/rstructionji Alldel.ilsto befill€d ln Blo.

k Letters (To be valid lor 3 monthsJrorn ddte ol issue)

To be pintedon ploin A4 pdpersize; liot rcqui.edto print on letter head;

f\-il -H EorZ
Non-Resident lndian (NRl] New Enrolment Update Request
ffiResident I
Aadhaar Number:
(For update only) 6t?bl+.ql?nl8q
FullNarne: e

clo:,
KAPTITAI-ACI ozA{r} f/
House No./ Bldg./ Apt:

sleet/ Road/ Lane: t\opTU S T RF FT

Lardmarlc

Alea/ Locality/ Sector:

Village/ Town/ City:

,q tr \/ ll l- \r R
Post Office:

tAb, Tf/V/]Dr

)_ 0

Name of the Certifier:

.Dra ^f r-r I rZl$ 4 c_A \l^9l4a.6-.-f A
Designation: ( ac'r-roQ- A..--a'l sv {L Vt .> o rv I

Oltice Address: U\P*c--

D a- *r AY A- D OA.-f 4)
Contact Numbei: 4 t€ Lr 6'1 Sd f s-
I hereby certify aborre mentioned details ol the resident Checklist fo. Certifi€l
and I a2a.,,, (lick zppropriate box below) t * $certifier's
fl{o o,u,*,itns flisue date rs filred frf,ustaunt- risn details

[,'/Gazetted fficer - Group A Photo is cross signed and cross stamped fpdpe. to phato ot photo to pope4

I Village Panchayat Head or Mukhiya

I Gazetted o{icer - Group B

n rr4p/ VUI tUfc/ fr,,tuncipal Councilor

[] tehsitd"r

! Head of Recognized Educational lnstitution $.!r.Nru;: r{ t,l}f tirurol+,

I Super;ntendent/ Wardeh/ Matron/ Head of lnstitution
;1,'I"ii"rnunnttt' ,
of Recoghized shelter homes/ orphanages

I eero offr...
"*oro*oii''"'**t
tie cediner
Signature & stamp of

NOTE: Thisformat is appli.able for POI documents at Sl. Nos. 17, 20, 21, 22, 31 & 32; POA do.uments atSl. Nos.23,24,37, 38,44 &45; POR docum€nts at Sl. Nos. 13
& 14 DOB documents at Sl. Nos.4,5, 14 & 15 ofSchedule lloftheAadhaar (Enrolmentand Update) Regulations, 2016, as amend€d from timeto time.