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The document is an Aadhaar enrolment form for an applicant named Krishna Kumari, detailing personal information such as date of birth, address, and guardian's name. It outlines the appointment details for enrolment, including the required documents and the confirmation of identity and residency. The form emphasizes the voluntary nature of Aadhaar enrolment and the importance of providing accurate information for the generation of Aadhaar.

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kashyapshiwang2003
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73 views2 pages

About Blank

The document is an Aadhaar enrolment form for an applicant named Krishna Kumari, detailing personal information such as date of birth, address, and guardian's name. It outlines the appointment details for enrolment, including the required documents and the confirmation of identity and residency. The form emphasizes the voluntary nature of Aadhaar enrolment and the importance of providing accurate information for the generation of Aadhaar.

Uploaded by

kashyapshiwang2003
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

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 : 06-08-
Application Type : Enrolment
2025
Applicant Details Appointment Details

Resident RESIDENT
Type:
Full KRISHNA KUMARI
Name:
Date Of 20-08-1985
Birth/Age:
Address C/O Shambhu Prasad Singh, Near Ram
Janki Mandir, Sekhopur, Shekhopur,
Samastipur , Bihar, 848101
Email manojkumarsingh9576547504@[Link]
Guardian Appointment Id: 1754491672759
Shambhu Prasad Singh
Name: Aadhaar Seva P JHA Complex 2nd Floor,
Guardian 467213963436 Kendra Address:
Sahi Lane, S.P Verma Road,
Aadhaar:
Gender: Female
Patna Bihar 800001
Appointment
30-08-2025 (14:30)
Documents to Carry: Date and Time:

Bring original documents for


Enrolment/Update. No photocopy
required.
Original documents are scanned and given
back to you.
Carry/Bring appointment print copy.

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 Photograph Identity Card / Certificate with
relation: Photograph issued by Central Govt./ State
Govt. like Bhamashah, Domicile
Certificate, Resident Certificate,
JanAadhaar, MGNREGA/ NREGS Job Card,
Labour Card etc.
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.

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