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    Q016748129 Signed

    Uploaded by

    dsifcc2

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Q016748129 Signed

    Uploaded by

    dsifcc2
    16 views4 pages

    Original Title

    Q016748129_SIGNED (2)

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    16 views4 pages

    Q016748129 Signed

    Uploaded by

    dsifcc2

    Copyright:

    © All Rights Reserved
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    U-Q016748129

    4311114424944635 / PY0143265027
    06/11/2024 11:44:23
    D:327313210018
    UserI Amount
    : Rs.:106.90/- 06/11/2024
    UserName: 327313210018 Appl
    icat
    i ce:EWALLET
    onSour - A - CSC E GOVERNANCE SERV
    dMode:Both physical PAN and e-PAN Card
    PANCar Appl
    icat
    ionMode: Digital Application

    F H O P M 4 3 1 0 P

    ✘
    ✔
    G O G O I
    B O R N A L I

    B O R N A L I G O G O I

    ✔
    G O G O I
    P R A B I N

    ✔ 2 0 0 1 1 9 9 7
    ✔ ✔ ✔
    ✔ ✔ ✔

    C / O : L A K H Y A J Y O T I M O R A N 1
    N O T E Z I G A O N T E Z I G A O N
    N O - 1 D O O M D O O M A

    T I N S U K I A

    ASSAM 7 8 6 1 5 2 INDIA

    ✔
    9 1 9 1 8 8 2 2 5 6 2 6 4 7
    dsifcc2@gmail.com
    ✔ 6 2 2 0 5 3 5 9 4 4 3 2
    B O R N A L I G O G O I

    ✔
    F HOPM4 3 1 0 P F HOPM4 3 1 0 P
    BORNALI GOGOI HIMSELF/HERSELF

    4
    KAKAPATAR TOWN

    0 6 1 1 2 0 2 4
    Enrolment No.: XXXX/XXXXX/XXXXX
    To
    Download Date:06/11/2024

    Bornali Gogoi
    C/O: Lakhya Jyoti Moran
    1 NO TEZI GAON
    VTC: Tezi Gaon No-1
    PO: Kakapathar
    District: Tinsukia
    State: Assam
    PIN Code: 786152
    Issue Date:12/01/2021

    Signature Not Verified


    Digitally signed by
    Sandeep Bhardwaj
    Date: 2024.11.06
    11:45:48 IST

    6220 5359 4432

    Bornali Gogoi Address:


    Download Date:06/11/2024

    Date of Birth/DOB: 20-01-1997 C/O: Lakhya Jyoti Moran, 1 NO TEZI


    Issue Date:12/01/2021

    GAON, Tezi Gaon No-1, PO: Kakapathar,


    Female/ FEMALE
    Dist: Tinsukia,
    Assam, 786152

    6220 5359 4432 6220 5359 4432


    Consent Form Aadhaar holders

    Biometric and/or OTP based eKYC and Aadhaar Authentication

    PAN/ApplicationNo.:
    Q016748129

    Name as per PAN card:760255072247


    BORNALI GOGOI

    Aadhaar number: xxxx-xxxx-4432

    Name as per Aadhaarcard: BORNALI GOGOI

    Declaration:

    I do hereby confirm that the Aadhaar given above has been issued to me by UIDAI. As a
    part of process, the Aadhaar/eKYC data may be used only for the requirement of PAN
    allotment.

    I state that I do not have any objection in authenticating myself with Aadhaar based
    authentication system and I hereby provide my consent to use my Aadhaar number,
    Biometric and/or One Time Password (OTP) data for authentication for the purpose of
    fulfilling the requirement under PAN process.

    I understand that the Biometric and/or OTP provided for Aadhaar authentication /
    eKYC data shall be used only for authenticating my identity through the Aadhaar
    Authentication system for the purpose of only PAN allotment process.

    This is further acknowledged that while submitting through Change Request Form in
    PAN data. If in case, Aadhaar is not linked with PAN then through this process
    Aadhaar will not be linked with PAN i.e. will be used for authentication /eKYC
    purpose only.

    I understand that complete security and confidentiality shall be ensured for my personal
    identity data provided for the purpose of Aadhaar based authentication.

    Date 06/11/2024 Signature / Thumb Impression

    Signature Not
    Verified
    Signed by :BORNALI GOGOI
    Date : 06/11/2024 11:53:43
    Reason : eSign Service
    Location : India

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