Acknowledgement for Request for New PAN Card or/and Changes or Correction in PAN Data

ACKNOWLEDGEMENT NUMBER:

Affix recent
photograph
(3.5cm x 2.5cm)

Signature/ Left Thumb

Impression across this
photo

881020214808053

Category

Individual

Permanent
Account No.

BXVPS8815C

Name

Smt. SUPRIYA ABHISHEK DUDWADKAR

Affix recent
photograph
(3.5cm x 2.5cm)

Name to be
SUPRIYA ABHISHEK DUDWADKAR
printed on card
Father's Name

Shri SADANAND SHRIPAT SAKPAL

Date of Birth

19-04-1988

Address for
ROOM NO.B/7, PLOT NO.86
Communication SAI CHHAYA CHSL
NEAR BEST QUATERS
GORAI (I), BORIVALI (WEST
MUMBAI - 400092
Maharashtra
Other Address
Telephone No. 91 9833585057
Email ID

SUPRIYA_SAKPAL88@YAHOO.CO.IN

AADHAAR No. 633764622579

Photo Mismatch

Signature Mismatch

Request for cancellation of PAN(s)

PAN1:
PAN2:

Sex
PAN3:

PAN4:

Payment Mode

Credit Card: Your Payment of ` 105 against transaction number 401-1061289 has been successfully processed.

I/We, MRS.SUPRIYA ABHISHEK DUDWADKAR 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 AADHAR Card issued by the Unique Identification Authority of India
Proof of Address: Copy of landline telephone bill
Proof of Date of birth: Copy of Marriage certificate issued by Registrar of Marriages
Proof of PAN: Copy of PAN card
Proof of PAN to be cancelled:

Any other document:

Date: 09-09-2014

Service Tax Code (Registration Number): AAACN2082NST001

Service Tax Registration Category: BUSINESS AUXILIARY SERVICES
CIN U72900MH1995PLC095642

(PLEASE READ INSTRUCTIONS GIVEN ON NEXT PAGE)

Signature/ Left Thumb Impression of Applicant

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

Instructions:
1 The above-mentioned 15-digit acknowledgement number is a unique reference number for your application for 'Request for New
PAN Card or/and Changes or Correction in PAN Data'. Kindly quote this number for tracking the status of your application on
https://tin-nsdl.com or any queries relating thereto.
2 Save and print this acknowledgement.
3 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

Indian

105

Credit card / Debit card/ Net Banking / Demand Draft (DD) payable at
Mumbai/Cheque to be deposited in any HDFC bank branch across the country

Foreign

971

Credit card / Debit card / DD payable at Mumbai

Please mention name of applicant and acknowledgement number on the reverse of cheque/DD.
4 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 - Indian citizens only) as specified in the application form.
5 Superscribe the envelope with 'APPLICATION FOR PAN - Acknowledgement Number' (e.g. 'APPLICATION FOR PAN 881010100000973').
6 Send the documents as specified in point no. 4 above 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 Your acknowledgement, Demand Draft if any, and proofs, should reach NSDL within 15 days from the date of online application.
8 Application will be processed only on receipt of relevant proofs and realisation of payment.
9 Applications without proof of PAN will be processed on a good effort basis - (as mentioned in guidelines).