Escolar Documentos
Profissional Documentos
Cultura Documentos
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Please follow the instructions overleaf while filling up the form. Use capital letters only. |
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Pre-Enrolment ID/ :
Age/:
Full Name/ :
: ( ) ( ) ( )
House No/Bldg./Apt./ / :
Street/Road/Lane///:
Landmark/ :
Area/locality/sector/ //:
Village/Town/City/ //:
Post Office/:
District/:
Sub-District/-:
E Mail/ :
Mobile No/ :
State/:
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PIN CODE/ : |
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Name/
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I have no objection to the UIDAI sharing information provided by me to the UIDAI with agencies engaged in delivery of welfare services
UIDAI UIDAI |
( )/ ( )
Select One of the Below (OPTIONAL) (This data cannot be Corrected after Enrolment) ( )/( )
I want the UIDAI to facilitate opening of a new Bank/Post Office Account linked to my Aadhaar Number and have no objection to sharing my Information for
this purpose./ / / |
I have no objection to linking my present bank account provided here to my Aadhaar number.
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State /
Bank Name/Branch/ /
IFSC Code/IFSC
Account No./
Select only one of the above. Select Introducer or Head of Family only if you do not possess any documentary proof of identity and/or address. Introducer and Head of Family
details are not required in case of Document based Verification./ | /
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(Write Names of the documents produced. Refer back side of this form for list of valid documents/ | )
a. POI/ :
c. DOB/ :
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b. POA/ :
d. POR/ :
For HoF Based/ : Details of/: Father/ ( ) Mother/ ( )
Guardian/ ( ) Husband/ ( ) Wife/ ( )
HoFs EId/Aadhaar No./ / :
I hereby confirm/ _________________________________________________________________ the identity and address of as being true, correct and
accurate./ |
Introducer/HoFs Name:
/ :
Signature of Introducer/HOF
/ :
Consent/
I confirm that information (including biometrics) provided by me to the UIDAI and the information contained herein is my own and is true, correct and accurate. /
UIDAI (Biometrics ) |
Applicants signature/Thumbprint
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To be filled by the Enrolment Agency only
:
KYR+ Information/ . . .
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Name of Distributor
LPG Company
Customer No.
. . .
. . .
Ration Card
Card No.
.../...
Blue Card
Card No.
AAY/BPL/APL/.../
Driving Licence
Licence No.
Issuing Authority
Date of Issue
Arms Licence
Licence No.
Issuing Authority
Date of Issue
Pensions
PLA No.
...
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