AADHAAR ENROLMENT

FORM

(Aadhaar Enrolment is free &

भारतीय विशिष्ट पहचान प्राधिकरण भारत सरकार
Voluntary)
Under Section 3 of THE AADHAAR (TARGETED DELIVERY OF FINANCIAL AND OTHER SUBSIDIES, BENEFITS AND
SERVICES) ACT,2016 (Aadhaar Act)
Submission Date : 17-04-2023 Application Type : Enrolment
Applicant Details Appointment Details

Resident Type: RESIDENT

Full Name: PARAMJIT BARMAN
Date Of 29-10-2016
Birth/Age:
Address C/O DEBESWAR BARMAN, BALABHUT,
Balabhut, Tufanganj - I, Cooch Behar , West
Bengal, 736159
Guardian Name: KANIKA BARMAN
Guardian 564140490466
Aadhaar:
Gender: Male Appointment Id: 1681709428750
Aadhaar Seva Ground Floor, Ward BSNL
Documents to Carry: Kendra Address: Administrative Building, Near
Sagar Dighi, Post Office Cooch
1. Bring original documents for Enrolment/Update. Behar, West Bengal 736101
No photocopy required. Appointment Date
19-04-2023 (16:10)
2. Original documents are scanned and given back to and Time:
you.

Proof of date of birth:

Birth Certificate issued by Authorized Authority (in the
respective States) under the Registration of Births and Deaths
Act, 1969 read with Registration of Births and Deaths Rules
1999/2000/2002 of respective States
Proof of relation: Birth Certificate issued by Authorized
Authority (in the respective States) under the
Registration of Births and Deaths Act, 1969
read with Registration of Births and Deaths
Rules 1999/2000/2002 of respective States.
I hereby confirm the identity and address of (HOF/Relative Name) (auto populates) as being true, correct and
accurate.
 
HOF s Name: Signature of HOF
Disclosure under section 3(2) of THE AADHAAR (TARGETED DELIVERY OF FINANCIAL AND
OTHER SUBSIDIES, BENEFITS AND SERVICES) ACT, 2016
I confirm that I have been residing in India for at least 182 days in the preceding 12 months / I am Non Resident Indian (NRI) &
information (including biometrics) provided by me to the UIDAI is my own and is true, correct and accurate. I am aware that my
information including biometrics will be used for generation of Aadhaar and authentication. I understand that my identity information
(except core biometric) may be provided to an agency only with my consent during authentication or as per the provisions of the
Aadhaar Act. I have a right to access my identity information (except core biometrics) following the procedure laid down by UIDAI.
 
Verifier's Stamp and Signature Applicant's Signature/Thumbprint
(Verifier must put her/his name if stamp is not avaliable.)