Income Tax Pan Card Application Sample Form
Request For New PAN Card Or/ And Changes Or Correction in PAN Data
Permanent Account Number (PAN)
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
Last Name / Surname
First Name
Middle Name
Name you would like it printed on the PAN card
2
Father's Name
(Only 'Individual' applicants: Even married women should fill in father's name only)
Last Name / Surname
First Name
Middle Name
3 Date of Birth/Incorporation/Agreement/Partnership/Trust Deed/ Formation of Body of individuals or Association of Persons
4
Gender (for 'Individual' applicant only)
Male Female
(Please tick as applicable)
5 Photo Mismatch
6 Signature Mismatch
7 Address for Communication Residence Office
(Please tick as applicable)
Name of office
(to be filled only in case of office 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
8 If you desire to update your other address also, give required details In additional sheet.
9 Telephone Number & Email ID details
Country code Area/STD Code Telephone / Mobile number
Email ID
10 AADHAAR number (if allotted)
11 Mention other Permanent Account Numbers (PANs) inadvertently allotted to you
PAN 1 PAN 3
PAN 2 PAN 4
12 Verification
I/We
, the applicant, in the capacity of
I/We have enclosed
(number of documents) in support of proposed changes/corrections.
Place
D D M M Y Y Y Y
Date
Signature / Left Thumb Impression of
Applicant (inside the box)
do hereby declare that what is stated above is true to the best of my/our information and belief.
Day Month Year
Please read Instructions 'h' & 'i' for selecting boxes on left margin of this form.
Signature/ Left thumb impression across
this photo
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