Scribd Logo
Upload

Welcome to Scribd!

  • 3 views

    about_blank (18)

    Uploaded by

    Rohit Kamti

    Copyright:

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

    about_blank (18)

    Uploaded by

    Rohit Kamti
    3 views2 pages

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    3 views2 pages

    about_blank (18)

    Uploaded by

    Rohit Kamti

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    You are on page 1of 2

    AADHAAR ENROLMENT

    FORM

    (Aadhaar Enrolment is free &


    भारतीय विशिष्ट पहचान प्राधिकरण भारत सरकार Voluntary)
    Under Section 3 of THE AADHAAR (TARGETED DELIVERY OF FINANCIAL AND OTHER SUBSIDIES, BENEFITS AND
    SERVICES) ACT,2016 (Aadhaar Act)
    Submission Date : 14-12-
    Application Type : Enrolment
    2024
    Applicant Details Appointment Details

    Resident Type: RESIDENT


    Full Name: HUSNERA KHATOON
    Date Of 22-08-2012
    Birth/Age:
    Address C/O Pasida khatun, Kholaibakhtari/
    Tulsinagar, Matigara, Matigara,
    Darjeeling , West Bengal, 734010
    Guardian
    Pasida khatun
    Name:
    Guardian 511837139884
    Aadhaar: Appointment Id: 1734138337840
    Gender: Female Aadhaar Seva Ground floor, Mallar
    Kendra Address:
    Documents to Carry: Mukherjee Building, Holding
    No.22/19/18. S.B. Sarani ward
    no. XI Rajni Bagan(North),
    Bring original documents for
    Enrolment/Update. No photocopy required. Siliguri, West Bengal, Pin-
    Original documents are scanned and given 734001
    back to you. Appointment Date
    14-12-2024 (15:10)
    Carry/Bring appointment print copy. and Time:

    Proof of date of birth:


    Birth Certificate issued by Authorized Authority (in the
    respective States) under the Registration of Births and
    Deaths Act, 1969 read with Registration of Births and
    Deaths Rules 1999/2000/2002 of respective States
    Proof of Birth Certificate issued by Authorized
    relation: Authority (in the respective States)
    under the Registration of Births and
    Deaths Act, 1969 read with
    Registration of Births and Deaths
    Rules 1999/2000/2002 of respective
    States
    I hereby confirm the identity and address of (HOF/Relative Name) (auto populates) as being
    true, correct and accurate.

    HOF s Name: Signature of HOF


    Disclosure under section 3(2) of THE AADHAAR (TARGETED DELIVERY OF FINANCIAL
    AND OTHER SUBSIDIES, BENEFITS AND SERVICES) ACT, 2016
    I confirm that I have been residing in India for at least 182 days in the preceding 12 months / I am Non Resident
    Indian (NRI) & information (including biometrics) provided by me to the UIDAI is my own and is true, correct and
    accurate. I am aware that my information including biometrics will be used for generation of Aadhaar and
    authentication. I understand that my identity information (except core biometric) may be provided to an agency
    only with my consent during authentication or as per the provisions of the Aadhaar Act. I have a right to access my
    identity information (except core biometrics) following the procedure laid down by UIDAI.

    Verifier's Stamp and Signature Applicant's Signature/Thumbprint


    (Verifier must put her/his name if stamp is not avaliable.)

    Note: In case of Child(< 5 Yrs) or Guardian based application, Guardian/Relative will be required to accompany the
    applicant. In case of incapacitated person, the signature will be done by Legal Guardian of Incapacitated Person.

    You might also like