GOVERNMENT OF PUNJAB/

AADHAAR ENROLMENT / CORRECTION FORM /

Aadhaar Enrolment is free and voluntary. Correction within 96 hours of enrolment is also free. No charges are applicable for Form and Aadhaar Enrolment. In case of
Correction provide your EID, Name and only that field which needs Correction.
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In case of Correction provide your EID No here:

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Please follow the instructions overleaf while filling up the form. Use capital letters only. |

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Pre-Enrolment ID/ :

NPR Receipt/TIN Number/.. / :

Gender: Male ( ) Female ( ) Transgender ( )

Age/:

Full Name/ :

: ( ) ( ) ( )

Address/: C/o/( ) D/o/ ( ) S/o/ ( ) W/o/ ( ) H/o/ ( ) NAME

Yrs/ OR/ Date of Birth/ : |DD|MM|YYYY|

Declared/
Verified/

House No/Bldg./Apt./ / :

Street/Road/Lane///:

Landmark/ :

Area/locality/sector/ //:

Village/Town/City/ //:

Post Office/:

District/:

Sub-District/-:

E Mail/ :

Mobile No/ :

State/:

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PIN CODE/ : |

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Details of/: Father/ ( ) Mother/ ( ) Guardian/ ( ) Husband/ ( ) Wife/ ( )

For children below 5 years Father/Mother/Guardians details are mandatory. Adults can opt to not specify this information, if they cannot/do not want to disclose.
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Name/

EID/ Aadhaar No.// : |

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I have no objection to the UIDAI sharing information provided by me to the UIDAI with agencies engaged in delivery of welfare services
UIDAI UIDAI |

( )/ ( )

Select One of the Below (OPTIONAL) (This data cannot be Corrected after Enrolment) ( )/( )
I want the UIDAI to facilitate opening of a new Bank/Post Office Account linked to my Aadhaar Number and have no objection to sharing my Information for
this purpose./ / / |
I have no objection to linking my present bank account provided here to my Aadhaar number.
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State /

Bank Name/Branch/ /

IFSC Code/IFSC

Account No./

Verification Type/ : Document Based/ ( ) Introducer Based/ ( ) Head of Family/ ( )

Select only one of the above. Select Introducer or Head of Family only if you do not possess any documentary proof of identity and/or address. Introducer and Head of Family
details are not required in case of Document based Verification./ | /
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For Document Based/

(Write Names of the documents produced. Refer back side of this form for list of valid documents/ | )

a. POI/ :
c. DOB/ :

(Mandatory in case of Verified Date of Birth)/ ( )

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For Introducer Based Introducers Aadhaar No.

-

b. POA/ :
d. POR/ :
For HoF Based/ : Details of/: Father/ ( ) Mother/ ( )
Guardian/ ( ) Husband/ ( ) Wife/ ( )
HoFs EId/Aadhaar No./ / :

I hereby confirm/ _________________________________________________________________ the identity and address of as being true, correct and
accurate./ |

Introducer/HoFs Name:
/ :

Signature of Introducer/HOF
/ :

Consent/
I confirm that information (including biometrics) provided by me to the UIDAI and the information contained herein is my own and is true, correct and accurate. /
UIDAI (Biometrics ) |

Verifiers Stamp and Signature/ :

(Verifier must put his/her Name, if stamp is not available)

Applicants signature/Thumbprint
/

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To be filled by the Enrolment Agency only
:

Date & time of Enrolment

:

KYR+ Information/ . . .
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LPG GAS Connection

Name of Distributor

LPG Company

Customer No.

. . .

. . .

Ration Card

Card No.

No. of family members

FPS Licence No.

Head of the family

.../...

Blue Card

Card No.

No. of family members

FPS Licence No.

Head of the family

AAY/BPL/APL/.../

Enrolment/UID No. of Head of the family/ /...

3.
4.
5.

Relation with the Head of the Family/

Driving Licence

Licence No.

Issuing Authority

Date of Issue

Arms Licence

Licence No.

Issuing Authority

Date of Issue

Pensions

PLA No.

Issuing Authority (District)

...

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Instructions to follow while filling up the enrolment form/

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