v/

A S T H A
A N A N D

A S T H A A N A N D

v/

v/

2 1 0 9 1 9 9 7

A N A N D
V I J A Y
K U M A R

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8 1 4

1 0 , D U G R I R O A D

L U D H I A N A

PUNJAB 1 4 1 0 1 3 INDIA
8 Address for Communication v/ Residence Office (Please tick as applicable)

9 Telephone Number & Email ID details

Country code Area/STD Code Telephone / Mobile number
9 1 9 9 1 4 4 5 5 6 5 8
Email ID asthanand77@gmail.com
10 Status of applicant
Please select status, P as applicable Government

v/ Individual Hindu undivided family Company Partnership Firm Association of Persons

Trusts Body of Individuals Local Authority Artificial Juridical Persons Limited Liability Partnership
11 Registration Number (for company, firms, LLPs etc.)

12 In Case of a person, who is required to quote Aadhaar number/The Enrolment ID of Aadhaar application form as per section 139AA
Please mention your AADHAAR number (if allotted)
If AADHAAR number is not allotted, please mention the enrolment ID of Aadhaar application form

Name as per AADHAAR letter/card or as per the Enrolment ID of Aadhaar application form

13 Source of Income Please select, as applicable

Salary Capital Gains

v/ Income from Business / Profession Business/Profession code 2 0 [For Code: Refer instructions] Income from Other sources

Income from House property No income

14 Representative Assessee (RA)

Full name, address of the Representative Assessee, who is assessible under the Income Tax Act in respect of the person, whose particulars have
been given in the column 1-13.

Full Name (Full expanded name : initials are not permitted)

Please select title, as applicable Shri Smt. Kumari M/s

Last Name / Surname

First Name
Middle Name
Address
Flat / Room / Door / Block No.
Name of Premises / Building / Village
Road / Street / Lane/Post Office
Area / Locality / Taluka/ Sub- Division
Town / City / District
State / Union Territory Pincode

15 Documents submitted as Proof of Identity (POI), Proof of Address (POA) and Proof of Date of Birth (DOB)

I/We have enclosed Copy of aadhaar card as proof of identity, Copy of aadhaar card

as proof of address and Copy of AADHAAR Card as proof of date of birth.

[Please refer to the instructions (as specified in Rule 114 of I.T. Rules, 1962) for list of mandatory certified documents to be submitted as applicable]
[Annexure A, Annexure B & Annexure C are to be used wherever applicable]

16 I/We ASTHA ANAND , 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.

Place : LUDHIANA

D D M M Y Y Y Y
Date :
Signature of Applicant (Inside the Box)
7408227067
 INSTRUCTIONS
Please refer the following steps after Application Form is downloaded and printed.
1. Once the Application Form is downloaded you should print the same, attach your
recent, coloured Passport size (3.5cm X 2.5cm) photographs on the prescribed boxes
in the form.

Kindly Sign Across the ‘Left’ photograph (signature should not be done on the face).
Sign beneath the ‘Right’ Photograph in the box provided.

2. If the applicant is unable to sign and choose to put a thumb impression, then the same
should be attested by Notary on the form. Make sure that Thumb impression or
Notary stamp should not be on the right photograph.

3. Once the form is duly signed and photograph is attached on the form, it should be sent
along with self-attested document proofs for Identity, Address and Date of Birth by
Courier/Speed post to the mentioned address i.e.

The Manager,
PANIND Services Unit,
No. 5, Site 4, Vikaspuri,
New Delhi-110018
India

4. The PAN Application process would start once we receive the duly signed form along
with all the document proofs.

5. You would be intimated by an email your Coupon/Ack number after receiving the
signed application form along with ID Proof, DOB Proof and Address Proof.