2/9/2015

RequestForNewPANCardOr/AndChangesOrCorrectioninPANData
RequestForNewPANCardOr/AndChangesOrCorrectioninPANData
Fieldsmarkedwith*(asterisk)aremandatory..Toavoidmistake(s),pleasereferguidelinesandinstructions.

*WhethercitizenofIndiaYes
*PermanentAccountNumber(PAN)

No

*1.Name(Initialsarenotpermittedinfirstandlastname.Applicant'sproofofidentity,proofofaddressandproofofdateofbirthshouldcontaintheexactnamementionedinthisfield)

TitleShri/Mr
Smt./Mrs.
LastName/Surname

Kumari/Ms

M/s
FirstName

MiddleName

*Nameasyouwouldlikeitprintedonthecard(PrefixlikeShri,Smt,Kumari,Late,Dr,CA,Ms,Mr,Mrs,M/s,Aliasetc.arenotallowed)
*2.Father'sName(Evenmarriedwomenshouldgivefather'snameonly.PrefixlikeShri,Smt,Kumari,Late,Dr,CA,Ms,Mr,Mrs,M/s,Aliasetc.arenotallowed)
LastName/Surname
FirstName
MiddleName
*3.Dateof
Birth/Incorporation/Agreement/Partnership DD
orTrustDeed/FormationofBodyof
DD
Individuals/
AssociationofPersons
*4.Gender
Male

MM
MM

YYYY

Female

5.PhotoMismatch
6.SignatureMismatch

*7.AddressforCommunication
OfficeName(tobefilledonlyincaseof
officeaddress)
Flat/Door/BlockNo.

NameofPremises/Building/Village

Road/Street/Lane/PostOffice

Area/Locality/Taluka/SubDivision

Town/City/District

State/UnionTerritory

PIN(IndicatingPINismandatory)

Country

Zip

Residential

Office

PleaseSelect
Pleaseselect

8.Ifyoudesiretoupdateyourotheraddress,giverequireddetails&Submitproofofotheraddressalso.
Countrycode(ISDcode)
Pleaseselect
*9.TelephoneNo.
(Countrycodeiscompulsory)

MobileNo.
Area/STDCode

TelephoneNo.
TelephoneNo./MobileNo.

EmailID
IncaseAADHAARnumberisprovided,thenproofofAADHAARalongwithsupportingdocumentsistobe
submittedtoNSDL
11.MentionotherPermanentAccountNumbers(PANs)ifany,inadvertentlyallottedtoyou.SubmitproofofsurrenderedPAN(s)alongwiththeapplication.
10.AADHAARnumber(ifallotted)

PAN1

PAN2

PAN3
12.Verification
I/We

PAN4
,theapplicant,inthecapacityof PleaseSelect

thatwhatisstatedaboveistruetothebestofmyinformationandbelief.
Ihaveenclosed
(numberofdocuments)insupportofproposedchanges/corrections.

Place

DD MMYYYY
Verifiedtoday,the 09022015
I/Wehaveenclosed
Pleaseselect
asproofofidentity, Pleaseselect
Pleaseselect
asproofofPANallotted.
proofofdateofbirthand PleaseSelect
OtherDetails
1.DepositoryAccountDetails
DPID:
ClientID:

2.PaymentDetails
DemandDraft/Cheque(infavourof'NSDLPAN'for 105.00)
DemandDraftnumber
DatedDD
MM
YYYY
DrawnOn
OR
Chequenumber

doherebydeclare

asproofofaddress,
as

Amount 105.00

payableatMumbai.
DatedDD

DrawnOn

MM

YYYY

Amount 105.00

Bank,depositedatHDFCBank,

Branchat

location(city/town).
CreditCard/DebitCard( 105.00plusapplicablebankcharges)
NetBanking( 105.00)ListofBanksavailable

SUBMIT

https://tin.tin.nsdl.com/pan2/servlet/NewPanCorrect

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