| INCOME TAX DEPARTMENT | GOVT. OF INDIA | |
| Cardholder name | ||
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Name of cardholders father – Even if it is a married woman this is still fathers name – |
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| Cardholder Date of Birth |
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Permanent Account Number
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Cardholder Signature
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In case this card is lost/found, kindly inform/return to:
Income Tax PAN Services Unit, UTITSL
Plot No.3, Sector 11, CBD Belapur,
Navi Mumbai – 400 614.
