aadhar enrolment form - Daman

AADHAAR ENROLMENT / CORRECTION FORM >,r...G,)d ''o!untCC '. Coi rei t otl tvi bin 96 hours of enroltnen !': No charge's ill e applicable for Forrriand Aadhaar Enrolment. In case of Correction provide your EID, blame and only that field which needs Correction.In case of Correction provide your EID No here:Please follow the instructions overleaf while filling up the form. Use capital letters only.1 Pre-Enrolment ID : 2 NPR Receipt/TIN Number:3 Full Name:4 Gender: Male () Female () Transgender () 56 Address: C/o()D/o()S/o()W/o()H/o()Age: Yrs OR Date of Birth:Declared qVerified qHouse No/ Bldg./Apt. Street/Road/LaneLandmark Area/locality/sectorVillage/Town/City Post OfficeDistrict Sub-District StateE Mail Mobile No PIN CODE7 Details of: Father ( ) Mother ( ) Guardian () Husband () WifeFor children below 5 years Father/Mother/Guardian's details ore mandatory. Adults Can opt to not specify this information, if they cannot/do riot want to disclose.NameEID/ Aadhaar No.:8 I have no objection to the UIDAI sharing information provided by me tote UIDAI with agenciesengaged in delivery of welfare services.9 Select One of the Below (OPTIONAL) ( This data cannot be Corrected after Enrolment)qqI want the UIDAI to facilitate opening of a new Bank/Post Office Account linked to myAadhaar Number and have no objection to sharing my information for this purposeI have no objection to linking my present bank account provided here to my Aadhaar numberState Bank Name/BranchIFSC Code Account No.Verification Type : Document Based () Introducer Based ( ) Head of FamilyYES () NOSelect only one of the above. Select Introducer or Head of Family only if you do not possess any documentary proof ofidentity and/or address. Introducer and Head of Family details are not required in case of Document based Verification.10 For Document Based (Write Names of the documents produced. Refer back side of this form for list of valid documents)a. POI b. POAc. DOB d. POR(Mandatory in case of Verified Date of Birth)For HoF Based - Details of : Father ( ) Mother ( ) Guardian () Husband () WifeFor Introducer Based - Introducers11 HoF's Eld/Aadhaar No.:Aadhaar No.I hereby confirm the identity and address of as being true, correct and accurate.Introducer/HoF's Name:Signature of Introducer/HOFConsentI confirm that information (including biometrics) provided by me to the UIDAI and the information contained herein ismy own and is true, correct and accurate.Verifier's Stamp and Signature:(Verifier must put his/her Name, if stamp is not available)-- - --- - ------------------ -------------------------------------------------------------To be filled by the Enrolment Agency only : Date & time of Enrolment:Applicant' s signature/Thumbprint

iField 2NPR NUMBERField 3NAMEF:e'd 5008/AGEField 6ADDRESSRELATIONSHIPField 8CONSENTField 9BANK ACCOUNTField 10DOCUMENTSField 11INTRODUCER/HoFList A. POI documents1. Passport2. PAN Card3. Ration/ PDS Photo Card4 Voter ID5. Driving LicenseInstructions to follow while fillinu p the enrolment formResident may bring his /her National Population Register Survey slip (if available ) and fill up the column.Write full name without salutationsftites . Please bring the original' Proof of Identity (P01) document. (See list A below ). Variation in Resident's IName in contrast to Pol is permissible as long as the change is minor spelling only , without altering the Name in Pol document. For Example: If IResidents Poll reads ' Preeti , then "Priti" can be recorded if Resident wants so.Fill in Date of Birth in DDMMYYYY format . If exact Date of Birth is not known . approx i mate age in Years may be filled in the space provided. Pleasebring the original Proof of Date of Birth (DoB), if available (See list D below) Declared checkbox may be selected if Resident does not have a validproof of Date of Birth document. Verified checkbox is selected where Res ident has provided documents as proof of Date of birthWrite complete address. Please bring the original Proof of Address (POA) document. (See list B below). Please note that the Aadhaar letter will bedelivered at the given address only• To include Parent / Guardian / Spouse name as part of the address, select the appropriate box and enter the name of the person• Minor Corrections / Enhancements are permissible to make the address complete without altering the base address as mentioned'in the POAdocument• In case of children below 5 years. it is mandatory to provide father/mother/guardian details with their Aadhaar or EID number• If the resident is not holding a Proof of Identity & using the Head of the Family identity for enrolment, it is mandatory to provide Head of thefamily's details with his/her Aadhaar or EID number. Please refer illustration below for filling EID. Please bring the original Proof of Relationship(POR) document (See list C below)6 Government Photo ID Cards/ service photoidentity card issued by PSU7. NREGS Job Card8. Photo ID issued by Recognized Educational Instituti9. Arms License10, Photo Bank ATM Card11. Photo Credit Card12. Pensioner Photo Card13 Freedom Fighter Photo Card14 , Kissan Photo Passbook15 CGHS / ECHS Photo Card16. Address Card having Name and Photoissued by Department of Posts17 Certificate of identity having photo issued byGazetted Officer or Tehsildar on letterhead18 Disability ID Card/handicapped medicalcertificate issued by the respective State/UTGovernments/Admin ,rationsList C. POR documents1. PDS Card2. MNREGA Job Card3. CGHS/State Govemment /ECHS/ESICMedical card4. Pension Card5. Army Canteen Card6 Passport7. Birth Certificate issued by Registrar of Birth,Municipal Corporation and other notified localgovernment bodies like Taluk , Tehsil etc.8. Any other Central /State government issuedfamily entitlement document• For other cases, it is optional for the resident to fill up the relationship detailsResident may specifically express willingness i unwillingness by selecting the relevant box.Resident may choose to open a new Aadhaar enabled bank / POSB account or can link existing bank account to Aadhaar number Relevant detailsas requested may be provided This is an optional fieldWrite the name of Documents for Pol and PoA In case proof of Date of Birth is available, then write the name of Date of Birth document if theresident is not holding a Proof of Identity & using the Head of Family based enrolment. then write the name of Proof of Relationship document. Fori Valid list of documents, please refer list of Documents belowResident who does not have P01 and POA may get enrolled through an Introducer! Head of Family. P1 contact nearest enrolment centre or yourRegistrar, for further details23456List B. POA documentsPassportBank Statement/ PassbookPost Office Account StatementlPassbookRation CardVoter IDDriving LicenseGovernment Photo ID cards! service photoidentity card issued by PSU8 Electricity Bill (not older than 3 months)9 Water bill (not older than 3 months)10. Telephone Landline Bill (not older than 3months)11. Property Tax Receipt (riot older than 3 months)12. Credit Card Statement (riot older than 3 months)13, Insurance Policy14 Signed Letter having Photo from Bank onletterhead15 Signed Letter having Photo issued by registeredCompany on letterhead16 Signed Letter having Photo issued by RecognizedEducational Instruction on letterhead17. NREGS Job Card18. Arms License19. Pensioner Card20. Freedom F yhter CardList D . DOB documents2321 Kissan Passbook22 CGHS I ECHS Card23. Certificate of Address having photo issued byMP or MLA or Gazetted Officer or Tehsildar onletterhead24 Certificate of Address issued by Village Panchayat heador its equivalent authority ( for rural areas)25'd1lncome Tax Assessment Order26 Vehicle Registration Certificate27 Registered Sale / Lease I Rent Agreement28. Address Card having Photo issued by Department ofPosts •Caste and Do•.nicile Certificate having Photo issued by30313233State GovtDisability ID Cardtandicapped medical certificateissued by the respective StateNTGovernments/AdministrationsGas Connection Bill (not older than 3 months)Passport of SpousePassport of Parents(in case of Minor)Birth CertificateSSLC Book/CertificatePassportCertificate of Date of Birth issued by Group A Gazetted Officer on LetterheadIllustration for filling up EID No.I.,^,olmc,.l !re. !.liR[F.t AYSt 'MI1. .Ac4nuwlc dl;cmcut rm .iJurt Copy •e r,ii ^ 1.111Fh 7711.:AA i)H A AAof LID No: J p f y, L r S r .., , L Ț T"t Z O J 1 J S O l b l'In instances where original documents are not available, copies attested / certified by a public notary / gazetted officer will be accepted.