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57 - Change Pan Application

This 3 sentence summary provides the key details from the document: The document is a request form for individuals to apply for a new PAN card or make changes/corrections to their existing PAN data such as name, father's name, date of birth, address, phone number. The applicant must provide identification details, address, contact information, and sign the form declaring that the information provided is true and correct while enclosing supporting documents. Upon receipt, the PAN service center will provide an acknowledgement along with a customer service request number.

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pawanrajvanshi
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113 views1 page

57 - Change Pan Application

This 3 sentence summary provides the key details from the document: The document is a request form for individuals to apply for a new PAN card or make changes/corrections to their existing PAN data such as name, father's name, date of birth, address, phone number. The applicant must provide identification details, address, contact information, and sign the form declaring that the information provided is true and correct while enclosing supporting documents. Upon receipt, the PAN service center will provide an acknowledgement along with a customer service request number.

Uploaded by

pawanrajvanshi
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLS, PDF, TXT or read online on Scribd
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Request For New PAN Card Or/ And Changes Or Correction In PAN Data

Permanent Account Number (PAN)


Only 'Individuals' to affix
recent photograph

1 Name
Signature/Left Thumb Impression
Please Tick P as applicable Shri P Smt ###
Kumari M/s
Last Name / Surname First Name

Middle Name

Name as you would like it printed on the card


2 Father's Name (Only 'Individual' applicants : Even married women should give father's name only)
Last Name / Surname First Name

Middle Name

3 Date of Birth / Incorporation / Agreement / Partnership or Trust Deed / Formation of Body - -


of Individuals / Association of Persons D D M M Y Y Y Y
4 Sex (For 'Individual' Applicants only) Male P Female
5 Photo Mismatch
6 Signature Mismatch
7 Address For Communication Please indicate if this is Residence Residence P or Office
Office Name (to be filled only in case of office 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

8 If you desire to update your other address also, give required details in additional sheet. (Indicating PIN is mandatory)
STD Code Tel. No.
9 Tel. No. Email

10 Mention other Permanent Account Numbers (PANs) inadvertently allotted to you


1 3

2 4

I/ We the applicant, do hereby declare that what is stated above is true


to the best of my/our information and belief. I have enclosed (number of documents) in support of proposed changes/ corrections.

Verified today, the - -

D D M M Y Y Y Y
Signature/LeftThumb Impression of Applicant
(Inside the box)

ACKNOWLEDGEMENT
Received with thanks from Shri / Smt / Kum / M/s
CSF Number

PAN Number
PAN Service Centre Code
PAN Service Centre Name
Enclosures : 1
2
3
4

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