Self Declara on
1. I, Sunita devi W/o Jayveer singh, resident of City road, Ramwali colony, Mohalla jai jai
ram, District Kasganj holding Aadhaar No 455160477368., do hereby solemnly affirm and
declare as under:-
i. That the deponent is the resident of the above said address.
ii. That the correct date of birth of the deponent is 02/01/1960 and the date of birth of the
deponent is wrongly men oned in the Aadhaar Card bearing Aadhaar No 455160477368.
iii. That the deponent wants to get his /her date of birth updated in the Aadhaar Card as
07/07/1960 instead of 02/01/1960 even a er u lizing the one me op on for DoB update,
for which the deponent is submi ng Birth cer ficate as document proof.
iv. That the date of Birth in the Aadhaar Card of the deponent was not correct earlier.
v. That the deponent further declares that no document in support of proof of birth was
submi ed by him at the me of Aadhaar Enrolment. However, if so submi ed, the
document submi ed at the me of upda on is not the same as the one submi ed at the
me of Aadhaar Enrolment.
2. Kindly select whichever are applicable (ü):
(i) Current DoB update request is the 1st request for DoB update
(ii) Current DoB update request is second (or greater) request for DoB
(iii) Date of birth men oned in the Aadhaar Card at the me of Aadhaar Enrolment was
declared/ approximate and was not verified
(iv) Date of birth men oned in the Aadhaar Card at the me of Aadhaar Enrolment was
Verified and was not declared/ approximate
3. That the undersigned undertakes that if the document submi ed in proof of date of birth
is found to be fraudulent/false/forged/non-genuine, the corresponding Aadhaar number
may be deac vated as per Rule 28 of the Aadhaar (Enrolment and Update) Regula ons,
2018. I hereby declare that all the informa on men oned above is true to the best of my
knowledge and belief. In case of any discrepancies if arises, the undersigned will be
personally held responsible.
Name & Signature of Resident
