lnstructitsns: Ali detaiis to be filled in &lock Letteys

{Tit be valid for 3 months lram date at' issue)

E-EI IiI
'l'ct
be printerl o* ploin A4 paper size Nat rcquired to print on letter head ,?f\r1F
&.'. v & .*lr

ruon-nesident tndian (NRt]

[l Update Request
.&adhaar hicmnbsr:
iFor update only)
inll hl*,-.^.

C/o:

!0r.ruse No./ Ulc{fl"/ Apt:

Street/ lioad,/ [.ane:

[.arrdlr'lark;

Arear/ Lacalityl $ector:

trili;gel Tbwrrl Ciry:

$trost {.}fficer

lfisirict:

St;ite:
tai\l4QRa1'1 l
t--_
[:ifU Creie:
m5-ist---l
$are s{ FJlrth:
l__o_l I oI Lrq6[*] ,,$r,H:l*"H,
Thtrmb/ Finger lmpression

f$an.re of the Certi'ffer:

Nlesignatiorr:

Sffice Address:
Y'.!T *F +\ L 5uR"tl le E;
f=t enV n I
flontact filumtrer:

E hereby cerin-fy ab*ve nlentirned.detaiis

of the resident
afid X ;*m a."." (Tick appropriate box befu:w) / - Checklist for Certifier

S$3u.r*r,t',,* ffirr" date is fiiled $(nlsiuent,s signature ffifirtifiert tretairs

f*l eu."rt*d Officer - Gi.oup A Photo is
f:f-Resident's cross signed and cross stamp ed {paper to phota ar ph6to
ta paper)
f-*j Vitiage parlchayat i-iead oi" tutrktriya

ffirzetie,l Dffirer- -Group B

[] vtpr'MLAI tvtlcl Muncipal Councilor
rl I -,.,.
i lensilcar
l*-l HeaU of Rerognized Educational ln$tit$tion
[] Superintendentl Vdardenl Mation/ Head of tnstitution
of Recognized sheiter homes,/ Orphanages
.----
I-i i tPl-U Ultrcer Signature & Stamp of the Certifier