भारतीय व श 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 : 27-12-2019 Application Type : Express

Fields To Be Updated In
Mobile, Email, BioMetric Update
Aadhaar:
Applicant Details Appointment Details

Resident Type: RESIDENT

Full Name: MRUNAL NANESHWAR BELE
Email Mrunalbele12345@Gmail.Com
Mobile
9579526601
Number:

Appointment Id: 1577436447895

Bilquish Plaza
Sadiqabad No 59
Aadhaar Seva Kendra
Koradi Road New
Address:
Mankapur Nagpur
440030
Appointment Date
27-12-2019 (15:10-15:30)
And Time:
Payment Type: PAY AT ASK
Payment Status: Pending

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.
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 12. Certificate Of Ldentity Having Photo And Relationship With HoF
Issued By
1. Passport 13. Passport
2. PAN Card 14. Birth Certificate Issued By Registrar Of Birth, Municipal
3. Ration/ PDS Photo Card Corporation And Other Notified Local Government Bodies Like
4. Voter ID Taluk, Tehsil Etc.
5. Driving License
6. Government Photo ID Cards/ Service Photo Identity Card Issued List Of POA Documents
By PSU
7. NREGS Job Card 1. Passport
8. Photo ID Issued By Recognized Educational Institution 2. Bank Statement/ Passbook
9. Arms License 3. Post Office Account Statement/Passbook
10. Photo Bank ATM Card 4. Ration Card
11. Photo Credit Card 5. Voter ID
12. Pensioner Photo Card 6. Driving License
13. Freedom Fighter Photo Card 7. Government Photo ID Cards/ Service Photo Identity Card Issued
14. Kissan Photo Passbook By PSU
15. CGHS/ECHS Photo Card 8. Electricity Bill (Not Older Than 3 Months)
16. Address Card Having Name And Photo Issued By Department Of 9. Water Bill (Not Older Than 3 Months)
Posts 10. Telephone Landline Bill (Not Older Than 3 Months)
17. Certificate Of Identify Having Photo Issued By Gazetted Officer 11. Property Tax Receipt (Not Older Than One Year)
Or Tehsildar On Letterhead 12. Credit Card Statement (Not Older Than 3 Months)
18. Disability ID Card/Handicapped Medical Certificate Issued By 13. Insurance Policy
The Respective State/UT Governments/Administrations 14. Signed Letter Having Photo From Bank On Letterhead
19. Bhamashah Card 15. Signed Letter Having Photo Issued By Registered Company
20. Certificate From Superintendent/ Warden/ Matron/ Head Of Onletterhead
Institution Of Recognized Shelter Homes For Orphanages, 16. Signed Letter Having Photo Issued By Recognized Educational
Homes Etc On Their Official Letterhead Institution On Letterhead Or Photo ID Having Address Issued By
21. Certificate Of Ldentity Having Photo Issued By MP Or MLA Or Recognized Educational Institution
MLC Or Municipal Councillor On Letterhead 17. NREGS Job Card
22. Certificate Of Identity Having Photo Issued By Village Panchayat 18. Rms License
Head Or Mukhiya (For Rural Areas) 19. Pensioner Card
23. Gazette Notification For Name Change 20. Freedom Fighter Card
24. Marriage Certificate With Photograph 21. Kissan Passbook
25. RSBY Card 22. CGHS / ECHS Card
26. SSLC Book Having Candidates Photograph 23. Certificate Of Address Having Photo Issued By MP Or MLA Or
27. ST/ SC/ OBC Certificate With Photograph Gazetted Officer Or Tehsildar On Letterhead
28. School Leaving Certificate (SLC)/ School Transfer Certificate (TC), 24. Certificate Of Address Issued By Village Panchayat Head Or Its
Containing Name And Photograph Equivalent Authority (For Rural Areas)
29. Extract Of School Records Issued By Head Of School Containing 25. Income Tax Assessment Order
Name And Photograph 26. Vehicle Registration Certificate
30. Bank Pass Book Having Name And Photograph 27. Registered Sale / Lease / Rent Agreement
31. Certificate Of Identity Containing Name And Photograph Issued 28. Address Card Having Photo Issued By Department Of Posts
29. Caste And Domicile Certificate Having Photo Issued By State
List Of DOB Documents Govt.
30. Disability ID Card/Handicapped Medical Certificate Issued By
1. Birth Certificate Therespective State/UT Governments/Administrations
2. SSLC Book/Certificate 31. Gas Connection Bill (Not Older Than 3 Months)
3. Passport 32. Passport Of Spouse
4. Certificate Of Date Of Birth Issued By Group A Gazetted Officer 33. Passport Of Parents(In Case Of Minor)
OnLetterhead 34. Allotment Letter Of Accommodation Issued By Central/State
5. A Certificate Or ID Card Having Photo And Date Of Birth (DOB) Govt.Of Not More Than 3 Years Old.
Duly Signed And Issued By A Government Authority 35. Marriage Certificate Issued By The Government,
6. Photo ID Card Having Date Of Birth, Issued By Recognized Containingaddress.
Educational Institution 36. Bhamashah Card
7. PAN Card 37. Certificate From Superintendent/ Warden/ Matron/ Head Of
8. Marksheet Issued By Any Govt. Board Or University Institution Of Recognized Shelter Homes For Orphanages,
9. Govt. Photo ID Card/Photo Identity Card Issued By PSU Homes Etc. On Letter Head
Containing DoB. 38. Certificate Of Address Having Photo Issued By Municipal
10. Central/State Pension Payment Order. Councillor On Letterhead
11. Central Govt. Health Service Scheme Photo Card Or Ex- 39. Identity Card Issued By Recognized Educational Institutions
Servicemen 40. SSLC Book Having Photograph
12. School Leaving Certificate (SLC)/ School Transfer Certificate (TC), 41. School Identity Card
Containing Name And Date Of Birth 42. School Leaving Certificate (SLC)/ School Transfer Certificate (TC),
13. Extract Of School Records Issued By Head Of School Containing Containing Name And Address
Name, Date Of Birth And Photograph 43. Extract Of School Records Containing Name, Address And
Photograph Issued By Head Of School
14. Certificate Of Identity Containing Name, DOB And Photograph 44. Certificate Of Identity Containing Name, Address And
Issued By Recognized Educational Institution Signed By Head Of Photograph Issued By Recognized Educational Institution Signed
Institute By Head Of Institute

List Of POR Documents

1. PDS Card
2. MNREGA Job Card
3. CGHS/State Government/ECHS/ESIC Medical Card
4. Pension Card
5. Army Canteen Card
6. Any Other Central/State Government Issued Familyentitlement
Document
7. Marriage Certificate Issued By The Government.
8. Address Card Having Name And Photo Issued By Department Of
Posts
9. Bhamashah Card
10. Discharge Card/ Slip Issued By Government Hospitals For Birth
Of A Child
11. Certificate Of Ldentity Having Photo Issued By MP Or MLA Or
MLC Or Municipal Councillor Or Gazetted Officer On Letterhead