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    Aadhaar Form

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    NABIN DEURI
    The document is an Aadhaar enrolment form for an individual named Nabin Chandra Deuri from Assam, India. It provides details about him such as his date of birth, address, appointment details for Aadhaar enrolment, documents required for identity, date of birth, address, and residency proof. It also contains disclosure information and instructions for applicants to follow regarding the Aadhaar enrolment process.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Aadhaar Form

    Uploaded by

    NABIN DEURI
    309 views3 pages
    The document is an Aadhaar enrolment form for an individual named Nabin Chandra Deuri from Assam, India. It provides details about him such as his date of birth, address, appointment details for Aadhaar enrolment, documents required for identity, date of birth, address, and residency proof. It also contains disclosure information and instructions for applicants to follow regarding the Aadhaar enrolment process.

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    Aadhar

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    The document is an Aadhaar enrolment form for an individual named Nabin Chandra Deuri from Assam, India. It provides details about him such as his date of birth, address, appointment details for Aadhaar enrolment, documents required for identity, date of birth, address, and residency proof. It also contains disclosure information and instructions for applicants to follow regarding the Aadhaar enrolment process.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    309 views3 pages

    Aadhaar Form

    Uploaded by

    NABIN DEURI
    The document is an Aadhaar enrolment form for an individual named Nabin Chandra Deuri from Assam, India. It provides details about him such as his date of birth, address, appointment details for Aadhaar enrolment, documents required for identity, date of birth, address, and residency proof. It also contains disclosure information and instructions for applicants to follow regarding the Aadhaar enrolment process.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    You are on page 1of 3

    10/31/2019

    AADHAAR ENROLMENT FORM

    (Aadhaar Enrolment Is Free & Voluntary)


    भारतीय व श ट पहचान ा धकरण
    भारत सरकार

    Under Section 3 of THE AADHAAR (TARGETED DELIVERY OF FINANCIAL AND OTHER SUBSIDIES, BENEFITS AND SERVICES)
    ACT,2016 (Aadhaar Act)

    Submission Date : 31/10/2019 Application Type : Enrolment


    Applicant Details Appointment Details

    Full
    NABIN CHANDRA DEURI
    Name:
    Date Of
    01/03/1983
    Birth/Age:
    DHIREN DEURI, KINAPATHAR/ 37,
    KINAPATHAR, NARAYANPUR, Kina
    Address
    Pathar, Narayanpur, Lakhimpur ,
    Assam, 784164
    Email Nabindeuri@Gmail.Com
    Gender: Male Appointment Id: 1572543116064
    Aadhaar Seva Kendra ASK Guwahati Sureka
    Documents To Carry:
    Address: Square
    GOVERNMENT PHOTO ID CARDS/ Appointment Date And 08-11-2019 (12:30 -
    Proof Of
    SERVICE PHOTO IDENTITY CARD Time: 12:50)
    Identity:
    ISSUED BY PSU
    Proof Of Photo ID Card Having Date Of Birth,
    Date Of Issued By Recognized Educational
    Birth: Institution
    Certificate From Superintendent/
    Proof Of Warden/Matron/ Head Of Institution Of
    Address: Recognized Shelter Homes For
    Orphanages, Homes Etc On Letter Head.

    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 & 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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    Instructions

    Please reach 15 min early at Aadhaar Seva Kendra and carry printed copy of this Application Form.
    Carry all the Document(s) selected while filling up the form.
    Get the printed copy of final application form before leaving the center. Also, please fill the feedback form at the exit counter to serve you
    better next time.

    List Of POI Documents List Of POA Documents


    1. Passport 1. Passport
    2. PAN Card 2. Bank Statement/ Passbook
    3. Ration/ PDS Photo Card 3. Post Office Account Statement/Passbook
    4. Voter ID 4. Ration Card
    5. Government Photo ID Cards/ Service Photo Identity Card 5. Voter ID
    Issued By PSU 6. Driving License
    6. NREGS Job Card 7. Government Photo ID Cards/ Service Photo Identity Card
    7. Photo ID Issued By Recognized Educational Institution Issued By PSU
    8. Arms License 8. Electricity Bill (Not Older Than 3 Months)
    9. Photo Bank ATM Card 9. Water Bill (Not Older Than 3 Months)
    10. Photo Credit Card 10. Telephone Landline Bill (Not Older Than 3 Months)
    11. Pensioner Photo Card 11. Property Tax Receipt (Not Older Than One Year)
    12. Freedom Fighter Photo Card 12. Credit Card Statement (Not Older Than 3 Months)
    13. Kissan Photo Passbook 13. Insurance Policy
    14. CGHS/ECHS Photo Card 14. Signed Letter Having Photo From Bank On Letterhead
    15. Address Card Having Name And Photo Issued By Department 15. Signed Letter Having Photo Issued By Registered Company
    Of Posts Onletterhead
    16. Certificate Of Identify Having Photo Issued By Gazetted 16. Signed Letter Having Photo Issued By Recognized
    Officer Or Tehsildar On Letterhead Educational Institution On Letterhead Or Photo ID Having
    17. Disability ID Card/Handicapped Medical Certificate Issued Address Issued By Recognized Educational Institution
    By The Respective State/UT Governments/Administrations 17. NREGS Job Card
    18. Rms License
    List Of DOB Documents 19. Pensioner Card
    20. Freedom Fighter Card
    21. Kissan Passbook
    1. Birth Certificate
    22. CGHS / ECHS Card
    2. SSLC Book/Certificate
    23. Certificate Of Address Having Photo Issued By MP Or MLA
    3. Passport
    Or Gazetted Officer Or Tehsildar On Letterhead
    4. Certificate Of Date Of Birth Issued By Group A Gazetted
    24. Certificate Of Address Issued By Village Panchayat Head Or
    Officer OnLetterhead
    Its Equivalent Authority (For Rural Areas)
    5. PAN Card
    25. Income Tax Assessment Order
    6. Marksheet Issued By Any Govt. Board Or University
    26. Vehicle Registration Certificate
    7. Govt. Photo ID Card/Photo Identity Card Issued By PSU
    27. Registered Sale / Lease / Rent Agreement
    Containing DoB.
    28. Address Card Having Photo Issued By Department Of Posts
    8. Central/State Pension Payment Order.
    29. Caste And Domicile Certificate Having Photo Issued By State
    9. Central Govt. Health Service Scheme Photo Card Or Ex-
    Govt.
    Servicemen
    30. Disability ID Card/Handicapped Medical Certificate Issued By
    Therespective State/UT Governments/Administrations
    List Of POR Documents 31. Gas Connection Bill (Not Older Than 3 Months)
    32. Passport Of Spouse
    1. PDS Card 33. Passport Of Parents(In Case Of Minor)
    2. MNREGA Job Card 34. Allotment Letter Of Accommodation Issued By Central/State
    3. CGHS/State Government/ECHS/ESIC Medical Card Govt.Of Not More Than 3 Years Old.
    4. Pension Card 35. Marriage Certificate Issued By The Government,
    5. Army Canteen Card Containingaddress.
    6. Passport
    7. Birth Certificate Issued By Registrar Of Birth, Municipal
    Corporation And Other Notified Local Government Bodies
    Like Taluk, Tehsil Etc.
    8. Any Other Central/State Government Issued
    Familyentitlement Document
    9. Marriage Certificate Issued By The Government.

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