FormNo.

49A ApplicationforAllotmentofPermanentAccountNumber [InthecaseofIndianCitizens/IndianCompanies/EntitiesincorporatedinIndia/ UnincorporatedentitiesformedinIndia]

Undersection139AoftheIncomeTaxAct,1961
Toavoidmistake(s),pleasefollowtheaccompanyinginstructionsandexamplesbeforefillinguptheform

Assessingofficer(AOcode)
Sign/leftTumbimpressionacross thisphoto

Areacode

AOtype

Rangecode

AONo.

Sir, I/Weherebyrequestthatapermanentaccountnumberbeallottedtome/us. I/Wegivebelownecessaryparticulars:

1 FullName(Fullexpandednametobementionedasappearinginproofofidentity/addressdocuments:initialsarenotpermitted)
Pleaseselecttitle, asapplicable

Shri

Smt.

Kumari

M/s

LastName/Surname FirstName MiddleName

2 Abbreviationoftheabovename,asyouwouldlikeit,tobeprintedonthePANcard

3 Haveyoueverbeenknownbyanyothername?
Ifyes,pleasegivethatothername
Pleaseselecttitle, asapplicable

Yes

No

(Pleasetickasapplicable)

Shri

Smt.

Kumari

M/s

LastName/Surname FirstName MiddleName

4 Gender(forIndividualapplicantsonly)

Male

Female

(Pleasetickasapplicable)

5 DateofBirth/Incorporation/Agreement/PartnershiporTrustDeed/FormationofBodyofindividualsorAssociationofPersons
Day Month Year

6 Father'sName(Only'Individual'applicants:Evenmarriedwomenshouldfillinfather'snameonly)
LastName/Surname FirstName MiddleName

7 Address ResidenceAddress
Flat/Room/Door/BlockNo. NameofPremises/Building/Village Road/Street/Lane/PostOffice Area/Locality/Taluka/SubDivision Town/City/District State/UnionTerritory Pincode/Zipcode CountryName

OfficeAddress Nameofoffice
Flat/Room/Door/BlockNo. NameofPremises/Building/Village Road/Street/Lane/PostOffice Area/Locality/Taluka/SubDivision Town/City/District

State/UnionTerritory

Pincode/Zipcode Residence

CountryName Office
(Pleasetickasapplicable)

8 AddressforCommunication 9 TelephoneNumber&EmailIDdetails
Countrycode Area/STDCode

Telephone/Mobilenumber

EmailID

10 Statusofapplicant
Pleaseselectstatus, Individual Trusts asapplicable Hinduundividedfamily BodyofIndividuals Company LocalAuthority PartnershipFirm ArtificialJuridicalPersons Government AssociationofPersons LimitedLiabilityPartnership

11 RegistrationNumber(forcompany,firms,LLPs,etc.) 12 IncaseofacitizenofIndia,then
PleasementionyourAADHAARnumber(ifallotted)

13 SourceofIncome
Salary IncomefromBusiness/Profession IncomefromHouseproperty Business/Professioncode
[ForCode:Referinstructions]

Pleaseselectstatus, CapitalGains

asapplicable

IncomefromOthersources Noincome

14 RepresentativeAssessee(RA)
Fullname,addressoftheRepresentativeAssessee,whoisassessableundertheIncomeTaxActinrespectoftheperson,whoseparticularshavebeengiveninthe column113.

FullName(Fullexpandedname:initialsarenotpermitted)
Pleaseselecttitle, asapplicable

Shri

Smt.

Kumari

M/s

LastName/Surname FirstName MiddleName Address Flat/Room/Door/BlockNo. NameofPremises/Building/Village Road/Street/Lane/PostOffice Area/Locality/Taluka/SubDivision Town/City/District State/UnionTerritory Pincode

15 DocumentssubmittedasProofofIdentity(POI)andProofofAddress(POA)
I/Wehaveenclosed asproofofaddress. [Pleaserefertotheinstructions(asspecifiedinRule114ofI.T.Rules,1962)forlistofmandatorycertifieddocumentstobesubmittedasapplicable] asproofofidentityand

16 I/We doherebydeclarethatwhatisstatedaboveis

,theapplicant,inthecapacityof truetothebestofmy/ourinformationandbelief.

Place D Date D M M Y Y Y Y Signature/LeftThumbImpressionof Signature / Left Thumb Impression of Applicant(insidethebox)