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rlce:

Aadhaar Seed|ng App||cat|on Iorm


App||cat|on Deta||s:
AppllcanL name*: 8elaLlon wlLh 8esldenL*:
uoor no: LocallLy / Landmark:
ulsLrlcL*: Mandal*:
vlllage/Ward*: lncode:
Moblle*: uellvery 1ype*:
Seed|ng Departments & Serv|ce Spec|f|c Deta||s:
Aadhaar number (ulu)*:
CusLomer name: ulsLrlcL name*:
Mandal name: vlllage/Ward name:
Clvll Supplles
8aLlon Card number*:________________________ Seedlng erson name*: _______________________________
enslon
enslon lu*:_________________________________
MCn8LCA
!ob Card number*:__________________________ Seedlng erson name*: _______________________________
LC
Agency 1ype*________________ LC ulsLrlbuLor Code*________________ LC Consumer no*______________
8ank name*__________________________ 8ank AccounL number*___________________________
8ank llSC Code* ______________________ 8ank 8ranch name* _____________________________
Dec|arat|on:-
l hereby declare LhaL Lhe above-menLloned lnformaLlon ls correcL up Lo my knowledge and l bear Lhe
responslblllLy for Lhe correcLness of Lhe above-menLloned.
Documents to be enc|osed: AppllcanL's SlgnaLure
1. 8esldenL roof
2. 8ank assbook
3. Aadhaar lu(e-Aadhaar also accepLable)
4. Scheme uocumenL(Llke 8aLlon Card/!ob Card/enslon ass 8ook/LC Consumer book)*
(ALLach 8ank passbook also ln LC scheme)
(* -- lndlcaLes MandaLory)

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