Re-issue of Lost / Damaged PAN Fill in the simple form and proceed for payment information

1PAN CARD INFORMATION
i
2PERSONAL INFORMATION
i
(Name should be exactly as per the ID proof. ID proof should have expansion of the initials)
i
(Name on the PAN Card should be based on the name of the applicant)
i
3CONTACT DETAILS
4DOCUMENT PROOF
5INCOME SOURCE
6ADDRESS INFORMATION

Residence Address *i

Office Address (Optional) i

DECLARATION

I have enclosed ________________________ as proof of identity, ________________________ as proof of address and ________________________ as proof of date of birth.

I ________________________, the applicant, in the capacity of do hereby declare that what is stated above is true to the best of my information and belief.

Date: 23-Jan-2017 City of residence ________________________

* Mandatory. Please ensure the name in the ID Proof matches  (Name of the Applicant). If the name does not match, the application would not be accepted.