eae VGN Instructions: All details to be filled in Block Letters (To be valid for 3 months from date of issue) To be printed on plain Ad paper size Not required to print on letter head Pearce ns [JResident [_] Non-Resident indian (NRI) [| New Enrolment [_—] Update Request Aadhaar Number: (For update only) Co: House No./ Bldg./ Apt: Street/ Road/ Lane: Landmark: Area/ Locality/ Sector: Village/ Town City: Post Office: Resident's Recent Esiour Photograph a ‘Sem x45 cm cross Signed and Cross Stempe Sythe Center balacstaed NB: 00 Nor oo Saeed OVERLAP Wi jonature ofthe Reside “Text BOXES Date of Birth: | | ‘Thumb Finger Impression Coe Name of the Certifier: Designation: Address: Contact Numbe I hereby certity above mentioned details ofthe resident Checklist for Coifier and am dow Tek eproorateboxelow) Cnc overwrtng ]istuediteistted C]eriden’s sigratore C]cersner's dette LD Geretod oFfeor- Group resident's Phat es sgned and cos stamped inaer to photo or hot to pebe witlage Panchayat Hoad or Multia D Gsseted officer Group 8 [Tar muy natc/ Muncipal Councilor 1 tensisar Head of Recognized Educational stitution superintendent’ Warden/ Matron/ Head of Institution cof Recognized shelter homes/ Orphanages BF enoomes Signature & Stamp othe Crter NOTE: Ts formats applicable for POI documents at SL Nos. 17, 20,21, 22 31 & 32; FOA documents 2 SI. NOs. 23,24, 37,38, 44 & 45; POR document tL. Nos. 13, {14008 documents at Sl. Nos. 5,14 & 15 of Schedule ofthe Aachaar (Enrolment and Update) Regulation, 2016, a amended from time te tire.