CERTIFICATE FOR AADHAAR ENROLMENT/ UPDATE
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 print on letter head; D 28D M 06
M Y Y Y
2025 Y
Resident’s Details
Resident Non-Resident Indian (NRI) New Enrolment Update Request
Aadhaar Number: 3764 4077 4964
(For update only)
Full Name: SISHTI DHARMESH NAYKA
C/o:
House No./ Bldg./ Apt: BARCHALI
Street/ Road/ Lane:
Landmark:
Area/ Locality/ Sector: HARIYA
Village/ Town/ City: HARIYA
Post Office: HARIYA
District: VALSAD
Resident’s Recent
State: Colour Photograph
GUJARAT 3.5cm x 4.5 cm
Cross Signed and
Cross Stamped
by the Certifier.
PIN Code: 396020 NB: DO NOT
OVERLAP WITH
TEXT BOXES
Signature of the Resident/
Date of Birth: 27 05 2019 Thumb/ Finger Impression
Certifier’s Details (To be filled by the certifier Only)
Name of the Certifier: MAHESHBHAI MANGUBHAI YADAV
Designation: SARPANCH
Office Address: GRAM PANCHAYAT HARIYA VALSAD GUJARAT-396020
Contact Number: 6352418557
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/ Muncipal Councilor
Tehsildar
Head of Recognized Educational Institution
Superintendent/ Warden/ Matron/ Head of Institution
of Recognized shelter homes/ Orphanages
Signature & Stamp of the Certifier
EPFO Officer
NOTE: This format is applicable for POI documents at SI. Nos. 17, 20, 21, 22, 31 & 32; POA documents at SI. Nos. 23, 24, 37, 38, 44 & 45; POR documents at SI. Nos. 13
& 14 DOB documents at SI. Nos. 4, 5, 14 & 15 of Schedule II of the Aadhaar (Enrolment and Update) Regulations, 2016, as amended from time to time.
