADHAAR Card issued by UIDAI (In Copy) as Proof of identity , AADHAAR Card issued | lby UIDAI (in Copy) 2s Proof of Address and AADHAAR Card issued by UIDAI (In Copy) as Proof of DOB. | [16. We ANMOL KESHARWANI ,the applicant.in the capacity of HIMSELF/HERSELF do hereby declare that what | is stated above is true to the best of my/our information and belief. Reson Wreck Res hereon, Signature/Left thumb impression of Eien, ee the applicant