10/01/2014 Acknowledgment for request for new PAN Application (881020121064031)

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Affix recent

photograph

(3.5cm x 2.5cm)

Acknowledgment for request for new PAN card(Form 49A)

ACKNOWLEDGMENT NUMBER: 881020121064031

Affix recent

photograph

(3.5cm x 2.5cm)

Signature/Left

Thumb Impression

across this photo

Citizen of India Y

Category Indiv idual

Name Shri JAMESH BABU

Name to be printed on card JAMESH BABU M

Father's Name Shri MOHAMED CHELLAPPA

Date of Birth 05 - 05 - 1987

Residential Address ROSE HOUSE CHERIKODE KAKKAYUR CHITTUR THALUK PALAKKAD - 678512 Kerala

Office Address Fluid Control Research Institute Kanj ikode Palakkad Kanj ikode West Palakkad - 678623 Kerala

Address for Communication Residential

Telephone No 91 9447368628

Aadhaar No.

Email Id jameshbabu@gmail.com

Payment Mode

Credit Card / Debit Card: Your Payment of 96.00 against transaction number 400-1148610 has been successfully 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 passport

Proof of Address: Copy of ration card

Proof of Identity of representative assessee:

Proof of Address of representative assessee:

Any other document:

Signature/Left Thumb Impression of Applicant

(inside the box without touching the sides & in BLACK INK

ONLY)

Date: 10 - 01 - 2014

Preview Application Form

Print Acknowledgment

New Application

Service Tax Code (Registration Number): AAACN2082NST001

Service Tax Registration Category: BUSINESS AUXILIARY SERVICES

Instructions:

1. The acknowledgement number abov e is y our unique ref erence 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: Pay ment f av ouring 'NSDL-PAN' can be made as f ollows:

Sr.No.

Address forCommunication

Amount payable( )

Mode of payment

1 Indian 96 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 962 Credit card / Debit card / Demand Draf t (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 f orm.

10/01/2014 Acknowledgment for request for new PAN Application (881020121064031)

https://tin.tin.nsdl.com/pan2/servlet/CPGClient?cpg_api=setCustomerResponse&CititoMall=0101|219287693004|1|22453746|400001148610|98.20|Y:|012 2/2

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

6. Send the documents as specif ied in point no. 4 abov e to Income Tax PAN Services Unit, NSDL e-Governance Infrastructure Limited, 5th floor,

Mantri Sterling, Plot No. 341, Survey No. 997/8, Model Colony, Near Deep Bungalow Chowk, Pune -411016 Tel: 020-27218080; Fax: 020-

27218081.

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

8. Application will be processed only on receipt of relev ant proof s and realisation of pay ment.

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

details ( item no.14 in Form 49A ) are mentioned in the application, PAN card will be despatched to the RA's address.