A PAN change declaration is signed by an employee to correct or update the PAN held in payroll records. Accurate PAN is essential for TDS deduction, TDS returns and Form 16, so HR uses this declaration before changing the PAN in payroll.
I, [Employee Name], [Designation], [Department], request that my PAN be updated in the company's payroll records as below.
Detail
As in Company Records
Correct / New
PAN
[Old PAN]
[New PAN]
Name as on PAN
[Name]
[Name]
Date of Birth as on PAN
[DD/MM/YYYY]
[DD/MM/YYYY]
Reason
Typing error in records
Name change reflected in new PAN
PAN obtained after joining
Other: [Specify]
PAN linked with Aadhaar (Yes / No / In process)
Effective from Payroll Month
Attachment: copy of PAN card
Payroll Use
PAN verified online on [Date]
Updated in payroll and TDS records
Prior quarter TDS correction required (Yes / No)
Privacy notice: [Company Name] collects the details on this page only for deducting and reporting TDS and issuing Form 16 under your correct PAN. Access is limited to authorised HR staff, and the record will be kept for the statutory period for tax and payroll records, after which it will be securely deleted or destroyed. You may ask HR to see or correct your data, consistent with the Digital Personal Data Protection Act, 2023.
Declaration
I declare that the PAN given above is mine and correct, and that I hold no other PAN. I understand the consequences of furnishing incorrect PAN.
I hereby cancel my earlier nomination(s) for the benefits ticked below and nominate the following person(s).
Gratuity
Group term life insurance
Group personal accident insurance
Unpaid salary, leave encashment and other dues
Other: [Specify]
Nominee Name
Relationship
Date of Birth
Address
Share (%)
Guardian (if minor)
[Name]
[Relationship]
[DD/MM/YYYY]
[Address]
[%]
[Guardian Name / NA]
[Name]
[Relationship]
[DD/MM/YYYY]
[Address]
[%]
[Guardian Name / NA]
[Name]
[Relationship]
[DD/MM/YYYY]
[Address]
[%]
[Guardian Name / NA]
Note: For Provident Fund, I will file or update my e-nomination through the EPFO member portal using my UAN.
Privacy notice: [Company Name] collects the details on this page only for paying benefits and dues to your nominees. Access is limited to authorised HR staff, and the record will be kept for the duration of employment and until all dues are settled, plus the retention period, after which it will be securely deleted or destroyed. You may ask HR to see or correct your data, consistent with the Digital Personal Data Protection Act, 2023.
Call-back done on registered mobile on [Date] by [Name]
Penny-drop / test credit successful (if used)
Updated in payroll from [Month YYYY]
Privacy notice: [Company Name] collects the details on this page only for crediting your salary and reimbursements. Access is limited to authorised HR staff, and the record will be kept for the duration of employment and the statutory retention period for payroll records, after which it will be securely deleted or destroyed. You may ask HR to see or correct your data, consistent with the Digital Personal Data Protection Act, 2023.