Applying As IndividualHUFMinor Applying For NewCorrection in existing one Title ---Shri.Smt.Kumari Last Name First Name Middle Name Proof of Identity Attach Photo (3.5X2.5 cms) Do You Want to Print Abbreviations or Short Name of the above name? Abbreviations or Short Name of the above name(optional) Have Applicant known by any other name? Other Name Details Last Name First Name Middle Name Gender MaleFemaleTransgender Date of Birth Attach Date of Birth Proof Details of Father Name Last Name First Name Middle Name (Even married women should fill in father’s name only) Details of Mother Name Last Name First Name Mother Middle Name Name to mention on Pan Card among parents FatherMother HUF Name Attach An affidavit by the karta Date of Birth of Karta Attach Date of Birth Proof (karta) Residence 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 Pin Code/Zip Code Attach Residence Address Proof Do You want to Communicate on Office Address NoYes 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 Pin Code Attach Office Address Proof Source of Income ---SalaryCapital GainsIncome from Business / ProfessionIncome from Other sourcesIncome from House propertyNo income Business/Profession Type 01 Medical Profession and Business02 Engineering03 Architecture04 Chartered Accountant/ Accountancy05 Interior Decoration06 Technical Consultancy07 Company Secretary08 Legal Practitioner and Solicitors09 Government Contractors10 Insurance Agency11 Films, TV and such other entertainment12 Information Technology13 Builders and Developers14 Members of Stock Exchange, Share Brokersand Sub-Brokers15 Performing Arts and Yatra16 Operation of Ships, Hovercraft, Aircrafts orHelicopters17 Plying Taxis, Lorries, Trucks, Buses or otherCommercial Vehicles18 Ownership of Horses or Jockeys19 Cinema Halls and Other Theaters20 Others Telephone / Landline Number Mobile Number Email Representative Assessee (In case of Minor Mention Parents or Guardian Details/In case of HUF mention Karta Details) Title ---Shri.Smt.Kumari Last Name First Name Middle Name Proof of Name(Representative Assessee) 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 Pin-Code/ Zip-Code Mobile Number Proof of Address(Representative Assessee) Attach Signature (2X4.5 cms) Your Message I hereby hereby declare that what is stated above is true to the best of my/our information and belief Δ
