Form 49A Application for Allotment of Permanent Account Number

[In the case of Indian Citizens/Indian Companies/Entities incorporated in India/

Unincorporated entities formed in India]
Under section 139A of the Income Tax Act, 1961
Print
Application/Coupon No.: N000220464
Assessing Officer(AO Code)
Area Code AO Type Range Code AO No

1. Full Name (Full expanded name: initials are not permitted):
Title:- Shri Last Name:- VELSUNDARAM First Name:- KARTHEESAN
Middle Name:-

2. Abbreviation of the above name, as you would like it, to be printed on the PAN card:- KARTHEESAN
VELSUNDARAM
3. Have you been known by any other name? No
N/A Last Name:- N/A Middle Name:- N/A
First Name:-
N/A
4. Gender:- Male
5.Date of Birth / Incorporation/Agreement/Partnership or Trust Deed/Formation of Body of
Individuals/Association of Persons:-
04/05/1981
6. Father's Name :
Last Name:- THANGADURAI Middle Name:- N/A First Name:- VELSUNDARAM
7. Address:-
Residential Address:-
Flat/Door/Block No.:- 14/19
Name of Premises/Building/Village:- NADUVAIKURICHI
Road/Street/Lane/Post Office:- TEMPLE STREET
Area/Locality/Taluka/Sub-Division:- SATHANKULAM
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Town/City/District:-
THOOTHUKUDI
State/Union Territory:-
TAMILNADU
PIN Code:-
628653
Country:- INDIA
Official Address:-
Office Name:-
KANOO TERMINAL SERVICES
LTD
Flat/Door/Block No.:- PO 20375
Name of Premises/Building/Village:- PORT AREA
Road/Street/Lane/Post Office:- PORT STREET
Area/Locality/Taluka/Sub-Division:- PORT AREA
Town/City/District:- JEDDAH State/Union Territory:- OTHER
PIN Code:-
21455
Country:- SAUDI ARABIA
8. Address for Communication:- Office
9. Telephone Number & Email ID Details :-
Country
Code:-
966
Area/STD
Code:-
966
Telephone/Mobile
Number:-
558755540
Email
Address:-
V_KARTHEESAN@YAHOO.CO.IN
10. Status of the Applicant:- Individual
11. Registration Number(for
Company,firms,LLP's etc):-
N/A
12. Please Mention your
AADHAAR Number(if allotted) :-
N/A
13.Source of Income
SALARIED Capital Gains
Income from Business/Profession Business/Profession code:- N/A Income from Other sources
Income from House property No income
14. Full Name, address of the Representative Assessee, who is assessable under the Income Tax Act in respect of the
person, whose particulars have been given in colmns 1 to 13.
N/A Last Name:- N/A Middle Name:- N/A First Name:- N/A
Flat/Door/Block No.:- N/A
Name of Premises/Building/Village:- N/A
Road/Street/Lane/Post Office:- N/A
Area/Locality/Taluka/Sub-Division:- N/A
Town/City/District:- N/A State/Union Territory:- N/A PIN Code:- N/A
15. I/We have enclosed PASSPORT as Proof of Identity , PASSPORT as Proof of
Address and PASSPORT as DOB Proof.
16. I/We KARTHEESAN VELSUNDARAM ,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 Date
Signature/Left thumb
impression of the
applicant
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