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

ACKNOWLEDGEMENT NUMBER:

Category

Affix recent
photograph
(3.5cm x 2.5cm)

Permanent
Account No.
Name

881030222916841

Individual
AOZPN2162F
Shri NADELLA V SATYANARAYANA

Affix recent
photograph
(3.5cm x 2.5cm)

Name to be
NADELLA V SATYANARAYANA
printed on card
Father's Name Shri RAJA RAO
Mother's Name Smt LAXMI
Date of Birth

Signature/ Left Thumb

Impression across this
photo

N-

17-03-1986

Address for
5-3-206
Communication PAKABANDA BAZAR
KHAMMAM URBAN
KHAMMAM - 507001
Telangana
Other Address
Telephone No. 91 9985873336
Email ID
ULIKEKMM@GMAIL.COM
AADHAAR No. 890373526198
Photo Mismatch

Signature Mismatch

Request for cancellation of PAN(s)

PAN1:
PAN2:

Sex
PAN3:

PAN4:

Payment Mode

Net Banking: Your Payment of ` 107 (inclusive of service tax & SBC as applicable(#)) against transaction number 401-1830711 has been successfully processed.

I/We, NADELLA V SATYANARAYANA 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: Bank certificate in original on letter head from the branch (along with name and stamp of the issuing officer) containing duly attested photograph
and bank account number of the applicant
Proof of Address: Copy of AADHAAR Card issued by the Unique Identification Authority of India
Proof of Date of birth: Copy of Matriculation certificate
Proof of PAN: Copy of PAN card
Proof of PAN to be cancelled:

Any other document:

Date: 28-04-2016

Service Tax Code (Registration Number): AAACN2082NST001

Service Tax Registration Category: BUSINESS AUXILIARY SERVICES
CIN U72900MH1995PLC095642
(#)includes Swachh Bharat Cess @0.5% (i.e ` 0.47)
(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
( )

Indian

107

Credit card / Debit card/ Net Banking / Demand Draft (DD) payable at Mumbai.

Foreign

989

Credit card / Debit card / DD payable at Mumbai

Mode of payment

Please mention name of applicant and acknowledgement number on the reverse of 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 - N - Acknowledgement Number' (e.g. 'APPLICATION FOR PAN N - 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).