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    ' F'-L T A :::: : :: ::: ::: : ' - /,"ci i..DJ, L

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    khuranacommunication57
    This document is a template for collecting identification details of an individual for Aadhaar enrollment or update. It requests information such as name, address, contact number, and certifier details. The certifier must be a gazetted officer, village head, elected representative, or head of an educational or shelter institution. They are required to verify the resident's details and sign the document.

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    © All Rights Reserved
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    ' F'-L T A :::: : :: ::: ::: : ' - /,"ci i..DJ, L

    Uploaded by

    khuranacommunication57
    61 views1 page
    This document is a template for collecting identification details of an individual for Aadhaar enrollment or update. It requests information such as name, address, contact number, and certifier details. The certifier must be a gazetted officer, village head, elected representative, or head of an educational or shelter institution. They are required to verify the resident's details and sign the document.

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    PK

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    This document is a template for collecting identification details of an individual for Aadhaar enrollment or update. It requests information such as name, address, contact number, and certifier details. The certifier must be a gazetted officer, village head, elected representative, or head of an educational or shelter institution. They are required to verify the resident's details and sign the document.

    Copyright:

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

    ' F'-L T A :::: : :: ::: ::: : ' - /,"ci i..DJ, L

    Uploaded by

    khuranacommunication57
    This document is a template for collecting identification details of an individual for Aadhaar enrollment or update. It requests information such as name, address, contact number, and certifier details. The certifier must be a gazetted officer, village head, elected representative, or head of an educational or shelter institution. They are required to verify the resident's details and sign the document.

    Copyright:

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

    nstrurtions: All details to be filled in Block Letters

    Not required to print on fetter head;


    o be printed on plofn A4 paper size;

    ~ esident

    adhaar Number:
    For update only)
    1°18 9 9 5 J V3 3 3J J
    r ll Name: I;=P=:6:~o.~r4J:.l4---1J_.w-=-~a~h1-
    ,___ -
    '--
    _,_
    ;f-::'.:'._
    C!i~C'q-:
    A_, -':=_---=------=------=------_-_-_-_-_----=-_-_ -----=-----_ -_-_-_- _-_- __J/
    a~-f

    L---1- - - - - - - - - - - - - - - - - - '

    C/o:

    ouse No./ Bldg./ Apt:

    treet/ Road/ Lane:

    ndmark:

    Area/ Locality/ Sector:


    r-1
    ::=~=~t:_r=_t::_o:_Y=_~=_J=_-==--==--==--==--==--==
    - -==--==--==--==--==--==--==--==-/
    r llage/ Town/ City:
    I Rl)hihi I
    rost Office:

    r strict:

    rate: I D llhi

    I o O8 S:-
    Signature of the Resident/
    Thumb/ Finger Impression

    lesignation: '~=f'-l~t=A=======::::;:===~===~~==~::;:::;:::;~~===~
    r ffice Address: ::£r!~{)~\}~~=L======~~G~~£~=~::::s~u~µ'=·r=-1";::;;=='==t~=~=
    ~AiZ-
    ======:: : : :'.
    / I K~Wf--1,_
    ;:I

    1)~1-tL --(l (;\9&'


    r ntactNumber: I & y L1 r:-s~
    s J_C_ _ _ _ _I - - - - - - - - ,
    I hereby certify above mentioned details of the resident Checklist for Certifier
    nd I am a .... (Tick awropriate box below) g-i.io overwriting ~ e date is filled ~ 's signature ~ er's details
    !dent's Photo is cross signed and cross stamped (poper to photo or photo to poper)
    Gazetted Officer - Group A

    ,,,___ _
    Village Panchayat Head or Mukhiya
    Gazetted Officer - Group B
    P/ MLA/ MLC/ Muncipal Councilor

    Head of Recog nized Educational Institution


    Superintendent/ Warden/ Matron/ Head of In stitution
    ~'-;/,"ci~i..DJ,l
    ,
    [ of Recognized shelter homes/ Orphanages 7l10HA~t:,'if·
    p EPFO Officer Signature~ e Certifier

    ~OTE: This format is applicable fo r POI documents at SI. Nos. 17, 20, 21, 22, 31 & 32; POA documents at SI. Nos. 23, 24, 37, 38, 44 & 4S; POR documents at SI. Nos. 13
    \ " ooa •• "m,ou • "· "°' •• s, " , ,s , , ' " """ " ' " " ' ~a,,., ( '"'°'~"""' o,a,,-) ~,, <aoo•, '°''• as am,ooeo ••m om, <o om,

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