AADHAAR ENROLMENT / CORRECTION FORM AS. ‘Aadhoar Enrolment is free and voluntary. Correction within 96 hours of enrolment is also free. No charges are applicable for Form and Aadhaar Enrolment. Incase of Correction provide your EID, Name and only that field which needs Correction. Incase of Correction provide your E1D No here: Please follow the instructions overleaf while filing up the form. Use capital letters only. 1 | Pre-Enrolment ID: 2 | NPR Receipt/TIN Number = 3 | Full Name ‘Age: Yrson Date of Birth: 4 | Gender: Male() Female ( ) Transgender ( } 5 Declared Cy Verihed 6 | address: C/o() D/o()S/o() W/o() H/o() House No/ Bidg./Apt. Street/Road/Lane Landmark Area/locality/sector Village/Town/City Post Office District Sub-District State E Mail Mobile No PIN CODE 7_| Details of: Father( ) Mother { ) Guardian () Husband () wife () For chlarn below 5 yar Fah ater/Curdo’ deta are manta, Aus can op at pe hs iormatn te annt/so not want tose Name EID/ Aadhaar No. @ | Ihave no objection to the UIDAI sharing information provided by me to the UIDAI with agencies, engaged in delivery of welfare services. ves() NO() 99 | Select One of the Below (OPTIONAL) { This data cannot be Corrected after Enrolment) 1 Iwant the UIDA\ 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 1 thave no objection to linking my present bank account provided here to my Aadhaar number State Bank Name/Branch IFSC Code 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. 10 | For Document Based (write Names of he documents produces, ler backside of his form for st of abd documents} a. PO! b. POA funn fee nt POR For Introducer Based — Introducer’s For HOF Based - Details of: Father} Mother{ ) Guardian ( ) Husband () wife () aa | Fornerone HoF’s Eld/Aadhaar No. Thereby confirm the identity and address of as being true, correct and accurate. Introducer/HoF’s Name: Signature of Introducer/HOF Consent | 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, Applicant's signature/Thumbprint Verifier’s Stamp and Signature; (verter must putinfher Name tmp erat vase) Tobe filed bythe Enrolment Agery ony Date & time of ratmenInstructions to follow while filling up the enrolment form N's uot pty ge aloo am Fraser Poet NAME Resident's Pol reads “Pree, then “Pit” can be recorded i Resident wars 0. maa Fis ir ODN YY To Oe Be pie os a in Sep Pi Sg ac PO a wr ar sb ny ane old DOB) AGE _proof of Date of Binh document. Verified chackoax is selaciag whare Resident has provided documents as proof of Date of birth. ee case ‘Melts. ADDRESS |* Minar Coractions ! Enhancements are permissible lo make the address complete withoul abating the base address as menoned in the POA > fran iin ja Trace wot aan Sain ass EO = reat Spt dn hy ery el Fld 8 /unailirgness by selecting he relevant box. ras Feta pec een hg tee a ras Tea os op a ev ta wb ink POR ser oni i aka ata abt a Bank accounT | aml ooo a Thea dws a om pa TR ae Fey ape TUG TT DOCUMENTS _Vald Ist of documents, please refer Ist of Documents bel. INTRODUCERHoE | ur da UTA, P01 documents TH, POR dosumenis > Bate © Bett et SSeS 5: Rao rs ca & MOEN Eureston |. Setaecrcna pw sty Bate ¢ is iowa f: Gaetan pce wiepide | Bartle 24 Co aces ey ig Pet 1 fetta sonvortrenin fat a hoe St Pec 1, Pepe racacitirdalrton3 res. Seo ie Pn dy 5 Seton on aw me Sera seen 1. Sling ety mon | arr ptt ent) 7. Seteaettonsevgsimity | Seer areata 2 Stones linac Otorarowts asta’ | w.cytarit tnenty oman |. rbot tino tit) 1s btn atid oi sso tne Srmaaa Misuse FB cos 7 ain catae 5 GGistaetommnecisese || 2 S.CBinCatiae Males etl ote of dy Gu A CantedOexrn ated 4 5. Amy Canoe Cad 8 Pastor % nist byRegearcten, | Mlstration for filing up EID No. Nara Capron and obra al otonagennt meen op, sa ome — governess ie Tab Teh a ony on en 1 Rryoher Conan governed in Hm [a soa 0008123450002 “instances where orginal documents ae not aalable copes testes / certified by 2 pubte notary /geeted oer willbe zecepted, 28 O% 20 IS SO 16