aaa Instructions: All details ta be filled in Block Letter (To be valid for 3 months from date of issue) To be printed on plain AS paper size Not required to print on letter head Resident's Details [_JResident [_]Non-Resident indian (NR) [_] New Enrolment [__] Update Request ‘Aadhaar Number: (Ferupdete only) Full Name: co: House No./ Bldg./ Apt: Street/ Road/ Lane: Landmark: Area/ Locality/ Sector: Village/ Town/ City: ome ene state seunatee aa fnar ein coal | | ee seunrectenesamy || SSE Date of Birth: ll | nd Se ee ee) Name of the Certifier Designation: Address: Contact Number: Ihereby certify above mentioned details of the resident (Tick appropriate box below) Gazetted Officer - Group A village Panchayat Head ar Muihiya Gazetted officer - Group B Py MUAY MLC/ Muncipal Counclior Tensilgar Head of Recognized Educational institution ‘Superintendent/ Warden) Matron/ Head of Inctitution ‘of Recognized shelter homes/ Orphanages ooo00000 Signature ofthe Certfier Stamp ofthe Certifier NOTE: This fomat is applicable for FOI documents at. Nos. 17,20, 2,22, 31 6 32; PO dacumen at SI. Nos. 23, 24,37, 38,44 6 45; POR documents tS. Nos. 13. 1 DOB documents 3 51 Nos. 5, 14 615 of Schedule Il ofthe Radha (Envelmert ard Updete) Regulation, 2016, 2 avended rom inet time