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    Self Declaration 22.07.2021

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    mayanksonic77

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    © All Rights Reserved
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    Self Declaration 22.07.2021

    Uploaded by

    mayanksonic77
    130 views2 pages

    Original Title

    Self Declaration 22.07.2021 (1)

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    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    130 views2 pages

    Self Declaration 22.07.2021

    Uploaded by

    mayanksonic77

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 2

    Self Declaration

    1. I, SINGH SAMIR S/o,CHANDRAPAL resident of BAG SOC.MADRASI MANDIR


    KHOKHRA AHMEDABAD holding Aadhaar No.XXXX XXXX 8028, 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 09-07-2001 and the date of
    birth of the deponent is wrongly mentioned in the Aadhaar Card bearing
    Aadhaar No.XXXX XXXX 8028 as 09-09-2003.
    iii. That the deponent wants to get his /her date of birth updated in the
    Aadhaar Card as 09-09-2003 instead of 09-07-2001 even after utilizing the
    one time option for DoB update, or which the deponent is submitting BIRTH
    CERTIFICATE 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 submitted by him at the time of Aadhaar Enrolment. However, if so
    submitted, the document submitted at the time of updation is not the same
    as the one submitted at the time of Aadhaar Enrolment.
    2. Kindly select whichever are applicable :

    Sl. Parameter Selection


    No.
    (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 mentioned in the Aadhaar Card at the
    time of Aadhaar Enrolment was declared
    /approximate and was not verified.
    (iv) Date of birth mentioned in the Aadhaar Card at the
    time of Aadhaar Enrolment was verified and was
    not declared / approximate.

    3. That the undersigned undertakes that if the document submitted in proof of date of birth is
    found to be fraudulent / false /forged/non-genuine, the corresponding Aadhaar number
    may be deactivated as per Rule 28 of the Aadhaar (Enrolment and Update) Regulations,
    2018.

    I hereby declare that all the information mentioned above is true to the best of my
    knowledge and belief. In case of any discrepancy if arises, the undersigned will be personally
    held responsible.

    Date- 05-01-2024

    Name & Signature of Resident

    (Parent/Guardian in case of Minor)

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