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 : 19-11-
Application Type : Enrolment
2024
Applicant Details Appointment Details
Resident Type: RESIDENT
Full Name: HARINA BHATT
Date Of 18-06-1990
Birth/Age:
Address C/O bhan dev bhatt, 22/ Sheikhpura,
rukanpura, Rukanpura, B.v. College,
Patna , Bihar, 800014
Gender: Female
Documents to Carry:
Appointment Id: 1731999803354
Bring original documents for Aadhaar Seva Grand Majestic Centre,
Enrolment/Update. No photocopy required. Kendra Address:
No.12, 2nd Cross Road, SC
Original documents are scanned and given
back to you. Road, Gandhi Nagar,
Carry/Bring appointment print copy. Bengaluru - 560009
Appointment Date
19-11-2024 (14:10)
and Time:
Proof of identity:
Voter Identity Card Card/e-Voter Identity Card
Proof of date of birth:
Pensioner Photo Identity Card / Freedom Fighter Photo
Identity Card / Pension Payment Order issued by
Central Govt./ State Govt./ PSU/ Regulatory Bodies/
Statutory Bodies
Proof of address:
Voter Identity Card Card/e-Voter Identity Card
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.)
Note: In case of Child(< 5 Yrs) or Guardian based application, Guardian/Relative will be required to accompany the
applicant. In case of incapacitated person, the signature will be done by Legal Guardian of Incapacitated Person.