Only 'Individuals' to affix recent photograph
(3.5 cm × 2.5 cm)
Signature / Left thumb impression across this photo
Only 'Individuals' to affix recent photograph
(3.5 cm × 2.5 cm)
Signature / Left thumb impression
Request For New PAN Card Or/ And Changes Or Correction in PAN Data
Permanent Account Number (PAN)
Please read Instructions 'h' & 'i' for selecting boxes on left margin of this form.
✔
1 Full Name (Full expanded name to be mentioned as appearing in proof of identity/address documents: initials are not permitted)
Please select title:
✔
as applicable
Shri
Smt
Kumari
M/s
Last Name / Surname:
First Name:
Middle Name:
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Name you would like it printed on the PAN card
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2 Details of Parents (applicable only for Individual applicants)
Father's Name (Mandatory. Even married women 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)
Father's Name
Mother's Name
(Please tick as applicable)
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3 Date of Birth/Incorporation/Agreement/Partnership/Trust Deed/ Formation of Body of individuals or Association of Persons
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