Select Correction Type

Tick BoxNameDate of BirthGenderAddressContact DetailsFather’s NameMother’s Name

Permanent Account Number (PAN) *0 / 10

Aadhaar Number *0 / 12

PART A – Personal Information

First Name

Middle Name

Last Name *

Date of Birth *

Day *

Month *

Year *

Gender (select one) *MaleFemaleTransgender

Communication AddressResidence AddressRepresentative Assessee AddressOffice Address

Residence Address *Flat/Door/Building

Road/Street/Block/Sector *

Post Office *

Area/Locality/Town/City *

District *

PIN / ZIP CODE *0 / 6

State/Union Territory *–Select–Andhra PradeshArunachal PradeshAssamBiharChhattisgarhGoaGujaratHaryanaHimachal PradeshJharkhandKarnatakaKeralaMadhya PradeshMaharashtraManipurMeghalayaMizoramNagalandOdishaPunjabRajasthanSikkimTamil NaduTelanganaTripuraUttar PradeshUttarakhandWest BengalAndaman and Nicobar IslandsChandigarhDadra and Nagar Haveli and Daman and DiuDelhiJammu and KashmirLadakhLakshadweepPuducherry

Contact Details *0 / 10

Email ID *

Office Address

Residence AddressFlat/Door/Building

Road/Street/Block/Sector

Post Office

Area/Locality/Town/City

District

PIN / ZIP CODE0 / 6

State/Union Territory *–Select–Andhra PradeshArunachal PradeshAssamBiharChhattisgarhGoaGujaratHaryanaHimachal PradeshJharkhandKarnatakaKeralaMadhya PradeshMaharashtraManipurMeghalayaMizoramNagalandOdishaPunjabRajasthanSikkimTamil NaduTelanganaTripuraUttar PradeshUttarakhandWest BengalAndaman and Nicobar IslandsChandigarhDadra and Nagar Haveli and Daman and DiuDelhiJammu and KashmirLadakhLakshadweepPuducherry

PART B – Details of Parents

Father’s First Name

Father’s Middle Name

Father’s Last Name *

Mother’s First Name

Mother’s Middle Name

Mother’s Last Name *

Name of parent to be printed on Permanent Account Number card (select one)FatherMother

CapacitySelfRA

Date

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