Forms 49a

1. 8AddressforCommunication Residence Office (Pleasetickasapplicable)
FormNo.49A
ApplicationforAllotmentofPermanentAccountNumber
[InthecaseofIndianCitizens/IndianCompanies/EntitiesincorporatedinIndia/
UnincorporatedentitiesformedinIndia]
Undersection139AoftheIncomeTaxAct,1961
I/Weherebyrequestthatapermanentaccountnumberbeallottedtome/us.
I/Wegivebelownecessaryparticulars:
1FullName(Fullexpandednametobementionedasappearinginproofofidentity/addressdocuments:initialsarenotpermitted)
Pleaseselecttitle, asapplicable Shri Smt. Kumari M/s
LastName/Surname
FirstName
MiddleName
2Abbreviationoftheabovename,asyouwouldlikeit,tobeprintedonthePANcard
3Have youeverbeenknownbyanyothername? Yes No (Pleasetickasapplicable)
Ifyes,pleasegivethatothername
Pleaseselecttitle, asapplicable Shri Smt. Kumari M/s
AONo.Areacode AOtype RangecodeSign/leftTumbimpressionacross
thisphoto
LastName/Surname
FirstName
MiddleName
4Gender(forIndividualapplicantsonly) (PleaseMale Female tickasapplicable)
5DateofBirth/Incorporation/Agreement/PartnershiporTrustDeed/FormationofBodyofindividualsorAssociationofPersons
6Father'sName(Only'Individual'applicants:Evenmarriedwomenshouldfillinfather'snameonly)
LastName/Surname
FirstName
MiddleName
7Address
ResidenceAddress
Flat/Room/Door/BlockNo.
NameofPremises/Building/Village
Road/Street/Lane/PostOffice
Area/Locality/Taluka/Sub-Division
Town/City/District
State/UnionTerritory Pincode/Zipcode Country Name
OfficeAddress
Nameofoffice
Flat/Room/Door/BlockNo.
NameofPremises/Building/Village
Road/Street/Lane/PostOffice
Day Month Year
Area/Locality/Taluka/Sub-Division
Town/City/District
State/UnionTerritory Pincode/Zipcode Country Name
Only ‘Individuals’
to affix recent
photograph
(3.5 cm x 2.5 cm)
Only ‘Individuals’
to affix recent
photograph
(3.5 cm x 2.5 cm)
Signature/Left Thumb Impression
avoidmistake(s),pleasefollowtheaccompanyinginstructionsandexamplesbeforefillinguptheform
Assessingofficer(AOcode)
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2. 9TelephoneNumber&EmailIDdetails
CountrycodeArea/STDCode Telephone/Mobilenumber
EmailID
10Statusofapplicant
Pleaseselectstatus,Dasapplicable Government
Individual Hinduundividedfamily Company PartnershipFirm AssociationofPersons
Trusts BodyofIndividuals LocalAuthority ArtificialJuridicalPersons LimitedLiabilityPartnership
11RegistrationNumber(forcompany,firms,LLPs,etc.)
12IncaseofacitizenofIndia,then
PleasementionyourAADHAARnumber(ifallotted)
asapplicable
Salary CapitalGains
IncomefromBusiness/Profession Business/Professioncode [ForCode:Referinstructions] IncomefromOthersources
IncomefromHouseproperty Noincome
14RepresentativeAssessee(RA)
Pleaseselecttitle, as
LastName/Surname
FirstName
MiddleName
Address
Flat/Room/Door/BlockNo.
NameofPremises/Building/Village
Road/Street/Lane/PostOffice
Area/Locality/Taluka/Sub-Division
Town/City/District
State/UnionTerritory Pincode
15DocumentssubmittedasProofofIdentity(POI)andProofofAddress(POA)
I/Wehaveenclosed asproofofidentityand
asproofofaddress.
[Pleaserefertotheinstructions(asspecifiedinRule114ofI.T.Rules,1962)forlistofmandatorycertifieddocumentstobesubmittedasapplicable]
I/We16
Fullname,addressoftheRepresentativeAssessee,whoisassessableundertheIncomeTaxActinrespectoftheperson,whoseparticularshavebeengiveninthe
column1-13.
FullName(Fullexpandedname:initialsarenotpermitted)
applicable Shri Smt. Kumari M/s
,theapplicant,inthecapacityof
do hereby declare that what is stated above is true to the best of my/our information and belief.
Place
DDMMYYYY Signature/Left Thumb Impression of
Date Applicant(insidethebox)
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13 Sourceof income Please select status,
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3. RAVIKANT
SARDA
SURESH
NARAYAN
POONAM
RAVI
RAO
SATY M
VENKAT M K
A
KANDASWAMY
M ADURAI
SOM ASUNDRAM
a)
b) Each box, wherever provided, should contain only one character (alphabet /number / punctuation sign) leaving a blank box after each word.
Form to be filled legibly in BLOCK LETTERS and preferably in BLACK INK. Form should be filled in English only.
c) ‘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:
XYZ
I A )
DATA CORPORATION (IND
PR IVA T E LIM ITED
M ANOJ M AFATLAL DAVE (HUF)
RAO
M
SATYAM
VENKAT K
DDMMYYYY
02081975
91 11 22555705
91 9102511111
Pvt. P.P. Ltd., P Ltd

4. 1.
2.
Proof of Address is required for residential address
mentioned in item no. 7
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
1. In case of Minor, any of the above mentioned documents as
proof of Identity and Address of any of parents/guardians of such
minor shall be deemed to be the proof of identity and address for
the minor applicant.
2.For HUF an affidavit made by the Karta of Hindu Undivided
Family stating name, father’s 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.
Code Business/Profession
1 Medical Profession and Business
2 Engineering
3 Architecture
4 Chartered Accountant/Accountancy
5 Interior Decoration
6 Technical Consultancy
7 Company Secretary
8 Legal Practitioner and Solicitors
9 Government Contractors
10 Insurance Agency
Code 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 20
11
12
13
14
15
17
18
19
16
a.
UTI Infrastructure Technology & Services Ltd. P. B NO 20, Plot no 3, Sector-11 CBD- Belapur, Navi Mumbai- 400614 Telephone: [phone]
Fax : [phone] Email ID : [email protected]
Navi Mumbai
UTI Infrastructure Technology & Services Ltd. Ground Floor, Jeevan Tara Building Opp Patel Chowk Metro Station 5, Parliament Street, New Delhi- 110001
Telephone : [phone] Fax: (011 ) 23741280 Email ID :- [email protected]
New Delhi
Kolkata
UTI Infrastructure Technology & Services Ltd 29,Netaji Subhash Road, Ground Floor, Opp Gilander House & Standard Chartered Bank,
Kolkata- 700001 Telephone: [phone], 2242 - 4774/4810/4783 Fax: ( 033) 22435217 Email ID : [email protected],[email protected]
Chennai
UTI Infrastructure Technology & Service Ltd 45, Justice Basheer Ahmed Building, Second Floor Second Line Beach, Chennai- 600001
Telephone:-[phone]/ 1265/ 1356 Fax : ( 044)- 25341346 Email ID:- [email protected]/[email protected]
AADHAAR number if allotted has to be quoted(Supported by copy of AADHAAR Letter/Card)
or State
Authorized Signatory
b.
c.
d.