Cae Leuk eA es (fo be vl for 3 months from dat of sue} Instructions: All etal tobe filed in Block Letters Tobe printed on pain A¢ pope size; Not required to print on letterhead [Ee io a 2o2 Sree k [A] resident [J] nom-esdentndion (ur) [_] new Enrolment [7] uncate Request wan" [F284 25649070 Full Name: G@oPAL DEBNATH i a Ge: [S_ UK HRANTAN DEBNATH i Howeno/aie/ae [PLOT NO -415 47 7 | Street/Road/ Lane: ROADNoO-41428 Landmark: Bloc K-c wea/tocaity/secor: [FT A HE R PUR Village/ Town/ City: TAHER PUR a Post Office: TAHE R PUR T District: NADIA i State wEsT BENGAL PIN code: 4 i259 Gooral Debnath. ate of sth: o2|[e3|[24ore Tent ge npn UC YRSes ae) Nameotthecenite: [A Cu TN TYA KUMAR PAUL Designation: EXE Cu PEVE OFFICER Office Address: TAH ERPUR NOTIFIED AREA AUTHORITY TAHE RP UR 3 NADIA i Contact Number: "hereby certify above mentioned details ofthe resident and lam a... [Tek appropriate box below) [J Gazeree omer - Group a Ey ilage Panchayat Heas or Mukniya Ganetet Officer - Group 8 IMP/ MLA/ MLC Muncpal Councilor Tehsldar Head of Recognized Educational insturion Superintendent Warden/ Matron/ Head of Institution ‘of Recognized shelter homes/ Orphanages PFO Officer O o0000 [954122 eRe ‘Checklist for Certfier Lnocverwritng Cisse datets tiled ] Residents signature Di residents Photos cross signed and cas stamped (paper to photo or phot to paper) Dleertiters deta Male utive Officer ected Mea AUN Taherput, Nadia Slaatre 8 Star of the center NOTE: This format is apateaie for POI documents tS. Nos 17, 20,21, 2,34 & 32; POA documents at SI. Nos. 23,24, 37,38, 48 & 45; POR documents at St, Nos. 13 {818 008 documents at SL Nos 4, 5,148 18 of Scheaule ofthe Aadhaar (Enrclment and Update} Regulations, 2016, at smended trontime tote