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 : 14-01-
Application Type : Enrolment
2025
Applicant Details Appointment Details
Resident Type: RESIDENT
Full Name: YASHASVI DUBEY
Date Of 19-06-2015
Birth/Age:
Address C/O DHEERAJ SAKAR DUBEY,
Barahua, Chhapiya, Gorakhpur ,
Uttar Pradesh, 273016
Gender: Female
Documents to Carry:
Appointment Id: 1736870978062
Bring original documents for Aadhaar Seva Aadhaar seva Kendra above
Enrolment/Update. No photocopy Kendra Address:
UBI Bank Dubey complex
required.
Original documents are scanned and Hanuman Mandir road
given back to you. Betiahata Gorakhpur
Carry/Bring appointment print copy. 273001
Appointment
01-02-2025 (10:20)
Proof of identity: Date and Time:
Photograph Identity Card / Certificate with
Photograph issued by Central Govt./ State Govt. like
Bhamashah, Domicile Certificate, Resident
Certificate, JanAadhaar, MGNREGA/ NREGS Job Card,
Labour Card etc.
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 address:
Certificate of Address issued on UIDAI standard
certificate format for enrolment/ update by: Village
Panchayat Head or Mukhiya or its equivalent
authority (for rural areas),Village Panchayat
Secretary or VRO or equivalent (for rural areas)
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.
