eae ee a eee Insrcron: ll datas tobe ile in Block Letters (abe wots for 3 months fom date af ee) Tobe pritedn lan At paper ste: Net reuted tobe printed on keter head: Gees Resident Non-Resident Indian (NR New Enrolment Update Request ‘adhaar Number: CrTT+titittttity {For update ony) Full Nar eo: House No, Bids. / Apt: street/Road/ Lane: Lendmark: Area/ Locality/ Sector: Village/ Town/ City: Post ofce: District state: lou Paget SSemx85 om ions yimecerte PIN Code: t:00 Nor Date of Birth Hifonics Is (To be filled by the certifier Only) Name of the Certifir Designation: Office Address Contact Numbe hereby certify above mentioned detail ofthe resident Checklist for Certifier ‘appropriate box below) Tl nooverwriting [] issue date is filled [Resident's signature []Certifer’s details 1 Gazettes ofticer- Group & resident’ Photo cos sgned and cross stamped (pope to photo orphoto to poper) 5) Witage Panchayat Head or Mukhiva Ey azetted officer Group 8 (C1 ey muy wic/ Municipal Councillor Oy rensiéar L) Head of Recognized Educational Insttsion 1 superinendont/ warden/ Matron/ Head of institution of Recognizes sheter homes Orphanages 1 errooticer siete step ote cater "To be used a Proof of dent (Pol onlyin specifi cases as mentioned inthe tof applicable supporting dacuments,