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8/31/22, 2:19 PM PANform

Form 49A
Under section 139A of the Income-Tax Act, 1961

PAN Application Acknowledgment Receipt For Form 49A


( Physical Application
)

Received Rs. 107.00/-


(incl of
SMT HEENA
taxes) from
Application No./Coupon No. U-A058998589
Name to be printed on PAN card HEENA
Gender FEMALE
Date of Birth/Incorporation 01/01/1997
Father's Name MOHD ALI
Aadhaar Number/EID Number xxxx-xxxx-6757 (MENTIONED, MATCHED)*
Name as per Aadhaar HEENA
Applicant's Contact details 8439577702 / sagat56780@GMAIL.COM
Communication Address RESIDENCE
Residence State UTTAR PRADESH
Proof of Identity AADHAAR Card issued by UIDAI (In Copy)
Proof of Address AADHAAR Card issued by UIDAI (In Copy)
Proof of DOB AADHAAR Card issued by UIDAI (In Copy)
Date of Receipt 31/08/2022 02:11:32
Mode of Pancard Both physical PAN and e-PAN Card
Payment Ref No 61322231085914128298 / PY0079324060
Payment Date 31/08/2022 02:12:59
*AADHAAR MATCHED USING DEMOGRAPHIC DETAILS - WILL BE LINKED WITH PAN.

PAN Service Center Code  779099 SAGAR KUMAR


PAN Service Center Name (Sign/Stamp)
SAGAR KUMAR Received for submission to UTIITSL

Centre Contact Details:


SAGAT56780@GMAIL.COM
/8430296626
To know your PAN
Application status, you may visit our website: https://www.utiitsl.com.
As per instruction from Income Tax Department, an authorized agency's agent may visit you
for your identity and address
verification as per the documents submitted by you with the PAN application form. You are requested to ask authorization
letter/ID card from the agent before verification.Your cooperation is solicited in this regard.

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