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AUTO FILLUP - PAN APPLICATION FORM 49A

- STATUS 1 - - STATUS 2 - - SEX -


Mr. INDIVIDUAL MALE

- NAME -
First Middle Last
VISHAL RAVINDRA PATIL

- PRINT NAME ON PAN CARD -


VISHAL RAVINDRA PATIL

- RESIDENCE ADDRESS -
Flat/Door/Block No.
10.00
Name of Premises / Building / Village
SIRADHON
Road / Street / Lane / Post Office
SIRADHON
Area / Locality / Taluka / Sub - Division
MALKAPUR
Town / City / District
BULDANA
State / Union Territory PIN
MAHARASHTRA 443102

- COMPANY REGISTRATION NUMBER -

- CORRES. ADDRESS - - CITIZEN - - eMail -


Residence INDIAN VISHAL_PATIL@ICAI.ORG

- CONTACT US -
email - Qvisitor@gmail.com
web - www.GrowShine.com
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- FATHER NAME -
First Middle Last
RAVINDRA SADASHIV PATIL
''''''''''''''''''''''''''' '''''''''''''''''''''''''''
- DATE OF BIRTH / INCORPORATION - (DD - MM - YY) ''''''''''''''''''''''''''' '''''''''''''''''''''''''''
01 10 1986 ''''''''''''''''''''''''''' '''''''''''''''''''''''''''
''''''''''''''''''''''''''' '''''''''''''''''''''''''''
- OFFICE ADDRESS - ''''''''''''''''''''''''''' '''''''''''''''''''''''''''
Flat/Door/Block No.

Name of Premises / Building / Village

Road / Street / Lane / Post Office

Area / Locality / Taluka / Sub - Division

Town / City / District

State / Union Territory PIN

- CONTACT NUMBER -
9372937016

- APPLICANT NAME -
VISHAL RAVINDRA PATIL

ONTACT US -
visitor@gmail.com
w.GrowShine.com
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Form No. 49A
Application for Allotment of Permanent Account Number

Under Section 139A of the Income Tax Act, 1961


(To avoid mistake(s), please follow the accompanying instructions and examples carefully before filling up the form)
To Area AO Range AO PHOTO
The Assessing Officer Code Type Code No.
Ward / Circle
Range
Commissioner
Sir,
I/We hereby request that a permanent account number be allotted to me/us.
I/We give below necessary particulars : X
1. Full Name (Full expanded name : initials are not permitted) Signature/Left Thumb
Please Tick ✘ As Applicable Shri b Smt. Kumari M/s Impression
Last Name / Surname First Name
P A T I L V I S H A L
Middle Name
R A V I N D R A

2. Name you would like printed on the card V I S H A L R A V I N D R A P A T I L


3. Have you ever been known by any other name ? Please
✘ asTick
applicable Yes No a
If yes, please give that other name
(Full expanded name : initials are not permitted) Shri Smt. Kumari M/s
Last Name / Surname First Name

Middle Name

4. Father’s Name (Only ‘Individual’ applicants : Even married women should give father’s name only)
Last Name / Surname First Name
P A T I L R A V I N D R A
Middle Name
S A D A S H I V
5. Address
R.R.Residential
ResidentialAddress
Address
Flat/Door/Block No.
1 0
Name of Premises / Building / Village
S I R A D H O N
Road / Street / Lane / Post Office
S I R A D H O N
Area / Locality / Taluka / Sub - Division
M A L K A P U R
Town / City / District State / Union Territory Pin
B U L D A N A MAHARASHTRA 4 4 3 1 0 2
O. Office Address (Name of Office) (Indicating PIN is mandatory)

Flat/Door/Block No.

Name of Premises / Building / Village

Road / Street / Lane / Post Office

Area / Locality / Taluka / Sub - Division

Town / City / District State / Union Territory


-
(Indicating PIN is mandatory)

6. Address for communication Please Tick


✘ as applicable R or O
[www.GrowShine.com]
STD Code Tel. No.
7. Tel. No. 9 3 7 2 9 3 7 0 1 6

email ID VISHAL_PATIL@ICAI.ORG

8. Sex (For ‘Individual’ Applicants only) Please Tick ✘ as applicable Male a Female

9. Status of the Applicant Please Tick ✘ as applicable

Individual P a Firm F Body of Individuals B

Hindu Undivided Family H Association of Persons A Local Authority L

Company C Association of Persons (Trusts) T Artificial Juridical Person J

10. Date of Birth / Incorporation / Agreement / Partnership or Trust Deed / Formation of Body 0 1 - 1 0 - 1 9 8 6
D D M M Y Y Y Y

11. Registration Number (In case of Firms, Companies etc.) -

12. Whether citizen of India Please Tick ✘ as applicable Yes a No

13. (a) Are you a salaried employee? If yes, indicate Government Others

Name of the Organisation where working #REF!

(b) If you are engaged in a business / profession, indicate nature of business or profession and fill the relevant code

(c) If you are not covered by (a) or (b) above, indicate sources of income, if any

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 column 1 to 13.

Full Name (Full expanded name : initials are not permitted) Please tick as applicable Shri Smt. Kumari M/s

Last Name / Surname First Name

Middle Name

Address
Flat/Door/Block No.

Name of Premises / Building / Village

Road / Street / Lane / Post Office

Area / Locality / Taluka / Sub - Division

Town / City / District State / Union Territory Pin

PASSPORT PASSPORT (Indicating PIN is mandatory)


15. I/We have enclosed as proof of identity and as
proof of address. TRUST DEED TRUST DEED
PARTNERSHIP DEED PARTNERSHIP DEED
I/We VISHAL RAVINDRA PATIL , the applicant, do hereby declare that
what is stated above is true to the best of my / our information and belief. S
RATION CARD K RATION CARD
BANK PASS BOOK XEROX BANK PASS BOOK XEROX
VOTING CARD VOTING CARD

Verified today, the X


D D M M Y Y Y Y
Signature / Left Thumb Impression of
Applicant (inside the box)

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