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 : 14-12-
Application Type : Enrolment
2024
Applicant Details Appointment Details
Resident Type: RESIDENT
Full Name: HUSNERA KHATOON
Date Of 22-08-2012
Birth/Age:
Address C/O Pasida khatun, Kholaibakhtari/
Tulsinagar, Matigara, Matigara,
Darjeeling , West Bengal, 734010
Guardian
Pasida khatun
Name:
Guardian 511837139884
Aadhaar: Appointment Id: 1734138337840
Gender: Female Aadhaar Seva Ground floor, Mallar
Kendra Address:
Documents to Carry: Mukherjee Building, Holding
No.22/19/18. S.B. Sarani ward
no. XI Rajni Bagan(North),
Bring original documents for
Enrolment/Update. No photocopy required. Siliguri, West Bengal, Pin-
Original documents are scanned and given 734001
back to you. Appointment Date
14-12-2024 (15:10)
Carry/Bring appointment print copy. and Time:
Proof of date of birth:
Birth Certificate issued by Authorized Authority (in the
respective States) under the Registration of Births and
Deaths Act, 1969 read with Registration of Births and
Deaths Rules 1999/2000/2002 of respective States
Proof of Birth Certificate issued by Authorized
relation: Authority (in the respective States)
under the Registration of Births and
Deaths Act, 1969 read with
Registration of Births and Deaths
Rules 1999/2000/2002 of respective
States
I hereby confirm the identity and address of (HOF/Relative Name) (auto populates) as being
true, correct and accurate.
HOF s Name: Signature of HOF
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.
