Hkkjrh; fof'k"V igpku iz kf/kdj.

k
;kstuk vk;ksx] Hkkjr ljdkj

;g vkosnu i= fu%'kqYd gS

i;k ,d ckj gh ukekadu djk;s

PLEASE ENROL ONLY ONCE

THIS ENROLMENT FORM IS FREE

uksV % i;k Li"V v{kjksa esa Hkjas Note : Please use CAPITAL letters
fnukad% Date % _ _ / _ _ / _ _ _ _
Hkkx d & izkFkfed tkudkjh Part A Primary Details

uke: Name: ______________________________________________________________________________________________

tUe frfFk% _ _ / _ _ / _ _ _ _

;fn ugha irk] mez% _ _ _

tUe frfFk nLrkost+ksa ds fy, lwph ihNs ns[ksa ___________________________

Date of Birth: _ _ / _ _ / _ _ _ _

If not known, Age: _ _ _

Date of Birth Document (List overleaf) _______________________________

fyax%

iq#"k

L=kh

vU;

Gender:

Male

Female

Transgender

vkoklh; irk% Residential address:

c/o: _______________________________________________________________________________________________________________

?kj dk uEcj vkSj uke% House No. and Name: ______________________________________________________________________________

___________________________________________________________________________________________________________________

eksgYyk@xyh uEcj vkSj uke% Street No. and Name: _________________________________________________________________________

___________________________________________________________________________________________________________________

eq[; igpku% Landmark: _______________________________________________________________________________________________

xzke@kgj% Village / City: ______________________________________________________________________________________________
ft+yk% District: ______________________________________________________________________________________________________
jkT;% State: ______________________

fiu dksM% Pin code:

Hkkx [k & lR;kiu Part B - Verification

igpku izek.k nLrkost+% Proof of Address Document:
(lwph ihNs ns[ksa% List Overleaf)
;k@or
igpkudkkZ dk uke%

vkokl izek.k nLrkost+% Proof of Identity Document:

lwph ihNs ns[ksa% List Overleaf)
igpkudkkZ ;k ifjokj ds eqf[k;k dk bZvkbZMh ua0@vk/kkj ua0%

Introducer Name:
_______________________________________________

Introducer or Head of Family's EID No./Aadhaar No.:

_________________________________________________________________

;k@or
ifjokj ds eqf[;k dk uke% Head of Family Name:

laca/k ds nLrkost% Relationship Document:

_______________________________________________

_________________________________________________________________

(vuqnsk ihNs ns[ksa% Instructions Overleaf)

ekrk
firk

ifr

(lwph ihNs ns[ksa% List Overleaf)

vfHkHkkod dk uke

Husband

Guardian's Name

Mother

Father

5 o"kZ ls de mez ds cPpksa ds fy;s ekrk@firk@vfHkHkkod dk uke vfuok;Z gS

(Name of Mother/Father/Guardian is must for children below 5 years of age)

Hkkx x & vU; tkudkjh Part C - Additional Information

Qksu uEcj @ eksckby uEcj bPNk/khu% Phone No. / Mobile No. (optional): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
bZesy bPNk/khu% Email (optional): ________________________________________________________________________________________
tkudkjh lk>k djuk% Information Sharing Consent :
gk% Yes
uk% No
Hkkx ?k & fokh; tkudkjh Part D - Financial Information
eSa vk/kkj uEcj ls tqMk cSad [kkrk [kksyuk pkgrk@pkgrh gwA
I want to open UID enabled bank A/c.

eSa pkgrk@pkgrh gw fd esjs orZeku cSad [kkrs dks vk/kkj uEcj ds lkFk tksM+ fn;k tk, ,oa blesa eq>s dksbZ vkifk ugha gSA

cSad dk uke o kk[kk% Bank Name and Branch ______________________________________________________________________________

[kkrk la[;k% A/c No. ______________________________________________________

Version 1.1

I want to link my existing bank A/c to Aadhaar Number and I have no objection on this issue.

bu ckrksa dk /;ku j[ksa

Important Points to Remember

vk/kkj uacj izkIr djuk fu%'kqYd gS&QkWeZ] QksVksdkWih] iathdj.k izf;k vFkok igpkudrkZ lsok ds fy, fdlh dks iSls u nsaA
The Aadhaar Enrolment process is completely free. Please dont pay anyone for any services like obtaining/filling form, photocopy, enrolment process or
help of introducer./

vk/kkj uacj thou esa ,d gh ckj feysxk&nksckjk iathdj.k u djk,saA

Aadhaar is issued only once in your lifetime. Please do not apply for a second Aadhaar number.

vk/kkj lcds fy, gS&uotkr f'k'kq ls ysdj fdlh Hkh vk;q ds O;fDr ds fy,&viuk vkSj vius ifjokj ds lHkh lnL;ksa dk iathdj.k djok,saA
Aadhaar number is for everyone from newborns to persons of any age. Get your whole family enrolled.

iathdj.k ds le; cSad [kkrk [kksyus] vius eksckby uacj ;k cSad [kkrk uacj dks vk/kkj ls tksM+us vkSj ^MkVk 'ks;fjax* ds fy, viuh lgefr dks lkQ&lkQ
izdV djsaA
Clearly express your CONSENT for opening of bank account, linking your bank account or mobile number with Aadhaar and data sharing.

i;k izkfIr jlhn dks iqu% tkp ysA ;fn dksbZ Hkh xyrh ut+j vk, rks 48 ?kaVs ds Hkhrj vkWijsVj ls lEidZ djsaA
Please recheck your entries in the acknowledgement slip. In case of any error, please let the operator know within 48 hours of enrolment.

i;k izkfIr jlhn dks lqjf{kr j[ksaA Hkfo"; es lanHkZ ds fy, iathdj.k vkbZ Mh ekad dk iz;ksx djsaA
Please keep the acknowledgment slip safely. You can use the Enrolment ID (given in acknowledgment slip) for future reference.

iathdj.k ds ckn Mkd }kjk vk/kkj i= vkus esa 90 fnuksa dk le; yx ldrk gSA
After enrolment your Aadhaar letter can take up to 90 days to reach you by post.

igpku izek.k nLrkost+ List of Documents for Vefifying Proof of Identity

1.
2.
3.
4.
5.
6.

ikliksVZ Passport
isu dkMZ PAN Card
jk'ku dkMZ@ihMh,l QksVks okyk dkMZ Ration/PDS Photo Card
oksVj vkbZ-Mh- Voter ID
Mkbfoax ykblsal Driving Licence
ljdkjh QksVks vkbZ-Mh- dkMZ Government Photo ID Cards/Service Photo

7.
8.
9.
10.
11.
12.
13.
14.
15.
16.

,e-th- jkst+xkj xkjaVh dkMZ eujsxk NREGS Job Card

ySVjgSM ij ekU;rkizkIr f'k{k.k laLFkku }kjk tkjh gLrk{kfjr i= QksVks
ds lkFk Photo ID issued by Recognized Educational Institution
'kL= ykblsal Arms Licence
QksVks okyk ,Vh,e dkMZ Photo Bank ATM Card
QksVks okyk sfMV dkMZ Photo Credit Card
QksVks okyk iSa'kuj dkMZ Pensioner Photo Card
QksVks okyk Lora=rk lsukuh dkMZ Freedom Fighter Photo Card
QksVks okyh fdlku iklcqd Kissan Photo Passbook
QksVks okyk lhth,p,l@bZlh,p,l dkMZ CGHS/ECHS Photo Card
Mkd foHkkx }kjk tkjh vkokl izek.k i= QksVks ds lkFk Address Card

17.

ySVjgSM ij xtsfVM vkWfQlj }kjk tkjh gLrk{kfjr i= QksVks ds lkFk

identity by PSU.

having Name and Photo issued by Department of Posts

Certificate of Identify having photo issued by any Gazetted Officer on
Tehsildaron letter head

tUefrfFk izek.k nLrkost+ List of Documents for Vefifying DoB

1.
2.
3.
4.

tUe izek.k i= Birth Certificate

ek/;fed fo|ky; NksMus dh fdrkc@izek.k i= SSLC Book/Certificate
ikliksVZ Passport
ySVjgSM ij xtsfVM vkWfQlj }kjk tkjh gLrk{kfjr tUe frfFk dk izek.k
i= Certificate of Date of Birth issued by Group A Gazetted Officer on
letterhead

ifjokj ds eqf[k;k ds igpku izek.k nLrkost+

vkokl izek.k nLrkost+ List of Documents for Vefifying Proof of Address

1.
2.
3.

ikliksVZ Passport
cSad LVsVeSaV@iklcqd Bank Statement/Passbook
iksLV vkWfQl ,dkmaV LVsVeSaV@iklcqd Post Office Account Statement/

4.
5.
6.
7.
8.

jk'ku dkMZ Ration Card

oksVj vkbZ-Mh- Voter ID
Mkbfoax ykblsal Driving Licence
ljdkjh QksVks vkbZ-Mh- dkMZ Government Photo ID Cards
fctyh dk fcy 3 eghus ls iqjkuk ugha Electricity Bill (not older than 3

9.

ikuh dk fcy 3 eghus ls iqjkuk ugha

Passbook

months)

10.

VsyhQksu ySaMykbu fcy 3 eghus ls iqjkuk ugha Telephone Landline Bill

11.

laifk dj jlhn 3 eghus ls iqjkuk ugha Property Tax Receipt (not older

12.

sfMV dkMZ LVsVeSaV 3 eghus ls iqjkuk ugha Credit Card Statement (not

13.
14.

chek ikWfylh Insurance Policy

ySVjgSM ij cSad }kjk tkjh gLrk{kfjr i= QksVks ds lkFk Signed Letter

15.

ySVjgSM ij jftLVMZ dEiuh }kjk tkjh gLrk{kfjr i= QksVks ds lkFk

(not older than 3 months)

than 3 months)
older than 3 months)

having Photo From Bank on letterhead

Signed Letter having Photo issued by registered Company on
letterhead
16.

ySVjgSM ij ekU;rkizkIr f'k{k.k laLFkku }kjk tkjh gLrk{kfjr i= QksVks

ds lkFk Signed Letter having Photo issued by Recognized Educational

17.
18.
19.
20.
21.
22.
23.

,e-th- jkst+xkj xkjaVh dkMZ eujsxk NREGA Job Card

'kL= ykblsal Arms License
iSa'kuj dkMZ Pensioner Card
Lora=rk lsukuh dkMZ Freedom Fighter Card
fdlku iklcqd Kissan Passbook
lhth,p,l@bZlh,p,l dkMZ CGHS/ECHS Card
ySVjgSM ij laln lnL; ;k oxZ ^A* xStsfVM vf/kdkjh }kjk tkjh vkokl
izek.k i= QksVks ds lkFk Certificate of Address having photo issued by

24.

xko ljiap ;k mlds rqY; izkf/kdkj }kjk tkjh vkokl izek.k i= xzkeh.k
{ks= ds fy, Certificate of Address issued by Village Panchayat head or

25.
26.
27.

vk;dj ewY;kadu vkWMZj Income Tax Assessment Order

okgu jftLVs'ku lfVZfQdsV Vehicle Registration Certificate
jftLVMZ lsy @ yht+ @ jsaV ,xfjesaV Registered Sale / Lease / Rent

28.

Mkd foHkkx }kjk tkjh vkokl izek.k i= QksVks ds lkFk

Instruction on letterhead

List of Documents for Vefifying Head of Family

1.
2.
3.
4.
5.
6.
7.

lkoZtfud fokj.k iz.kkyh dkMZ PDS Card

,e-th- jkst+xkj xkjaVh dkMZ eujsxk MNREGA Job Card
lhth,p,l@ jkT; ljdkj@ bZlh,p,l @ bZ,lvkbZlh esfMdy dkMZ
CGHS/State Government/ECHS/ESIC Medical Card
iSa'ku dkMZ Pension Card
lsuk dsUVhu dkMZ Army Canteen Card
ikliksVZ Passport

dsUnzh;@jkT; ljdkj }kjk tkjh ifjokj ntkZ nLrkost+ Any other Central/
Mkd foHkkx }kjk tkjh irk dkMZ ftlesa uke ,oa QksVks gks
having Name and Photo issued by Department of Posts

MP or MLA or Group 'A' Gazetted Officer on letterhead

its equivalent authority (for rural areas)

Agreement

State Government issued family entitlement document

8.

Water Bill (not older than 3

months)

Address card

Address Card

having Photo issued by Department of Posts

29.

jkT; ljdkj }kjk tkjh tkfr ,oa vf/kokl izek.k i= QksVks ds lkFk

Caste and Domicile Certificate having Photo issued by State Govt.

Gas Connection Bill (not older
than 3 months)
31. ifr dk ikliksVZ Passport of Spouse
32. vfHkHkkod dk ikliksVZ vxj ukckfyx gks rks Passport of Parents (in
case of minor)
30.

xsl laca/kh fcy 3 eghus ls iqjkuk ugha