CERTIFICATE FOR AADHAAR ENROLMENT/ UPDATE
Instructions: All details to be filled in Block Letters                                                                       (To be valid for 3 months from date of issue)
To be printed on plain A4 paper size; 	         Not required to print on letter head;			                                 D D           M M              Y     Y     Y         Y
                                                                     Resident’s Details
                                          Resident                 Non-Resident Indian (NRI)                            New Enrolment                       Update Request
Aadhaar Number:
(For update only)
Full Name:
C/o:
House No./ Bldg./ Apt:
Street/ Road/ Lane:
Landmark:
Area/ Locality/ Sector:
Village/ Town/ City:
Post Office:
District:
                                                                                                                                                    Resident’s Recent
State:                                                                                                                                              Colour Photograph
                                                                                                                                                    3.5cm x 4.5 cm
                                                                                                                                                    Cross Signed and
                                                                                                                                                     Cross Stamped
                                                                                                                                                     by the Certifier.
PIN Code:                                                                                                                                             NB: DO NOT
                                                                                                                                                     OVERLAP WITH
                                                                                                                                                      TEXT BOXES
                                                                                                      Signature of the Resident/
Date of Birth:                                                                                        Thumb/ Finger Impression
                                                Certifier’s Details (To be filled by the certifier Only)
Name of the Certifier:
Designation:
Office Address:
Contact Number:
I hereby certify above mentioned details of the resident                                                   Checklist for Certifier
and I am a.... (Tick appropriate box below)                           ✔   No overwriting     ✔   Issue date is filled    ✔   Resident’s signature   ✔   Certifier’s details
       Gazetted Officer - Group A                                     ✔   Resident’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
       Head of Recognized Educational Institution
       Superintendent/ Warden/ Matron/ Head of Institution
       of Recognized shelter homes/ Orphanages
                                                                                                        Signature & Stamp of the Certifier
       EPFO Officer
NOTE: This format is applicable for POI documents at SI. Nos. 17, 20, 21, 22, 31 & 32; POA documents at SI. Nos. 23, 24, 37, 38, 44 & 45; POR documents at SI. Nos. 13
& 14 DOB documents at SI. Nos. 4, 5, 14 & 15 of Schedule II of the Aadhaar (Enrolment and Update) Regulations, 2016, as amended from time to time.