You are on page 1of 2

Form No.

49A
Application for Allotment of Permanent Account Number
[In the case of Indian Citizens/lndian Companies/Entities incorporated in India/ Only
Only
‘Individuals’ Unincorporated entities formed in India] ‘Individuals’
WRDI¿[UHFHQW See Rule 114 WRDI¿[UHFHQW
SKRWRJUDSK SKRWRJUDSK
7RDYRLGPLVWDNH V SOHDVHIROORZWKHDFFRPSDQ\LQJLQVWUXFWLRQVDQGH[DPSOHVEHIRUH¿OOLQJXSWKHIRUP FP[
FP[
FP FP
$VVHVVLQJRI¿FHU $2FRGH

Area code $2W\SH Range code $21R


Sign / Left Thumb impression
across this photo

 6LU
 ,:HKHUHE\UHTXHVWWKDWDSHUPDQHQWDFFRXQWQXPEHUEHDOORWWHGWRPHXV
 ,:HJLYHEHORZQHFHVVDU\SDUWLFXODUV 6LJQDWXUH/HIW7KXPE,PSUHVVLRQ

1 )XOO1DPH )XOOH[SDQGHGQDPHWREHPHQWLRQHGDVDSSHDULQJLQSURRIRILGHQWLW\GDWHRIELUWKDGGUHVVGRFXPHQWVLQLWLDOVDUHQRWSHUPLWWHG

  3OHDVHVHOHFWWLWOH 9 DVDSSOLFDEOH 6KUL 6PW .XPDUL 0V

/DVW1DPH6XUQDPH
)LUVW1DPH
0LGGOH1DPH

 $EEUHYLDWLRQVRIWKHDERYHQDPHDV\RXZRXOGOLNHLWWREHSULQWHGRQWKH3$1FDUG

 +DYH\RXHYHUEHHQNQRZQE\DQ\RWKHUQDPH" Yes No SOHDVHWLFNDVDSSOLFDEOH


,I\HVSOHDVHJLYHWKDWRWKHUQDPH
  3OHDVHVHOHFWWLWOH 9 DVDSSOLFDEOH 6KUL 6PW .XPDUL 0V

/DVW1DPH6XUQDPH
)LUVW1DPH
0LGGOH1DPH

 *HQGHU IRU,QGLYLGXDODSSOLFDQWVRQO\ Male Female SOHDVHWLFNDVDSSOLFDEOH

 'DWHRI%LUWK,QFRUSRUDWLRQ$JUHHPHQW3DUWQHUVKLSRU7UXVW'HHG)RUPDWLRQRI%RG\RILQGLYLGXDOVRU$VVRFLDWLRQRI3HUVRQV
 'D\ 0RQWK <HDU

 'HWDLOVRI3DUHQWV DSSOLFDEOHRQO\IRULQGLYLGXDODSSOLFDQWV

  )DWKHU¶V1DPH 0DQGDWRU\(YHQPDUULHGZRPHQVKRXOG¿OOLQIDWKHU¶VQDPHRQO\

/DVW1DPH6XUQDPH
)LUVW1DPH
0LGGOH1DPH

  0RWKHU¶V1DPH RSWLRQDO

/DVW1DPH6XUQDPH
)LUVW1DPH
0LGGOH1DPH
6HOHFWWKHQDPHRIHLWKHUIDWKHURUPRWKHUZKLFK\RXPD\OLNHWREHSULQWHGRQ3$1FDUG Select one only
  ,QFDVHQRRSWLRQLVSURYLGHGWKHQ3$1FDUGZLOOEHLVVXHGZLWKIDWKHU¶VQDPH
)DWKHU¶VQDPH 0RWKHU¶VQDPH (Please tick as applicable)

7 Address
Residence Address
)ODW5RRP'RRU%ORFN1R
1DPHRI3UHPLVHV%XLOGLQJ9LOODJH
5RDG6WUHHW/DQH3RVW2I¿FH
$UHD/RFDOLW\7DOXND6XE'LYLVLRQ
7RZQ&LW\'LVWULFW
  6WDWH8QLRQ7HUULWRU\3LQFRGH=LSFRGH&RXQWU\1DPH
  2I¿FH$GGUHVV  
1DPHRIRI¿FH
)ODW5RRP'RRU%ORFN1R
1DPHRI3UHPLVHV%XLOGLQJ9LOODJH
5RDG6WUHHW/DQH3RVW2I¿FH
$UHD/RFDOLW\7DOXND6XE'LYLVLRQ
7RZQ&LW\'LVWULFW
  6WDWH8QLRQ7HUULWRU\3LQFRGH=LSFRGH&RXQWU\1DPH

8 Address for Communication Residence 2I¿FH 3OHDVHWLFNDVDSSOLFDEOH


9 Telephone Number & Email ID details
&RXQWU\FRGH $UHD67'&RGH 7HOHSKRQH0RELOHQXPEHU

  (PDLO,'
10 Status of applicant
  3OHDVHVHOHFWVWDWXV 9 DVDSSOLFDEOH *RYHUQPHQW
Individual +LQGXXQGLYLGHGIDPLO\ &RPSDQ\ 3DUWQHUVKLS)LUP $VVRFLDWLRQRI3HUVRQV
7UXVWV %RG\RI,QGLYLGXDOV /RFDO$XWKRULW\ $UWL¿FLDO-XULGLFDO3HUVRQV /LPLWHG/LDELOLW\3DUWQHUVKLS
 5HJLVWUDWLRQ1XPEHU IRUFRPSDQ\¿UPV//3VHWF

  ,QFDVHRIDSHUVRQZKRLVUHTXLUHGWRTXRWH$DGKDUQXPEHURUWKH(QUROPHQW,'RI$DGKDUDSSOLFDWLRQIRUPDVSHUVHFWLRQ$$
  3OHDVHPHQWLRQ\RXU$$'+$$5QXPEHU LIDOORWWHG 
,I$$'+$$5QXPEHULVQRWDOORWWHGSOHDVHPHQWLRQWKHHQUROPHQW,'RI$DGKDDUDSSOLFDWLRQIRUP

1DPHDVSHU$$'+$$5OHWWHURUFDUGRUDVSHUWKH(QUROPHQW,'RI$DGKDDUDSSOLFDWLRQIRUP

13 Source of Income Please select, 9 as applicable

6DODU\ &DSLWDO*DLQV
,QFRPHIURP%XVLQHVV3URIHVVLRQ %XVLQHVV3URIHVVLRQFRGH >)RU&RGH5HIHULQVWUXFWLRQV@ ,QFRPHIURP2WKHUVRXUFHV
 ,QFRPHIURP+RXVHSURSHUW\    1RLQFRPH
 5HSUHVHQWDWLYH$VVHVVHH 5$
)XOOQDPHDGGUHVVRIWKH5HSUHVHQWDWLYH$VVHVVHHZKRLVDVVHVVLEOHXQGHUWKH,QFRPH7D[$FWLQUHVSHFWRIWKHSHUVRQZKRVHSDUWLFXODUVKDYH
EHHQJLYHQLQWKHFROXPQ
)XOO1DPH )XOOH[SDQGHGQDPHLQLWLDOVDUHQRWSHUPLWWHG
  3OHDVHVHOHFWWLWOH 9 DVDSSOLFDEOH 6KUL 6PW .XPDUL 0V
/DVW1DPH6XUQDPH
)LUVW1DPH
0LGGOH1DPH
Address
)ODW5RRP'RRU%ORFN1R
1DPHRI3UHPLVHV%XLOGLQJ9LOODJH
5RDG6WUHHW/DQH3RVW2I¿FH
$UHD/RFDOLW\7DOXND6XE'LYLVLRQ
7RZQ&LW\'LVWULFW
6WDWH8QLRQ7HUULWRU\3LQFRGH

 'RFXPHQWVVXEPLWWHGDV3URRIRI,GHQWLW\ 32, 3URRIRI$GGUHVV 32$ DQG3URRIRI'DWHRI%LUWK 32% 


,:HKDYHHQFORVHG DVSURRIRILGHQWLW\
DVSURRIRIDGGUHVVDQG DVSURRIRIGDWHRIELUWK
>3OHDVHUHIHUWRWKHLQVWUXFWLRQV DVVSHFL¿HGLQ5XOHRI,75XOHV IRUOLVWRIPDQGDWRU\FHUWL¿HGGRFXPHQWVWREHVXEPLWWHGDVDSSOLFDEOH@
>$QQH[XUH$$QQH[XUH% $QQH[XUH&DUHWREHXVHGZKHUHYHUDSSOLFDEOH@
16 ,:H WKHDSSOLFDQWLQWKHFDSDFLW\RI
  GRKHUHE\GHFODUHWKDWZKDWLVVWDWHGDERYHLVWUXHWRWKHEHVWRIP\RXULQIRUPDWLRQDQGEHOLHI

3ODFH
'' M M Y Y Y Y 6LJQDWXUH/HIW7KXPE,PSUHVVLRQRI
'DWH $SSOLFDQW LQVLGHWKHER[

You might also like