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ENROLMENT
AADHAARI EnrolmentNumber:
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FORM (~'tf?f)
Date (~) DO DO
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Fields marked in * are mandatory (~

I PART A: PRIMARY DETAILS (cti) ~

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I. Name<mf: 2.0

000000000000000000000000000000 000000000000000000000000000000 MotherO Father 0 Husband OOuardian's Name 000000000000000000

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3. Date of Birth DO

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4. Gender:

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5. For childrenbelow 5 years of age, Name of Mother IF atherl Guardianis mandatory. ~ CIli ~ ~ ~ i\; ~ i\; f<:rlt lffifT/ fq-ffi / ~ ~ ';fIl{ ~ ~

o Mother0 FatherO~~::i:an'S 000000000000000000000000

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6. ResidentialAddress : ~

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c/o.: DDDDDDDDDDDDDDDDDDDDDDDDDDDDDD

0000000000000000000000000 StreetNo. and Name: 0000000000000000000000000 ~ /m:i't ;:iaR am: Landmark:0000000000 Village/Towm: DDDDDDDDDDDDDDD District:0000000000 State:DDDDDDDDDD Pin Code: 000000 ftrw ~ fQ;{~
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PART B: ADDITIONAL INFORMATION I

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7. Ph?ne No.lMobi~e No.:

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Client ID DDDDDDDD

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00000000

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FINANCIAL INFORMATION 1(11')

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9.0 I wantto link my existingBankAle to AADHAARand ihave no objectionon this issue.

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10. I hereby declarethat the above detailsprovided by me are authenticand correctto the best of my knowledgeand belief. .q ~ cron/~ ~";3'tR fu1!ft ~ -it =tf ~ wrl~ am:.~ i\; ~ ~ ~ ~

Receivedby Name: Signatureand Date : ~ ~ <mf, ~&R

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Supporting documents acceptable as Photo Identity

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 1I. 12. 13. 14. 15. 16. 17. Passport PAN Card Ration/ PDS Photo Card Voter TD Driving License Government Photo ID Cards NREGS Job Card Photo ID issued by Recognized Educational Institution AnllS License Photo Bank ATM Card Photo Credit Card Pensioner Photo Card \ Freedom Fighter Photo Card Kissan Photo Passbook CGHS / ECIIS Photo Card Address Card having Name and Photo issued by Department of Posts Certificate of Identify having photo issued by Group A Gazetted Officer on letterhead

I. 2. 3. 4. 5. 6. 7.

.8.
9. 10. II.

12.
13.

14.
IS. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29.

Passport Bank Statement/ Passbook Post Office Account Statement/Passbook Ration Card Votcr ID Driving License Governmcnt Photo ID cards Electricity Bill (not older than 3 months) Water bill (not older than 3 months) Telephone Landlinc Bill (not older than 3 months) Propcrty Tax Receipt (not olqcr than 3 months) Credit Card Statement (not oldcr than 3 months) Insurance Policy Signed Lcttcr having Photo from Bank on lettcrhead Signed Letter having Photo issued by registcred Company on letterhead Signcd Lettcr having Photo issucd by Rccognized Educational Instruction on letterhead NREGS Job Card Arms License Pcnsioncr Card Frcedom Fighter Card Kissan Passbook CGHS / ECHS Card Certificate of Addrcss having photo issued by MP or MLA or Group A Gazetted Officer on letterhead Certificatc of Addrcss issued by Village Panchayat head or its equivalent authority (for rural areas) Income Tax Assessmcnt Order Vchicle Registration Ccrtificate Rcgistered Sale / Leasc / Rent Agreement Addrcss Card having Photo issued by Department of Posts Caste and Domicile Ccrtificate having Photo issued by State GovL

Supporting documents acceptable as Date of Birth

I. 2. 3. 4. Birth Certificate SSLC BookiCeltificate Passport Certificate of Date of Birth issued by Group A Gazetted OffIcer on letterhead