CERTIFICATE FOR AADHAAR ENROLMENT/ UPDATE (TO BE USED ONLY AS PROOF OF ADDRESS*)
Instructions: All details to be filled in Block Letters (To be valid for 3 months from date of issue)
To be printed on plain A4 paper size; Not required to be printed on letter head; 0D 5
D M M
0 6 Y2 Y0 2
Y 5Y
Resident’s Details
✔ Resident Non-Resident Indian (NRI) New Enrolment ✔ Update Request
Aadhaar Number: 5 9 5 2 1 0 0 7 0 0 8 9
(For update only)
Full Name: SHAIK SALMAN BASHA
C/o: SHAIK SHAMSUDDIN
House No./ Bldg./ Apt: 69/706-9-20
Street/ Road/ Lane: JOHARAPURAM
Landmark: JOHARAPURAM
Area/ Locality/ Sector: JOHARAPURAM
Village/ Town/ City: KURNOOL
Post Office: KURNOOL
District: KURNOOL
Resident’s Recent
State: Colour Photograph
ANDHRA PRADESH 3.5cm x 4.5 cm
Cross Signed and
Cross Stamped
by the Certifier.
PIN Code: 5 1 8 0 0 1 NB: DO NOT
OVERLAP WITH
TEXT BOXES
Signature of the Resident/
Date of Birth: 1 9 0 6 1 9 9 6 Thumb/ Finger Impression
Certіfіer’s Details (To be fіlled by the certіfіer Only)
Name of the Certifier:
Designation:
Office Address:
Contact Number:
I hereby certify above mentioned details of the resident Checklist for Certifier
and I am a.... (Tick appropriate box below) No overwriting Issue date is filled Resident’s signature Certifier’s details
Gazetted Officer - Group A Resident’s Photo is cross signed and cross stamped (paper to photo or photo to paper)
Village Panchayat Head or Mukhiya
Gazetted Officer - Group B
MP/ MLA/ MLC/ Municipal Councillor
Tehsildar
Head of Recognized Educational Institution
Superintendent/ Warden/ Matron/ Head of Institution
of Recognized shelter homes/ Orphanages
Signature & Stamp of the Certifier
EPFO Officer
*To be used as Proof of Identify (PoI) only in specific cases as mentioned in the list of applicable supporting documents.
