CERTIFICATE FOR AADHAAR ENROLMENT/ UPDATE

filled in Block Letters (To be valid for 3 rmonths

Instructions: All details to be frorn date of is5ue)
size; Not required to print on letter hae
To be printed on plain A4 paper

Kesident's Detalls
Resident
Non-Resident Indian (NRI) New Enrolment
update Request
Aadhaar Number:
(For update only) 83303804 6n83
Full Name: KA NDUkURI GoTHAM

S/o: k BHANU SEKHAR

House No./ Bldg./ Apt:
3-13
Street/ Road/ Lane:
NALN ROAD
Landmark:
AMADAGOR MAN DAL
Area/ Locality/ Sector:
kANDUkuRI PALLT
Village/ Town/ City:
JowkALA koTHA PALE
Post Office:
JowkALA JeoTHA PALLE
District:
SRI SATH yA SAL
State:
ANDARA PRADESH
PIN Code:

Date of Birth:
O39 2 009
k.Gruta dal)
Dy, TA LDAk
AMAIAGURU (Mah
Thumb/ Finger Impression

Certifier's Details (To be filled by the certifier Onlv) Sri Sathya sat (tSi
Name of the Certifier:

Designation:

Office Address:

Contact Number:
94931 8883
Ihereby certify above mentioned details of the resident Checklist for Certifier
and Iam a... (Tick appropriate box below) Vyo overwriting ssue date is filled MResident's signature Certifier's details
Gazetted Officer - GroupA NResident's Photo is cross signed
and cross stamped (paper to photo or
photo to paper)
Village Panchayat Head or Mukhiya
Gazetted officer -Group B
MP/ MLA/ MLC/ Muncipal Councilor
Tehsildar
Dy. TAHSILDAR
Head of Recognized Educational Institution AMADAGURU(Mandal)
Superintendent/ Warden/ Matron/ Head of Institution
Sri Sathya Sai (Dist.)
of Recognized shelter homes/9rphanages
EPFO Officer Signature &Stamp of the Certifier

NOTE: This format is applicable for POl douments at SI. Nos. 17, 20, 21, 22, 31 &32; POA documents at Sl. Nos. 23, 24, 37,7.38, 44& 45; POR documents at SI. Nos. 13
&14 DOB documents at Sl. Nos. 4, 5, 14 &15 of Schedule ll of the Aadhaar (Enrolment and|Update) Regulations, 2016, as aamended from time to time.