Gilad eee rare) Instructions ‘All etal tobe fled in Block eters Yaa (Tob vad for 3 months rom doteof issue) [ee Be) Gt Gel = Non-Resident indian NR) New Enrolment pate Request emer 1 Bl 7 bs. faname: (punt THA Vv Cr WMENKATESAN & House No./ Blde,/ Apt: | 4. “7 Stroet/Road/ Lane: RUMAL ROjL STREET Landmark: ANNBNWHG PIR cio Cow y aaloanmisecor [TF ROAD. vaermmnvor — [VY ANTIYANCHATHRAM . nec [ALAM ATA) Dist THIRUVALL @ state: TAmiL_ Anu: PI coe: 6 O8HEo J 27 (66 JL1997. Peete. Nameottneceniter [MM . Lak S @ mo i Designaton: [PAtseoeanT | kar 4epucibn oce Address: WE CCHGe Ppeciteg ef Cl sr Contact Number: FRO os On ‘ray ceraysbov mentioned state othe resent ‘and tam a... (Tick appropriate box below) a officer -Group A DS Check tee dent's Photo i cross signed and cross stamped (oper to photo or photo to paper) ci a Village Panchayat Head or Mukhiya (G1 Gazetted officer - Group B (DO MP/MLA/ MiC/ Municipal Councilor tehaar Had of Recognizes Educatona instttion (E supertendeny/ Warden Maton Heed finsttuion of Recognized shelter homes/ Orphanages 1 erro orteer a serafemymd erm A tebe est A garua ‘Stature & Stamp the Cerer NOTE: This formats applicable for POI documents aS. Nos. 17,20, 21, 22,31 & 32; POA documents at SL. Nos. 23, 24,37, 38,44 & 45; POR documents tS. Nos. 13, {8.14008 documents at. Nos. 4,5, 18 815 of Schedule I ofthe Aachaar (Enrolment and Updete) Regulations, 2016, a amended fom time to time.