‘SELF DECLARATION APPLICABLE FOR UPDATION IN DOB UNDER EXCEPTION HANDLINGPROCESS — ONCE IN LIFETIME )- os | JUNAID S/D/Wio JAVED resident of NEAR NEW MASJID, SHAIKHZADGAN, POST-TITRON, DISTRICT-SAHARANPUR, STATE-UTTAR PRADESH, PINCODE-247343 holding Aadhaar No (Last eight digits only XXXx/4304/5974, do hereby solemnly affirm and declare as und i That the deponent is the resident of the above said address. ji, That the correct date of birth of the deponent is 12-NOV-2004 and the date of birth of the deponent is wrongly mentioned in the Aadhaar Card bearing Aadhaar No. 3107 4304 5974 as 12-NOV-2001 ii, That the deponent wants to get his /her date of birth updated in the Aadhaar Card as 12-NOV-2004 instead of 12-NOV-2001 even after utilizing the one- time option for DOB update, or which the deponent is submitting MARKS SHEET as document proof iv. That the Date of Birth in the Aadhaar Card of the deponent was not correct earlier. v. That the deponent further declares that no document in support of proof of birth was submitted by him/her at the time of Aadhaar Enrolment. However, if so submitted, the document submitted at the time of updation is not the same as the one submitted at the time of Aadhaar Enrolment. 2. __ Kindly select whichever are applicable 'SI_No. - Parameter Selection {y | Current DoB update request is the 1¥ request for DoB | update (i) |Current DoB update request is second (or greater) v request for DoB. | Date of birth mentioned in the Aadhaar Card at the time of | (ii) | Aadhaar Enrolment was declared /approximate and was not verified Date of birth mentioned in the Aadhaar Card at thetime: | (v) | of Aadhaar Enrolment was verified and was not declared / approximate. | 3, That the undersigned undertakes that if the document submitted in proof of date of birth is found to be fraudulent/falsetforged/non-genuine, the corresponding Aadhaar number may be deactivated as per Rule 28 of the Aadhaar (Enrolment and Update) Regulations, 2018. 4, | hereby declare that all the information mentioned above is true to the best of my knowledge and belief. In case of any discrepancy if arises, the undersigned will be personally held responsible. Je Date: 02/12/2022 JUNAID Name & Signature of Resident [Parent/Guardian in case of Minor (Below 18 year's of age)]Sovt. ils India S STATEMENT-CUM- a5 ee amet woven ne To MeLSHOFD ‘OUR UTTAR PRADESH 128 obtained the marks as mentioned below: £ ca - __urates_-MARKS OBTAINED — waanricuees (Raiteenlareittre: [rere] gat | Be tame a) | Theory Practical] TMA |Total| TOTAL MARKS IN WORDS: 46 24SYC TWEN’ a