FORM No.

ITS 49A Sl No:

Application for Allotment of Permanent Account Number - FORM 49A

Under Section 139A of the Income-Tax Act, 1961
(To avoid mistake(s), please follow the accompanying instructions and examples carefully before filling up the form)
To
The Assessing Officer Area AO Range AO
Code Type Code No
Ward/Circle ________________
Range Only individual to
________________
affix recent photograph
Commissioner _______________
(3.5cm x 2.5cm)

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 :initials are not permitted): Please tick as applicable : Shri Smt Kumari M/s

Last Name/Surname : First Name : Middle Name :

2.Name you would like printed on the card

3.Have you ever been known by any other name ? Please tick as applicable Yes No
If yes, please give that other name (Full expanded name : Initials are not permitted) Shri Smt Kumari
Last Name / Surname |First Name

|Middle Name

4.Father’s Name (Only ’Individual’ applicants : Even married women should give father’s name only)
Last Name / Surname |First Name

|Middle Name

5.Address
R. Residential Address :
Flat/Door/Block No.

Name of Premises/Building/Village

Road/Street/Lane/Post Office

Area/Locality/Taluka/Sub-Division

Town/City/District |State/Union Territory |Pin(Indicating PIN is mandatory)

O. Office Address: (Name of Office)

Flat/Door/Block No.

Name of Premises/Building/Village

Road/Street/Lane/Post Office

Area/Locality/Taluka/Sub-Division

Town/City/District |State/Union Territory |Pin(Indicating Pin is mandatory)

6. Address for communication :Please tick as applicable R or O

 STD Code Tel Number e-mail ID

7.Tel.No.

8. Sex(For ’Individual Applicants only)Please as applicable. Male Female

9. Status of the Applicant: Please as applicable

Individual P Firm F Body of Individuals B

Hindu Undivided Family H Association of Persons A Local Authority L
Company C Association of Persons (Trusts) T Artificial Juridical Person J

10. Date of Birth/Incorporate/Agreement/Partnership or Trust Deed/Formation of Body

of Individuals/Association of Persons DD MM YYYY
11. Registration Number(In case of Firms, Companies etc.)

12. Whether citizen of India? Please as applicable. Yes No

13. (a) Are you a salaried employee? if yes, indicate: Government Others

Name of the Organization where working

(b) If you are engaged in a business/profession, indicate nature of business or profession and fill the relevant code.

(c) If you are not covered by (a) or (b) above, indicate sources of income, if any

14. Full Name, address of the Representative Assessee, who is assesable under the Income Tax Act in respect of the
person whose particulars have been given in column 1 to 13.
Full Name (Full expanded name :initials are not permitted): Please tick as applicable : Shri Smt Kumari M/s
Last Name / Surname |First Name

|Middle Name

Address :
Flat/Door/Block No.

Name of Premises/Building/Village

Road/Street/Lane/Post Office

Area/Locality/Taluka/Sub-Division

Town/City/District State/Union Territory Pin(Indicating Pin is mandatory)

15. I/We have enclosed as proof of identity and

as Proof of address.
I/We , the applicant, do hereby declare that what is stated above
is true to the best of my / our information and belief.

Verified today, the - -

DD MM YYYY

Signature/Left thumb impression of Applicant (inside the

box)
____________________________________________________________ _____________________________________________________________________________
 General Information for PAN Applicants

1.Application for PAN should be made only on form supplied by UTIISL or from website http://www.pancard.utiisl.co.in or obtained IT PAN Service
Center. Cost of the form is Rs.5/-.Applications on any other form including re-printed or photocopied from original will be summarily rejected.
For forms downloaded from website http://www.pancard.utiisl.co.in, you have to pay Rs. 5/- in cash at the PAN Card Center as cost of the form.
2.Before submission of form, a Processing Coupon of Rs. 60/- should be obtained from the IT PAN Service Center and affixed on the top of the form.
3.Those already allotted a ten digit alphanumeric PAN shall not apply again as having or using more then one PAN are illegal. Such allottees
may,however,request for the new tamper proof PAN card, with several security features, on payment of Rs.60/-at IT PAN Service Centers.
5.Documents to be submitted along with application for PAN (Column 15 of Form 49 A):
Category Documents Required
Individual For proof of identity : Copy of school leaving certificate or matriculation certificate or degree of a recognised educational
institution or depository account or credit card bank account or water bill or ration card or property tax assessment order or passport
or voter identity card or driving license or certificate of identity signed by a Member of Parliament or Member of Legislative
assembly or Municipal Councilor or a Gazetted Officers,as the case may be.
For Proof of Address : Copy of electricity bill or telephone bill or depository account or credit card or bank account or ration card
or employer certificate or passport or voters identity card or property tax assessment order Legislative Assembly or Municipal
Councilor or Gazetted Officer, as the case may be.
Incase of a person being a minor, any documents of any of the parents or guardian of such minor shall be deemed to be the proof of
identity and address.
HUF For proof of identity and address,any document prescribed in the case of individuals in respect of Karta of the HUF
Company Copy of Certificate or Registration issued by Registrar of Companies.
Firms Copy of Certificate of Registration issued by the Registrar or Copy of Partnership Deed.
AOP(Trusts) Copy of the Trust deed or Copy of Certificate of Registration Number issued by Charity Commissioners.
AOP/BOI/Local Copy of Agreement or Copy of Certificate or Registration Number issued by Charity Commissioners or Registrar of Co-operative
Authority/ Society or any other Competent Authority or any other document originating from any Central or State Government Department
Artifical Juridical establishing Identity and Address of such person.
Person

6.Businees/Professions along with codes (Column 13(b) of Form 49A):

01 Medical Profession and Business 11 Films,TV and such other entertainment

02 Engineering 12 Information Technology
03 Architecture 13 Builders and Developers
04 Chartered Accountant/Accountancy 14 Members of Stock Exchange, Share Brokers and Sub-Brikers
05 Interior Decoration 15 Performing Arts and Yatra
06 Technical Consultancy 16 Operation of Ship,Hovercraft,Aircarfts or Helicopters
07 Company Secretary 17 Plying Taxis,Lorries,Trucks,Buses or other Commercial Vehicles
08 Legal Practitioner and Solicitors 18 Ownership of Horses or Jockeys
09 Government Contractors 19 Cinema Halls and Other Theaters
10 Insurance Agency 20 Others
ACKNOWLEDGEMENT

Received with thanks from Shri / Smt / Kum / M/s

1. APPLICATION FORM 49A BEARING APPLICATION SR.No.

2. DATE OF RECEIPT
3. PROCESSING COUPON NUMBER
4. PROOF OF IDENTITY
5. PROOF OF ADDRESS
6. OTHERS (please specify)
PAN Service Center Code :
AUTHORISED SIGNATORY
PAN Service Center Name : ______________________
(with date stamp)
(Note:The PAN card will be issued within 10 working days from the date of receipt at PAN Service Center.
However,during the first six months effective from 1 st July,2003,the PAN card will be issued
in 15 working days from the date fof receipt at PAN Service Center.)
Any query / correspondence in this connection may be addressed by quoting the application
& Processing Coupon Number to :
The Vice President,(GSD) Income Tax PAN Service Unit (Managed by Unit Trust of India-Investor Services Ltd.)
Navi Mumbai-4000614 Telephone :(022 )55932300 Fax : (022) 55931099