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Ansh Raj

The document is an Aadhaar enrollment form containing details of an applicant such as name, date of birth, address, and appointment details for Aadhaar enrollment. The form collects information for identity verification and requires signatures for disclosure and verification.

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vikas16918251
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62 views1 page

Ansh Raj

The document is an Aadhaar enrollment form containing details of an applicant such as name, date of birth, address, and appointment details for Aadhaar enrollment. The form collects information for identity verification and requires signatures for disclosure and verification.

Uploaded by

vikas16918251
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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31/03/2024, 20:50 about:blank

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 : 31-03-2024 Application Type : Enrolment
Applicant Details Appointment Details

Resident Type: RESIDENT


Full Name: ANSH RAJ
Date Of 23-09-2016
Birth/Age:
Address C/O Pradeep Kumar, 34/ Jiyan bigha road,
durga mandir, jiyan bigha, Nimi, Nimi,
Sheikhpura , Bihar, 811103
Email [email protected]
Guardian Name: SONI KUMARI
Guardian 898144219795
Aadhaar: Appointment Id: 1711898413767
Gender: Male Aadhaar Seva Lower Ground Floor
Kendra Address: Akshardham Metro Mall
Documents to Carry:
(Parshuvanath), Delhi
Appointment Date
01-04-2024 (10:10)
Bring original documents for Enrolment/Update. and Time:
No photocopy required.
Original documents are scanned and given back
to you.
Carry/Bring appointment print copy.

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.)

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