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    Aadhaar Enrollment Form

    Uploaded by

    Jeherul Bhuyan
    (1) This document contains an Aadhaar enrolment/correction form under Section 3 of the Aadhaar Act of 2016. (2) Aadhaar enrolment is free and voluntary, and corrections within 96 hours of enrolment are also free with no applicable charges. (3) The form collects personal details for enrolment such as name, address, gender, and birth details along with supporting documents for verification.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Aadhaar Enrollment Form

    Uploaded by

    Jeherul Bhuyan
    444 views1 page
    (1) This document contains an Aadhaar enrolment/correction form under Section 3 of the Aadhaar Act of 2016. (2) Aadhaar enrolment is free and voluntary, and corrections within 96 hours of enrolment are also free with no applicable charges. (3) The form collects personal details for enrolment such as name, address, gender, and birth details along with supporting documents for verification.

    Original Description:

    AADHAAR ENROLLMENT FORM

    Original Title

    AADHAAR ENROLLMENT FORM

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    © © All Rights Reserved

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    (1) This document contains an Aadhaar enrolment/correction form under Section 3 of the Aadhaar Act of 2016. (2) Aadhaar enrolment is free and voluntary, and corrections within 96 hours of enrolment are also free with no applicable charges. (3) The form collects personal details for enrolment such as name, address, gender, and birth details along with supporting documents for verification.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    444 views1 page

    Aadhaar Enrollment Form

    Uploaded by

    Jeherul Bhuyan
    (1) This document contains an Aadhaar enrolment/correction form under Section 3 of the Aadhaar Act of 2016. (2) Aadhaar enrolment is free and voluntary, and corrections within 96 hours of enrolment are also free with no applicable charges. (3) The form collects personal details for enrolment such as name, address, gender, and birth details along with supporting documents for verification.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    Under Section 3 of THE AADHAAR (TARGETTED DELIVERY OF FINANCIAL AND OTHER SUBSIDIES, BENEFITS AND SERVICES) ACT, 2016

    (Aadhaar Act)

    AADHAAR ENROLMENT / CORRECTION FORM


    Aadhaar Enrolment is free and voluntary. Correction within 96 hours of enrolment is also free. No charges are applicable for Form
    and Aadhaar Enrolment. In case of Correction provide your EID, Name and only that field which needs Correction.
    In case of Correction provide your EID No here: | | | | | | | | | | | | | | | dd |mm| yyyy|hh: mm: ss|
    Please follow the instructions overleaf while filling up the form. Use capital letters only.
    1 Pre-Enrolment ID : 2 NPR Receipt/TIN Number :

    3 Full Name:
    Age: Yrs OR Date of Birth:| DD | MM | YYYY |
    4 Gender: Male ( ) Female ( ) Transgender ( ) 5
    Declared Verified
    6 Address: C/o ( ) D/o ( ) S/o ( ) W/o ( ) H/o ( ) NAME

    House No/ Bldg./Apt. Street/Road/Lane

    Landmark Area/locality/sector

    Village/Town/City Post Office

    District Sub-District State

    E Mail Mobile No | | | | | | | | | | | PIN CODE | | | | | | |


    7 Details of : Father ( ) Mother ( ) Guardian ( ) Husband ( ) Wife ( )
    For children below 5 years Father/Mother/Guardian’s details are mandatory. Adults can opt to not specify this information, if they cannot/do not want to disclose.

    Name

    EID/ Aadhaar No.: | | | | | | | | | | | | | | | dd |mm| yyyy|hh: mm: ss|


    Verification Type : Document Based ( ) Introducer Based ( ) Head of Family ( )
    Select only one of the above. Select Introducer or Head of Family only if you do not possess any documentary proof of
    identity and/or address. Introducer and Head of Family details are not required in case of Document based Verification.
    8 For Document Based (Write Names of the documents produced. Refer back side of this form for list of valid documents)

    a. POI b. POA
    b.
    c. DOB d. POR
    (Mandatory in case of Verified Date of Birth)
    For HoF Based - Details of : Father ( ) Mother ( ) Guardian ( ) Husband ( ) Wife ( )
    For Introducer Based – Introducer’s
    9 HoF’s EId/Aadhaar No.: | | | | | | | | | | | | | | |
    Aadhaar No. | | | | | | | | | | | | |
    dd |mm| yyyy|hh: mm: ss|
    I hereby confirm the identity and address of _as being true, correct and accurate.

    Introducer/HoF’s Name: Signature of Introducer/HOF

    Consent & Disclosure under section 3(2) of THE AADHAAR (TARGETTED 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 & 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:


    (Verifier must put his/her Name, if stamp is not available) Applicant’s signature/Thumbprint

    -------------------------------------------------------------------------------------------------------------------------------------------------------------------------
    To be filled by the Enrolment Agency only : Date & time of Enrolment: ----------------------------------------------------

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