Instructions: ll details tobe filled In Block Letters (fo be vais for 3 months from date of issue) Tobe printed on pin A& paper size; Not requiedto print om letterhead Pare Resident ‘Non-Resident Indian (NRI) [__] New enrotment Update Request sadhaar Number: (Porupdate oni) Full Name: a. J House No, Bldg. Apt: Tia | Street/ Road/ Lane: landmark: ‘Area/ Locality/ Sector: z Vilage/ Town/ city: = Post Office: District: | eens Rect state: | attendee a ios meee i, "Sem x5 098 Sane nd Senter Byte coder, | PIN Code: 8:0 Nor | coventap wn | Sina the Resident rit | ate of sith: “Tham Finer moreso. | rtifier’s Details (To be filled by the certifier Only) | Name ofthe Cetifer: | Designation: Office Address: [ Contact Number: | certify above mentioned details ofthe resident Checklist for Certifier + Tick apprepriate box below) LAnocverwrting [sie date filed L]Resident'ssgnature []oerier's detals 1D) Gotated ofcer- Group & resident's Photos consigned ant eos stamped (paper to photo or photo to rope) (C)oviiiage Panchayat Head or Mukhiya [D7 “Garetted officer -Group 8 (my Muay mic/ Muncipal Councilor tenstaar [Heed of Recognized Educational institution 1 superintendent/ Warden/ Matron/ Head of Institution (of Recognized shelter homes/ Orphanages DD ero officer ‘Signature & Stamp of the Certer [NOTE: This format Is aplieable for PO! documents tS. Nos. 17, 20,22, 22,31 & 32; POA documents ats. NOs. 23,28, 37, 448.45; POR documents at Sl. Nos. 13,Unique Identification Authory of india Government of nda Under Seton of THE AAOMAAR (TARGETED DELIVERY OF FINANCIAL AND OTHER SUBSIES, AX. ARDHAAR fFTS AND SERVICES ACT, 206 Aadhaae At) AADHAAR ENROLMENT/ CORRECTION/ UPDATE FORM ‘Aadhoor Enrolment and Mandatory Blometric Upéate ls fre. No charges are applicable for Form. Incase of Corretion/ Update, provide your Aadhaor Number (iO), Full Name and only that field which needs Correction/ Update. CO Resident. 1) Non-Resident indian (NRI*) Please follow the instructions overleaf while fling up the form. Use capital letters only. Pre Enrolment ID (if applicable): In case of Update provide Aadhaar Number (UID): I 2 a | (clamnere en scar ears ras cae Late of sith CJaddress Came Dcender Femail i oon cee [a Te Address: C/o House No./ Bldg./ Apt: Street/ Road/ Lane: Landmark: Area/ Locality/ Sector: i Village/ Town/ City: Post Office: Details of: [Father [Mother C]cuardian [Husband LJwife eee ag Sees eee Cn ce Y Name: EID/ Aadhaar No. Verification Type: [Jdocument Based introducer Based [-JHead of Family (HoF) Based 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 incase of Document based verification 8 | For Document Based wre nome: ofthe document produce. eer vere of thi fom fort of ald documents) a Pol b. POA DOB (iendetry incase of Verified Date of Bit) d. POR (andar in as of No based Earolent/ Ud) For Introducer Based - Introducer’s ‘Aadhaar No.: For HoF Based Dewi of [Father []Mother [Jovardian [Jpustard L]wie HoF’s EID/ Aadhaar No..: hereby confirm the identity and address of Introducer/ HoF’s Name: as being true, correct and accurate. Signature of Introducer/ HoF Disclosure under section 3(2) of THE AADHAAR (TARGETED DELIVERY OF FINANCIAL AND OTHER SUBSIDIES, BENEFTS AND SERVICES) ACT, 2016 confirm that have Been residing In Ind for at 2st 182 days in the preceding 12 months / 1 am Non Resident Inala (NRI) & information (including biometrics) Brovided by me tothe UIDA Is my own and is rue, correct and accurate. | am aware that my information including biometrics wil be used for generation of Aadhaar ‘and authentication. | understand that my Identity information (except core biometric] maybe provided to an agency only with my consent during authentication or a5 er the provisions ofthe Aachaar Act. haves right to access my identity information (except core Biometrics) follwing the procedure ald down by UIDAl. Verifier’ Stamp and Signature: (Veriter must put his/her Name, stamp snot avalabie) Tobe file by the Enrolment Agency only ‘Aplicant'ssignature/Thumbprnt Date & me of Enrolment: Noten cas of mins the lature wil be done by prest/avordn. Incase Icapctated person the signature il be done by Lege! Guardin of eapacted Person “Incas of MR ony non Psspor wil be vai os POL