AADHAAR ENROLMENT FORM

(Aadhaar Enrolment Is Free &

Voluntary)
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 : 19-02-2020 Application Type : Enrolment

Applicant Details Appointment Details

Resident Type: RESIDENT

Full Name: SANJANA PAL
Date Of Birth/Age: 24-10-1996
7-A S/O Sardar Mool Singh/
2, V3s Mall, West Guru
Address Angad Nagar, Nirman
Viahr, Gandhi Nagar, East
Delhi , Delhi, 110092
Email Amitsanjana60@Gamil.Com
Gender: Female
Documents To Carry: Appointment Id: 1582098467585
Lower Ground Floor
Marriage Certificate With Aadhaar Seva Kendra Akshardham Metro
Proof Of Identity: Address:
Photograph Mall (Parshuvanath),
School Leaving Certificate Delhi
(SLC)/ School Transfer Appointment Date And
Proof Of Date Of Birth: 20-02-2020 (16:00)
Certificate (TC), Containing Time:
Name And Date Of Birth
ELECTRICITY BILL (NOT
Proof Of Address:
OLDER THAN 3 MONTHS)

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