1.
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
Name you would like it printed on the PAN card
2 Details of Parents (applicable only for Individual applicants)
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)
3 Date of Birth/Incorporation/Agreement/Partnership/Trust Deed/ Formation of Body of individuals or Association of Persons
Day Month Year
4 Gender (for ‘Individual’ applicant only) Male Female (Please tick as applicable)
5 Photo Mismatch
6 Signature Mismatch
7 Address for Communication Residence (Please tick as applicable)
Flat/Room/ Door / Block No.
Name of Premises/ Building/Village
Pincode / Zip code
8 If you desire to update your other address also, give required details In additional sheet.
9 Telephone Number & Email ID details
Country code Area/STD Code Telephone / Mobile number
Email ID
10 AADHAAR number (if allotted)
Name as per AADHAAR letter/card
11 Mention other Permanent Account Numbers (PANs) inadvertently allotted to you
PAN 1 PAN 2 PAN 3 PAN 4
12 Verification
I/We , the applicant, in the capacity of do hereby
declare that what is stated above is true to the best of my/our information and belief.
I/We have enclosed (number of documents) in support of proposed changes / corrections.
Place
D D M M Y Y Y Y
Date
Signature / Left thumb impression
recent photographrecent photograph
Signature / Left thumb
impression across this photo

2.
INSTRUCTIONS FOR FILLING REQUEST FOR NEW PAN CARD OR/AND CHANGES OR CORRECTION IN PAN DATA
BLOCK LETTERS BLACK INK. Form should be filled in English only
across the photo affixed on the left side of the form in such a
within the box
stamp.
correction is required.
and surrender the same.
Item
No.
Item Details Guidelines for filling the form
Full Name Please select appropriate title.
For example RAVIKANT
Last
Name/Surname
R A V I K A N
First Name
Middle Name
For example SURESH SARDA
Last
Name/Surname
S A R D A
First Name S U R S H
Middle Name
For example POONAM RAVI NARAYAN
Last
Name/Surname
N A R A Y A N
First Name P O O N A M
Middle Name R A V I
For example SATYAM VENKAT M. K. RAO
Last
Name/Surname
R A O
First Name S A Y A M
Middle Name V N K A M K
For example M. S. KANDASWAMY(MADURAI SOMASUNDRAM KANDASWAMY) should be
Last
Name/Surname
K A N D A S W A M Y
First Name M A D U R A I
Middle Name S O M A S U N D R A M
for First and Middle Name.

3.
For example XYZ DATA CORPORATION (INDIA) PRIVATE LIMITED
Last
Name/Surname
X Y Z D A A O R P O R A I O N ( I N D
First Name I A P R I V A L I M I D
Middle Name
For example MANOJ MAFATLAL DAVE (HUF)
Last
Name/Surname
M A N O J M A F A L A L D A V ( H U F
First Name
Middle Name
full name to be
printed on the PAN
card
SATYAM VENKAT M. K. RAO
Last
Name/Surname
R A O
First Name S A Y A M
Middle Name V N K A M K
2 Details of Parents
(Applicable to Father’s Name
Mother’s Name
Appropriate flag should be selected to indicate the name (out of the father’s name and mother’s
3 Date of Birth/
Incorporation/
Agreement/
Partnership or
Deed/Formation
Association of
Persons
D D M M Y Y Y Y
2 8 5
4
5 & 6 Photo/signature
Mismatch the left margin.

4.
Address for
Residence and
office
Indicate either Residence or Office address for communication as the case may be.
8 Update
other
address
Number and
2 3 5 5 5 5
2 5
in the application form.
AADHAAR
number (if
Aadhaar Number
Name as per Aadhaar letter/card
Mention other
Permanent
Account
impression

5.
GENERAL INFORMATION FOR APPLICANTS
(www.incometaxindia.gov.in) (www.utiitsl.com) (www.tin-nsdl.com).
`
outside India then additional dispatch charge of `
Document acceptable as proof of identity, address and date of birth as per Rule 114 of Income Tax Rules, 1962
Proof of Identity Proof of Address Proof of date of birth
Indian Citizens (including those located outside India)
Individuals & HUF
(i) Copy of
(ii) in Original
(iii) Bank certificate in Original on letter
name and stamp of the issuing
photograph and bank account
number of the applicant
(i) Copy of
i. Allotment letter of accommodation
(ii) Copy of following documents of
not more than three months old
or
(iii) in Original
(iv) in original.
Copy of the following documents
if they bear the name, date, month
and year of birth of the applicant,
namely:-
or
Undertaking or State Public Sector
stating the date of birth.

6.
mentioned documents as proof of
parents/guardians of such minor
shall be deemed to be the proof
applicant.
address of all the coparceners on
name of Karta of HUF is required as
birth.
residence address mentioned in
bank account statements (not more
proof of address.
Other than Individuals and HUF
2 Partnership Firm
partnership deed.
3
4
5
Artificial Juridical Person
Foreign Citizens
Individuals not being a Citizen of India
Proof of Identity Proof of Address
or
or
or
registered in India.
or
or
or
or
branches of Scheduled Banks registered in India or
or
or
or
or
&
&

7.
For other than Individuals (Foreign companies/Entities incorporated outside India/Unincorporated entities formed outside India)
(a)
or authorised
or
(b)
(a)
or
or
(b)
Proof of PAN
Note: No other document shall be accepted as Proof of PAN.
‘good effort basis’.
Supporting document required for changes in PAN data
Case/Applicant type Document acceptable for change of name/father’s name
Married ladies - change of name on account of marriage
Individual applicants other than married ladies
Companies
Firms / Limited Liability Partnerships
AOP/Trust/BOI/AJP/LOCAL authority
acknowledgement
number can be used for tracking the status of the application.
Mode Income-tax Department NSDL e-Gov
Website www.incometaxindia.gov.in www.tin-nsdl.com
Call Center
Email ID tininfo@nsdl.co.in
SMS SMS NSDLPAN <space>
For example
Address INCOME TAX PAN SERVICES UNIT