Full Name (As Per PAN)
Date of Birth (As Per PAN)
Gender MaleFemaleOther
Marital Status SingleMarriedDivorcedWidowed
PAN Number (10-character PAN e.g. ABCDE1234F)
Aadhaar-Linked Mobile Number
Email Address
Occupation / Employment Type SalariedSelf-Employed / BusinessRetiredStudentHomemakerOther
City
State Andhra PradeshArunachal PradeshAssamBiharChhattisgarhGoaGujaratHaryanaHimachal PradeshJharkhandKarnatakaKeralaMadhya PradeshMaharashtraManipurMeghalayaMizoramNagalandOdishaPunjabRajasthanSikkimTamil NaduTelanganaTripuraUttar PradeshUttarakhandWest BengalAndaman and Nicobar IslandsChandigarhDadra and Nagar Haveli and Daman and DiuDelhi (National Capital Territory of Delhi)Jammu and KashmirLadakhLakshadweepPuducherry
Annual Income (₹) Below ₹2,50,000₹2,50,000 – ₹5,00,000₹5,00,000 – ₹10,00,000₹10,00,000 – ₹25,00,000₹25,00,000 – ₹50,00,000Above ₹50,00,000