7/3/2014

Acknowledgment for request for new PAN Application (881030123895633)

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

ACKNOWLEDGMENT NUMBER:
Citizen of India
Category
Name
Name to be printed on
card
Father's Name

Affix recent
photograph
(3.5cm x 2.5cm)
Signature/Left
Thumb Impression
across this photo

Date of Birth
Residential Address

Office Address
Address for
Communication
Telephone No
Aadhaar No.
Email Id

881030123895633

Y
Indiv idual
Smt. Dev aki Koorayil Karakkadillam
Dev aki Koorayil Karakkadillam
Shri Sankaran Namboothiri Karakkadillam
Koorayil
15 - 03 - 1965
#372
Kalyana Nagara
Hiremangalore By pass Roa
Near Rural Police station
Chickmangalure - 577101
Karnataka

Affix recent
photograph
(3.5cm x 2.5cm)

Residential
91

8123132648

sudhanyakrishnan@gmail.com

Paym ent Mode

Net Banking: Your Payment of

105.00 against transaction number 400-1415827 has been successfully processed.

I/We, the applicant, do hereby declare that what is stated above is true to the best of my/our information and belief.
The following documents are enclosed as:
Proof of Identity: Copy of driv ing license
Proof of Address: Copy of electricity bill
Proof of Date of birth: Copy of Matriculation certificate
Proof of Identity of representative assessee:
Proof of Address of representative assessee:
Any other document:

Signature/Left Thumb Impression of Applicant

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

Date: 03 - 07 - 2014

Preview Application Form

Print Acknowledgment

New Application

Service Tax Code (Registration Number): AAACN2082NST001

Service Tax Registration Category: BUSINESS AUXILIARY SERVICES

Instructions:
1. The acknowledgement number abov e is y our unique ref erence number f or PAN application. Kindly quote this number f or tracking the status of y our PAN
application on http://tin-nsdl.com or any queries relating thereto.
2. Save and print this acknowledgment.
3. Application fee and mode of payment: Pay ment f av ouring 'NSDL-PAN' can be made as f ollows:
Sr.
No.

Address for
Communication

Amount payable
(
)

Indian

105

Credit card / Debit card/ Net Banking / Demand Draf t (DD) pay able at Mumbai/Cheque
to be deposited in any HDFC bank branch across the country (except Dahej).

Foreign

971

Credit card / Debit card / Demand Draf t (DD) pay able at Mumbai

Mode of payment

Please mention name of applicant and acknowledgment number on the reverse of cheque/DD.

https://tin.tin.nsdl.com/pan2/servlet/CPGClient?cpg_api=setCustomerResponse&msg=NSDLPANAP| BD0001523868| MHDF3402968543| 703143905| 00000105

1/2

7/3/2014

Acknowledgment for request for new PAN Application (881030123895633)

4. Indiv idual applicants af f ix y our recent colour photograph (3.5 cm x 2.5 cm), sign the acknowledgment (inside the box prov ided without touching the sides
and in BLACK INK only ) and enclose a DD, if any , alongwith Proof of Identity & Proof of Address as specif ied in the application f orm.
5. Superscribe the env elope with 'APPLICATION FOR PAN - Acknowledgment Number' (e.g. 'APPLICATION FOR PAN - 881010100000973').
6. Send the documents as specif ied in point no. 4 abov e to Income Tax PAN Services Unit, NSDL e-Governance Infrastructure Limited, 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.
7. Y our acknowledgment, Demand Draf t if any , and proof s, should reach NSDL within 15 day s f rom the date of online application.
8. Application will be processed only on receipt of relev ant proof s and realisation of pay ment.
9. PAN card will be despatched only to the communication address prov ided in y our PAN application. Wherev er the Representativ e Assessee (RA) details (
item no.14 in Form 49A ) are mentioned in the application, PAN card will be despatched to the RA's address.

https://tin.tin.nsdl.com/pan2/servlet/CPGClient?cpg_api=setCustomerResponse&msg=NSDLPANAP| BD0001523868| MHDF3402968543| 703143905| 00000105

2/2