I, I, A: 8,L 2 M. tJR 1Afv'1 As::£ R.

AQ (Name as in Aadhaar), resident

of ~/2, SAM !3-A S.:i::L!A RRo' 'FL.KT NO - .3 03/ Vt-N~W R£S:WfNo/

'!fr~~#[. .. .I
22..-1- -l~, NbAR' ~ODA I\Jf>,4 i(A[Y)AJf\ljAM" VE.gASHAbRARIRtlm" (Addre~ l ' J ~
- 53!1D~
as provided in Aadhaar holding Aadhaar Number 150 S '9g 9 1..- ltl '?rJ ,do
hereby solemnly affirm and declare as under:-

i. That resi ~ent Mf./Ms.

I
k"ARt2(Y)f
"--\
2R1 ~RJ,.S'MvAt./fAU holding Aadhaar number
,
26 6 2.S 5 'l.t>86 is related to me as my _ T........_f;___,_6'--_ _ __
. . .,K)-.J.__
- - - - - - - - - - - - (Please specify the relation with applicant) and is

residing with me at the above mentioned address.

ii. That I agree to share my address in my Aadhaar with Mr./Ms. fiSAJ~[2lYU2 RT

K RJ;.~+JN AV f; f\U: for updating RJ./her address in Aadhaar in my capacity of

Head of the Family (HoF).

iii. That the undersigned undertakes that, the above mentioned information is correct

to the best of my knowledge and belief and at any point of time if any of the said
I

informati~n is found to be incorrect/fraudulent/false, the Aadhaar of Mf../Ms.

I
M\J RJ -1) R1 CtJNAV6"1l and mine can be deactivated and legal action

may be initiated against me, as per the provisions of the Aadhaar (Targeted Delivery

of Financial and Other Subsidies, Benefits and Services) Act, 2016 (18 of 2016) and,

Regulations framed there under and other applicable Acts and ules, etc.

Name & Signature of Head of the Family (HoF)

Note:
1. This document is valid for Head of Family (HoF) based Aadhaar address update purpose only.
2. This document is valid for 3 months from date of issue