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Self Declaration Form

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my.incredible.india.23
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1K views

Self Declaration Form

Uploaded by

my.incredible.india.23
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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SELF-DECLARATION FROM THE HEAD OF FAMILY (HOF) FOR SHARING ADDRESS

WITH IMMEDIATE FAMILY MEMBER RESIDING AT THE SAME ADDRESS

I,_ADITYA KUMAR YADAV_____________ (Name as in Aadhaar), resident

of _________________________________________________________________________

____________________________________________________________________ (Address

as provided in Aadhaar) holding Aadhaar Number___________________________________, do

hereby solemnly affirm and declare as under:-

_______________________ is related to me as my __________________________

___________________________ (Please specify the relation with applicant) and is

residing with me at the above mentioned address.

_____________________ for updating his/her address in Aadhaar in my capacity of

Head of the Family (HoF).

to the best of my knowledge and belief and at any point of time if any of the said

information is found to be incorrect/fraudulent/false, the Aadhaar of Mr./Ms.

___________________________ and mine can be deactivated and legal action

may be initiated against me, as per the provisions of the Aadhaar (Targeted Delivery

of Financial and Other Subsidies, Benefits and Services) Act, 2016 (18 of 2016) and,

Regulations framed there under and other applicable Acts and Rules, etc.

Date DD/MM/YYYY Name & Signature of Head of the Family (HoF)

Note:
This PDF document was edited with Icecream PDF Editor.
1. This document is valid for Head of Family
(HoF) based Aadhaar address update purpose only.
Upgrade to PRO to remove watermark.
2. This document is valid for 3 months from date of issue

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