Redesigned - PAN Card Correction Form

Application for Changes or Correction in PAN Data

Affix recent photograph (3.5cm x 2.5cm)

Permanent Account Number (PAN)

Affix recent photograph (3.5cm x 2.5cm)

1. Full Name

Shri Smt Kumari M/s

Last Name / Surname

First Name

Middle Name

Name to be printed on the PAN card

2. Parent's Details

Father's Name (Mandatory)

Last Name / Surname

First Name

Middle Name

Mother's Name (Optional)

Last Name / Surname

First Name

Middle Name

Name to be printed on card:

Father's Name Mother's Name

3. Date of Birth

4. Gender

Male Female

7. Communication Address

Residence Office

Flat / Room / Block No.

Premises / Building / Village

Road / Street / Post Office

Area / Locality / Sub-Division

Town / City / District

State / Union Territory

Pincode

9. Contact & 10. Aadhaar Details

Mobile Number

Email ID

Aadhaar Number

12. Verification

I/We, the applicant, do hereby declare that what is stated above is true to the best of my/our information and belief.

Place

Date (DD/MM/YYYY)

Applicant's Signature