Pies eee eee Inconel edn oc ates (ibe vei for ror fom doef se) Tobe pred onplan Ad pepe: Notreuted to prt itera Resident Non-Resident indian (NR) New tnvolment Udit Request Andina Number (Fer usdste ony cle: House No./ Bldg./ Apt: Street/ Road Lane: Landmark ‘rea/Locality/ Sector: Village/ Town/ Cty: Post office: District: esos acne state: Cour Poet ‘sem x45 cm bythe corer PIN Code: na:oo wor Date of Birth: Seed ete Certifier’s Details (To be filled by the certifier Only) Name ofthe Cortier: Designation: Office Address: Contact Number: | hereby certify above mentioned detals ofthe resident ‘Checklist for Corifier and | ar ai (Tec oppropriate bx Blom) Llriooverwniting Cisvediteistites C] esisersstnsture C]certers deal Gazetted Offcer Group A resident's Phat is cross sgned and cross stomped fpaer to phat ar photo ta paper village Panchayat Head or Mokiya Gazetted Officer - Group 8 MP/ MUAY MLC/ Muncipal Councilor Tebsildar Head of Recognized Ecveational Institution Superintendent/ Warden/ Matron Head of Institution lof Recognized shelter homes/ Orphanages PFO Officer oo0o00000 o NOTE: This formats applicable for POI documents 2S Nos.17, 20, 21,22, 31 & 32; POA documents at Sl. Nos 23,24, 37,38, 44 8 45; POR documents 3 Nos. 13 {444 B08 documents 3S Nos. 4,5, 14 15 of Sehecua ofthe AadraarfEnrlmant and Updst)Ragulators, 2016, a amend fem sim to tne.