CERTIFICATE FOR AAOHAAR ENROLMENT UPDATE

/n,rrvrrt,on, All det•ll1 to be flttl!d In lltodl u llen (To bl' •olldfnr J mo,it/'I, from do,,. of luut')

To be printed on plain ,14 poPff sl1t1, Not rrqvJrl'd to print on /p(tpr hPOd,
I \ \ I ID?> I 1'2 0 L \..\ I
Resident's Details
D Resid ent D N on -Resident Indi an (NRI) D Nf!W Enrolment ~ Up<b te ~quest

Aadh■-r Num ber:

(For upd1te only) I 2. 3 °I ~ 0 l 4 s- 6 )5 <?;- - G)_J
Full Name:
Ik g A \J JN D ~ A N. p,.. ti
,...,
'
C/o:
i.sl6 k· Q 9 i 7 Pt r3 ~ A n. A
House No./ Bids./ Apt:
IB L Q C t. 1\\ 0 3 fi
J.
"'
•
Strfft/ Ro ad/ l ane:
1~ Q u s j_ it Gi c.. 0 L-- 0 N y_
landmartc:
IN E A g w A r R ~

~ n. tJ ~ I
Area/ locality/ Sector:
15 [ --5 l-( A D 'e ,l r
~ B ~ E B.
__,J

V Ul. .e/ Town/ City:

IP f\ 0 1 12 ~ ~ A
Post Office :
i2 A D .1 ~ f- I' A-
District:
IT "" r-
J g_ u ~ A w ,
,...,

State :
(;A .p ' -.;

I: :,. 3 9 61 5 1~ 98"
PIN Code:
ls \ ::i 5 0 ~1 ~
- _y-->2- <
..._.;,,:i1Sl •\ ' li
~- ;_

'/--· 0
Date of Blnh:
[ (> 7 II t, 11 9 3 'l--! ~~urr of l h• Rr»d,n1/
Thumb/ f '"I" Imp,_,.;_
AF~

Certifier's Details (To be filled by the certifier Only)

Name of the Certifier:

Oe51gnatlon:

Office Address:

Conbct Numbff: S 4 y o ? 11 -=)93

I hereby certify above ment ioned details of the resident Checklist for Certifier
and I am a .... (Tldt appropriate box below) 0 No overwritJn1 0 Issue date Is filled O R~ldent's signature O Certifier's details
u Gazetted Officer - Group A D Resident's Phot o ·,s cross ~·,gned and cross stamped /poper to photo or photo to pop~r)

□
Village Panchayat Head or Mukhiya

□ Gazetted Officer - Group B

□ 0.SSISTANT EXEC
MP/ MLA/ MlC/ Muncipal Councilor
OPE.RATION _.,""TV..... ,
□ Tehsildar
APS?9CL :· TIRUGHAN0OR
□
Head of Recognized Educational lns-trtution

□
Superintendent/ Warden/ Matron/ Head of Institution
of Recognized shelter hom es/ Orphanages
Stgnature & Slam p of the (ffld~r

□ EPFO Officer

NOTE: This format Is applica ble for POI documents at SI. Nos. 17 . 20 , 21, 22, 31 & 32; POA dOaJments at SL Nos. 23, 24, 37, 38, 44 & 45;
POR dOaJments at SI. Nos. 13
& 14 DOB documents at SI. Nos. 4, 5, 14 & 15 of Schedule II of the Aadhaar (Enrolment and Update) R~ulat ions, 2016, ;is amended from time to time.