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Permanant Account Number

 

Form for request for New PAN card or/and changes or correction in PAN data:-

Such request should be given in following Form (This form is not prescribed under any law):-

 

 

Only ‘Individuals’ to affix recent photograph (3.5 cm × 2.5 cm)

Signature/Left Thumb Impression

 

 

Request For New PAN Card Or / And Changes Or Correction in PAN Data

 

Permanent Account Number (PAN)

 

Please read Instructions ‘f’ & ‘g’ for selecting boxes on left margin of this form.

 1 Name

Please Tick  as applicable   Shri  Smt.  Kumari  M/s

Last Name / Surname                                            First Name

Middle Name

Name as you would like it printed on the card

 

 2. Father's Name (Only 'Individual' applicants : Even married women should give father's name only)

Last Name / Surname                                            First Name

Middle Name

 

 3. Date of Birth / Incorporation / Agreement / Partnership or Trust Deed / Formation of Body of Individuals/ Associastions of Persons     
                                                                                             D D  M M Y Y Y Y
  4. Sex (for individual applicant only) Male   Female
  5.  Photo mismatch
  6.  Signature mismatch

    7.  Address For Communication Please indicate if this is Residence      or
           Office     

Office Name (to be filled only in case of office address)

Flat/Door/Block No.

Name of Premises / Building / Village

Road / Street / Lane / Post Office

Area / Locality / Taluka / Sub – Division

Town / City / District                                     State / Union Territory     Pin

(Indicating PIN is mandatory)

  8. If you desire to update your other address also, give required details in additional sheet.

                     STD Code      Tel. No.

9. Tel. No.         email ID

10. Mention other Permanent Account Numbers (PANs) inadvertently allotted to you

PAN 1

PAN 2

PAN 3

PAN 4

I , _______________________________________________ the applicant, do hereby declare that what is stated above is true to the best of my information and belief. I have enclosed _______ (number of documents) in support of proposed changes/ corrections.

 

Verified today, the     
                               D D  M M Y Y Y Y

Signature / Left Thumb Impression of

Applicant (inside the box)

 

Acknowledgment
Received with thanks from Shri/ Smt./ Kum./ M/s _______________________________
CSF Number                                                                          _______________________________
PAN Number                                                                          _______________________________
PAN Service Centre Code                                       _______________________________
PAN Service Centre Name                                                  _______________________________
Enclosures :                                      1                        _______________________________
2                        _______________________________
3                        _______________________________
4                        _______________________________