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5 cm)
Form No. 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
avoid mistake (s), please follow the accompanying instructions and examples before filling up the form
Area code
AO type
Range code
AO No.
Signature/Left Thumb Impressi on
I/We hereby request that a permanent account number be allotted to me/us. I/We give below necessary particulars:
1 Full Name (Full expanded name to be mentioned as appearing in proof of identity/address documents: initials are not permitted)
Please select title,
as applicable
Shri
Smt.
Kumari
M/s
2 Abbreviation of the above name, as you would like it, to be printed on the PAN card
Yes
No
(Pleasetick as applicable)
as applicable
Shri
Smt.
Kumari
M/s
Male
Female
6 Father's Name (Only 'Individual' applicants: Even married women should fill in father's name only)
Last Name / Surname First Name Middle Name
8 Address
for Communication
Residence
Office
Email ID
10 Status of applicant
Please select status, Individual Trusts
L D
as applicable Hindu undivided family Body of Individuals Company Local Authority Partnership Firm Artificial Juridical Persons
13 Source of income
Salary Income from Business / Profession Income from House property Business/Profession code
[For Code: Refer instructions]
as applicable
as applicable
Shri
Smt.
Kumari
M/s
Last Name / Surname First Name Middle Name Address Flat/Room/ Door / Block No. Name of Premises/ Building/ Village Road/Street/ Lane/Post Office Area / Locality / Taluka/ Sub- Division Town / City / District State / Union Territory Pincode
16 I/We
do hereby declare that what is stated above is true to the best of my/our information and belief.
Place D D M M Y Date Y Y Y
Form to be filled legibly in BLOCK LETTERS and preferably in BLACK INK. Form should be filled in English only. Each box, wherever provided, should contain only one character (alphabet /number / punctuation sign) leaving a blank box after each word. Individual' applicants should affix two recent colour photographs with white backgrounds (size 3.5 cm x 2.5 cm) in the space provided on the form. The photographs should not be stapled or clipped to the form. The clarity of image on PAN card will depend on the quality and clarity of photograph affixed on the form. d) Signature / Left hand thumb impression should be provided across the photo affixed on the left side of the form in such a manner that portion of signature/impression is on photo as well as on form e) Signature /Left hand thumb impression should be within the box provided on the right side of the form. The signature should not be on the photograph affixed on right side of the form. If there is any mark on this photograph such that it hinders the clear visibility of the face of the applicant, the application will not be accepted. f) Thumb impression, if used, should be attested by a Magistrate or a Notary Public or a Gazetted Officer under official seal and stamp. g) AO code (Area Code, AO Type, Range Code and AO Number) of the Jurisdictional Assessing Officer must be filled up by the applicant. These details can be obtained from the Income Tax Office Or IT PAN Service Centers may (managed by UTIITSL) Or UTIITSL website www.utiitsl.com h) Guidelines for filling the Form49A: a) b) c)
S S
A U
R R
D E
A S H
N P R R S V K M S
A O A A A E A A O
R O V O T N N D M
A N I
Y A
A M
Y K D U A
A A A R S
M T S A U W I N D R A M M A M K Y
X I
Y A
Z )
D P
A R
T I
A V A
C T
O E
P L
O I
R M
A I
T T
I E
O D
Pvt.
P .
P Ltd., P Ltd .
R S V
A A E
O T N Y K A A M T M K
D 0
D 2
M 0
M 8
Y 1
Y 9
Y 7
Y 5
Code 1 2 3 4 5 6 7 8 9 10
Business/Profession Medical Profession and Business Engineering Architecture Chartered Accountant/Accountancy Interior Decoration Technical Consultancy Company Secretary Legal Practitioner and Solicitors Government Contractors Insurance Agency
Code 11 12 13 14 15 16 17 18 19 20
Business/Profession Films, TV and such other entertainment Information Technology Builders and Developers Members of Stock Exchange, Share Brokers and Sub-Brokers Performing Arts and Yatra Operation of Ships, Hovercraft, Aircrafts or Helicopters Plying Taxis, Lorries, Trucks, Buses or other Commercial Vehicles Ownership of Horses or Jockeys Cinema Halls and Other Theatres Others
2. For HUF an affidavit made by the Karta of Hindu Undivided Family stating name, fathers name and address of all the coparceners on the date of application and copy of any of the above documents in the name of Karta of Huf is required.
1. Proof of Address is required for residential address mentioned in item no. 7 2. In case of an Indian Citizen residing outside India, copy of Bank Account statement in country of residence or copy of Non-resident External ( NRE ) bank account statement
or State
a. b. c.
d.
Authorized Signatory
Navi Mumbai UTI Infrastructure Technology & Services Ltd. P. B NO 20, Plot no 3, Sector-11 CBD- Belapur, Navi Mumbai- 400614 Telephone: (022) 67931300 Fax : (022) 67931399 Email ID : utiitsl.gsd@utiitsl.com
New Delhi UTI Infrastructure Technology & Services Ltd. Ground Floor, Jeevan Tara Building Opp Patel Chowk Metro Station 5, Parliament Street, New Delhi- 110001 Telephone : (011) 23741282-86 Fax: (011 ) 23741280 Email ID :- pan.delhi@utiitsl.com Kolkata UTI Infrastructure Technology & Services Ltd 29,Netaji Subhash Road, Ground Floor, Opp Gilander House & Standard Chartered Bank, Kolkata- 700001 Telephone: (033) 22108959, 2242 - 4774/4810/4783 Fax: ( 033) 22435217 Email ID : Kolkata@utiitsl.com, pan.kolkata@utiitsl.com Chennai UTI Infrastructure Technology & Service Ltd 45, Justice Basheer Ahmed Building, Second Floor Second Line Beach, Chennai- 600001 Telephone:-(044) 25341224/ 1265/ 1356 Fax : ( 044)- 25341346 Email ID:- chennai@utiitsl.com /isw.chennai@utiitsl.com