Sir,I/We hereby request that a permanent account number be allotted to me/us.
I/We give below the necessary details:
1. Full Name*
Last Name/Surname
First Name
Middle Name
2. Name on Card *
3. Have you been known by any other name?
4. Gender *
5. Date of Birth / Incorporation/Agreement/Partnership or Trust Deed/Formation of Body of Individuals/Association of Persons
DD/MM/YYYY
6. Details of Parents(applicable only for Individual applicants)*
Father's Name(Mandatory - Even married woman 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)
7. Address*
Residential Address
Flat/Door/Block Number
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
Office Address
Name of the Offices
Flat/Door/Block Number
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 *
9. Telephone number
Telephone ISD Code
Area/STD Code
Telephone/Mobile number
Email ID
Please Mention your AADHAAR number(if alloted)
Are you a citizen of India?
13. Source Of Income
Are you a salaried Employee?
Income from House Property
Income from Other source
Are you are engaged in a business / profession?
Capital Gains
No Income
14. Representative Assessee(RA) Full name and address of the Representative Assessee, who is assessable under the Income Tax Act in respect of the person, whose particulars have been given above
Last Name/Surname
First Name
Middle Name
Flat/Door/Block Number
Name of Premises/Building/Village
Road/Street/Lane/Post Office
Area/Locality/Taluka/Sub-Division
Town/City/District
State/Union Territory
PIN Code
15.Documents submitted as Proof of Identity(POI),Proof of Address(POA)and Date of Birth Proof
Which of these documents are you submitting as an Identity Proof *
Which of these documents are you submitting as an Address Proof *
Which of these documents are you submitting as a DOB Proof*
16. You do hereby declare that whatever stated above is true in the capacity of *