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Acknowledgment for request for new PAN card

ACKNOWLEDGMENT NUMBER: 881020110530932

Citizen of India Y

Category Individual

Name Shri Siv aram

Name to be printed on card Sivaram

Father's Name Shri Manickam

Date of Birth 17 - 03 - 1989Residentia l Address 3a

Thirunagar

5th crossManachanallur

Tiruchirappalli - 621005

Tamil Nadu

Office Address

Address for Communication Residential

Telephone No 0431 - 2560145

Email Id parcome@hotmail.com

Affix recent

photograph

(3.5cm x 2.5cm)

Payment Mode

Credi t Card / Debit Card: Your Payment of 94.00 against transaction number 400-209512 has been successfull y processed.

I/We, 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: Copy of voter's identity card

Proof of Address: Copy of voter's identity card

Proof of Identi ty of representati ve assessee:

Proof of Address of representative assessee:

Any other document:

Signature/Left Thumb Impression of Appl icant(inside the box without touching the sides & in BLACK INK

ONLY)

Date: 17 - 10 - 2011

Preview Application Form

Print Acknowledgment

New Application

Service Tax Registration No.: M-III/ST/BAS/2847

Instructions:

1. The acknowledgement number above is your unique reference number f or PAN application. Kindly quote this number f or tracking the status of y our

PAN application on http://tin-nsdl.com or any queries relating thereto.

2. Save and print this acknowledgment.

3. Application fee and mode of payment: Payment f avouring 'NSDL-PAN' can be made as f ollows:

Sr.

No.

Address for

Communication

Amount payable

( )Mode of payment

1 Indian 94 Credit card / Debit card/ Net Banking / Demand Draf t (DD) pay able at

Mumbai/Cheque to be deposited in any HDFC bank branch across the country

(except Dahej).

2 Foreign 944 DD pay able at Mumbai

Please mention name of applicant and acknowledgment number on the reverse of cheque/DD.

4. Indiv idual applicants af f ix y our recent colour photograph (3.5 cm x 2.5 cm), sign the acknowledgment (inside the box prov ided without touching the

sides and in BLACK INK only) and enclose a DD, if any, alongwith Proof of Identity & Proof of Address as specif ied in the application form.

5. Superscribe the envelope with 'APPLICATION FOR PAN - Acknowledgment Number' (e.g. 'APPLICATION FOR PAN - 881010100000973').

6. Send the documents as specified in point no. 4 above to Income Tax PAN Services Unit, National Securities Depository Limited, 3rd floor,

Sapphire Chambers, Near Baner Telephone Exchange, Baner Pune -411045 Tel: 020-27218080; Fax: 020-27218081.

7. Your acknowledgment, Demand Draf t if any, and proofs , should reach NSDL within 15 days f rom the date of online application.

8. Application will be processed only on receipt of relevant proofs and realisation of payment.

9. PAN card will be despatched only to the communication address provided in y our PAN application. Wherev er the Representativ e Assessee (RA)