Form No.

49A
Application for Allotment of Permanent Account Number
Only ‘Individuals’ [In the case of Indian Citizens /Indian Companise/Entities incorporated in India/
to affix recent
photograph Unicorporated entities formed india ]
(3.5cm x 2.5cm) See Rule 114 Only ‘Individuals’
To avoid mistake(s), Please follow the accompanying instructions and examples before filling up the form to affix recent
photograph
Assessing officer (AO code) (3.5cm x 2.5cm)
Area code AO code Range code AO No.

Sign/LeftTumb Impression
Photo

Sir
I/We hereby request that a permanent account number be allotted to me/us.
I/We give below necessary particulars: Signature / Left Thumb impression

1 Full Name (Full expanded name to be mentioned as appearing in proof identity/date of birth/address documents: Intials are not permitted)

Please select title, as applicable Shri Smt. Kumari M/s

Last Name/ Surname
First Name

Middle Name

2 Abbreviation of the above name, as you would like it, to be printed on the PAN card

3 Have you ever been known by any name? Yes No (please tick) as applicable
If yes, Please give that other name
Please select title, as applicable Shri Smt. Kumari M/s
Last Name/ Surname

First Name
Middle Name
4 Gender (for Individual applicants only) Male Female (Please tick as applicable)

5 Date of Birth/In corporation/Agreement/Partnership or Trust Deed/ Formation of Body of individuals or Association of Persons
Day Month Year

6 Details of Parents (applicable only for individual applicants)

Father’s Name (Mandatory. Even married women should fill in father’s name only)
Last Name/ Surname
First Name
Middle Name
Mother’s Name (optional)
Last Name/ Surname
First Name
Middle Name
Select the name of either father or mother which you may like to be printed on PAN card (Select one only)
(In case no option is provided then PAN card will be issued with father’s name)
Father’s name Mother’s name (Please tick applicable)

7 Address

Residence 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/Zip code Country Name

INDIA
Office Address
Name of Office
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/Zip code Country Name

8 Address for Communication Residence Office (Please tick as applicable)

9 Telephone Number & Email ID DETAILS

Country code Area/STD Code Telephone/Mobile number

Email ID

10 Status of applicant

Please select status as applicable

Govermment
Individual Hindu undivided family Company Partnership Firm Association of Persons

Trusts Body of Individuals Local Authority Artificial Juridical Persons Limited Liability Partnership

11 Registration Number (for company,firm,LLPs, etc.)

12 In case of person, who is required to quote Aadhar number or the Enrolment ID of Aadhar application form as per section 139 AA

Please mention your AADHAAR number (if allotted)

If AADHAR numben is not allotted please mention the enrolment ID of Aadhar application from

Name as per AADHAR letter or card as per the Enrolment ID of Aadhar application form

13 Source of Income Please select status as applicable

Salary Capital Gaius

Income from Business/Profession Business/Profession code (For Code Refer instructions) Income from other sources

Income from House property No Income

14 Representative Assessee (RA)

Full name, address of the Representative Assessee, who is assessible under the Income Tax Act in respect of the person, whose particulars have been given in the column1- 13.

Full Name (Full expanded name initials are not permitted)

Please select title, 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

15 Documents submitted as Proof of identity(POI), Proof of Address(POA) and Proof of Date of Birth (POB)

I/We have enclosed as proof of identity,

as proof of address and as proof of date of birth
[Please refer to the instructions (as specified in Rule 114 of I.T. Rules,1962) for list of mandatory certified documents to be submitted as applicable]
[Annexure A, Annxure B & Annexure C are to be used wherever applicable]
16 I/We ,the applicant, in the capacity of
do hereby declare that what is stated above is true to the best
of my/our information and lief.
Place
D D M M Y Y Y Y
Date
Signature/Left Thumb Impression of Applicant (Inside the box)