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Affix recent

photograph

(3.5cm x 2.5cm)

Affix recent

photograph

(3.5cm x 2.5cm)

Signature/ Left Thumb

Impression across this

 photo

ACKNOWLEDGEMENT NUMBER:

Citizen of India

Category

Name to be

printed on card

Father's Name

Name

Office Address

Address for

Communication

Residential

Address

Date of Birth

Telephone No.

AADHAAR No.

Email ID

Y

Individual

Shri GHULAM ABDUL QUADIR

GHULAM ABDUL QUADIR

Shri MOHAMMAD GHULAM SUBHANI

15-12-1995

5

PHARYANI

KHO KHA

SRINAGAR

PURNEA - 854301

Bihar

881020125360244

MAIL.QUADIR@GMAIL.COM

91 8146053586

RESIDENTIAL

Payment Mode

Credit Card: Your Payment of  ̀105 against transaction number 400-1555511 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 AADHAR Card issued by the Unique Identification Authority of India

Copy of AADHAR Card issued by the Unique Identification Authority of India

10-09-2014

Signature/ Left Thumb Impression of Applicant

(inside the box without touching the sides and in BLACK INK ONLY)

Service Tax Code (Registration Number): AAACN2082NST001

Service Tax Registration Category: BUSINESS AUXILIARY SERVICES

I/We, GHULAM ABDUL QUADIR 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 Birth certificate issued by the Municipal Authority or any office authorised to issue Birth and Death Certificate by the Registrar of 

Birth and Deaths or the Indian Consulate

CIN U72900MH1995PLC095642

(PLEASE READ INSTRUCTIONS GIVEN ON NEXT PAGE)

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

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nstructions:

The acknowledgement number above is your unique reference number for PAN application. Kindly quote this number for tracking

the 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

Communication

Amount payable

( )Mode of payment

1 Indian 105Credit card / Debit card/ Net Banking / Demand Draft (DD) payable at Mumbai/Cheque to be

deposited in any HDFC bank branch across the country (except Dahej).

2 Foreign 971 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 provided

without touching the sides and in BLACK INK only) and enclose a Demand Draft (DD), if any, alongwith Proof of Identity, Proof 

of 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 the

Representative Assessee (RA) details ( item no.14 in Form 49A ) are mentioned in the application, PAN card will be dispatched to

the RA's address.

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