AFFIDAVIT

Before the Executive Magistrate / Notary Public

I, ____________, Son/Daughter of ____________, aged about ____ years, resident of ____________________, do hereby solemnly affirm and declare as under:

1. That I am a citizen of India and residing at the above mentioned address.
2. That my Date of Birth is __/__/____ as recorded in my Aadhaar Card bearing No. XXXX XXXX XXXX.
3. That no Permanent Account Number (PAN) has ever been allotted or issued in my name by the Income Tax Department.
4. That I am applying for allotment of a new PAN Card and this affidavit is submitted in support of my application.
5. That the facts stated above are true and correct to the best of my knowledge and belief.

VERIFICATION

I, ____________, do hereby verify that the contents of this affidavit are true and correct to the best of my knowledge and belief.

Verified at __________ on dated __/__/____.