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AADHAAR ENROLMENT
FORM

(Aadhaar Enrolment is free &

भारतीय विशिष्ट पहचान प्राधिकरण भारत सरकार
Voluntary)
Under Section 3 of THE AADHAAR (TARGETED DELIVERY OF FINANCIAL AND OTHER SUBSIDIES, BENEFITS AND
SERVICES) ACT,2016 (Aadhaar Act)
Submission Date : 31-03-2024 Application Type : Enrolment
Applicant Details Appointment Details

Resident Type: RESIDENT

Full Name: ANSH RAJ
Date Of 23-09-2016
Birth/Age:
Address C/O Pradeep Kumar, 34/ Jiyan bigha road,
durga mandir, jiyan bigha, Nimi, Nimi,
Sheikhpura , Bihar, 811103
Email sonikumari805198@gmail.com
Guardian Name: SONI KUMARI
Guardian 898144219795
Aadhaar: Appointment Id: 1711898413767
Gender: Male Aadhaar Seva Lower Ground Floor
Kendra Address: Akshardham Metro Mall
Documents to Carry:
(Parshuvanath), Delhi
Appointment Date
01-04-2024 (10:10)
Bring original documents for Enrolment/Update. and Time:
No photocopy required.
Original documents are scanned and given back
to you.
Carry/Bring appointment print copy.

Proof of date of birth:

Birth Certificate issued by Authorized Authority (in the
respective States) under the Registration of Births and Deaths
Act, 1969 read with Registration of Births and Deaths Rules
1999/2000/2002 of respective States
Proof of relation: Birth Certificate issued by Authorized
Authority (in the respective States) under
the Registration of Births and Deaths Act,
1969 read with Registration of Births and
Deaths Rules 1999/2000/2002 of respective
States
I hereby confirm the identity and address of (HOF/Relative Name) (auto populates) as being true, correct
and accurate.

HOF s Name: Signature of HOF

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.)

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