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Self Declaration Form

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Yunus Pathan
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259 views1 page

Self Declaration Form

Uploaded by

Yunus Pathan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Self declaration

1 I_ RUKIYA SIDIK KOTWAL S/D/W/o SIDIK KOTWAL

resident of KHAJA NAGAR GALLI NO-17, OSMANABAD TA.DIST.OSMANBADA holding


Aadhaar No. 539398847011

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 20-12-1991 and the date of birth of the
deponent is wrongly mentioned in the Aadhaar Card bearing Aadhaar No. 539398847011. as
iii. That the deponent wants to get his / her date of birth updated in the Aadhaar Card as 20-12-1991

instead of 20-12-1991 even after utilizing the one time option forDoB update , for which the
deponent is submitting SCHOOL LIVING CERTIFECATE 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 Aadhar Enrolment.

2. Kindly select wherever are applicable

S.No. Parameter Selection


st
(i) Current DoB update request is the 1 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
Aadhar enrollment 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/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 discrepancies if arises, the undersigned
will be personally held responsible.

Date : 03-01-2024 Name & Signature of


Resident

Place : OSMANABAD (Parent /Guardian in case of Minor )

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