= G2@ | = | Ay ametetchotsay | AONIAR Under Section 3 of THE ARDHAAR (TARGETED DELIVERY OF FINANCIAL AND OTHER SUBSIDIES, BENEFITS AND SERVICES) ACT, 2016 (Aachaar Act) Please follow the instructions overleaf while filling up the form. Use Capital letters only. 1 [LE] __ New Enrolment Update 2_| [ [Resident indian® [E71 Non-Resident indian (NRI**) 3 | imease of Update Aachaar Number (UID): Biometric Update (Photo + Fingerprint + iris) [] Mobild—] Date of Birth] Addressl—] Name] Gender] Email 1) ___becument update [—] Language only Undate 4 | Name (Name as per PO! document): 5 | Gender:[—] Male] Female] Transgender 6 [Age Yrs OR Dateofaith: |i (J pproximate [1] Declared (J verified 7 | Adaress: Ce (Name-optional) House No. Bldg /Apt: Street/Road/tane Landmark Ward No ‘Area/Locality/Sector: Village/ Town/ Cry: Post Office (Mandatory) District: Sub-Distrit: state E-Mail Mobile No. Pin Code (Mandatory): Verification Type: [_] Document Based [_] Head of Family (HoF) Based Select nly ane ofthe above. Select Heodof Family ony you donot possess ony documentary proof of adress. Head of Family deta ore not equledin cose of Document based verification, For Document Based Enrolment (Write Names of the documents produced. Refer UIDAI website for list of documents) POI (rot fen) — .__ POA (ost cf Aen) €.__ DOB jose ofan (Mandatory incase of Verified Date of BIR) nnn 9 | For HOF Based Enrolment Details of: Father] Mother] Guardian [—JHusband[ wife [] Others] (specify) HoF’s Aadha: a. Pol POR (roof of Resist) ¢.__ DOB (andotoryin case of ered Date of ih Thereby confirm the identity of and am in agreement to share my address voluntarily. HoF's Name: Signature of HOF 10 | Demographic/ Document update (Write Names ofthe documents, Refer UIDAT website for list of documents) 3. POI eter enn B.__POA (roofat ate) DOB jowectaren POR (rostotneston) 1. Thereby give my consent to sharing of my identity information and supporting documents with government agencies for the purpose of verification of information as a prerequisite for generation/updating of Aadhaar. 2. understand that my identity information may be provided to an agency only with my consent during authentication or as per the provisions of the Aadhaar Act and its Regulations. have a right to access my identity information (except core biometrics) following the procedure laid down by UIDAl 3. Thereby confirm thatthe information/éocuments submitted are correct to the best of my knowledge and belief and at any point of time if any of ‘the said information is found to be incorret/fraudulent/false legal action may be initiated against me, as per the provisions of the Aadhaar Act, 2016 (28 of 2016) and, Regulations framed there under and other applicable Acts and Rules, etc. Verifier’s Stamp and Signature: (Verifier must put his/ her Name, if stamp is not available) Applicant's signature/ Thumb impression To be filled by the Enrolment Agency only: Date & time of Enrolment: Nete:tn a of ncapactstd pet, the grt wil be one age Gurion of incpctted Person “Resident means resident as per Section 32) of the Aadhaar Aci. **In ease of NRI, ony valid Indian Passport willbe accepted as POI. Incase of Resident Foreigner, separate form to be used.