25I2923
issue)
Update
Request ZP.ANADAGPIN
HEADMASTER
Schof
High
STsayaan
of
Certiier's
details
date paper)
eat
from to documents
months
3
for
photo
or
photo
signature ZPlgh
AMADAGURW)
HEADMISchpd
ime
ASTER0SaiHOR44&45;fom
lo
ime
valid to
Enrolment
New (paper amended
be for Resident's
Checklist
Certifier S
38, Z
UPDATE
(To
stamped
Resident/
Thumb/
Finger Oniy)
Impression
2016
the
certifier filledcoss Regulations,
FNROLMENT/
G of
Signature is
date
ssue
and
signed at
documents
Update)
the cross
Resident's
Details
Non-Resident
Indian
(NRI) CHEEK
REVULA
PALZ by
filled
is POAand
AADHAAR CHEEII
REVULA
PALLI 7a816%64
RNo Photo
overwriting
32,
(Enrolment
65592263
4356 SRI
SATHYA
SAIANOHRA
PRApSH 197
2 be YResident's &
head: GuPoRAMAPPA (To
31
22, Aadhaar
letter 21,
FOR Details
print
on
MAIN
RoAD resident
institution 20,
17,the
CERTIFICATE
required
Not
to Certifier's Nosofll
the SL Schedule
Letters 12-)4 of homes/Orphanages
institution
Head at
documents
Resident of of
details Councilor Matron/
Block below) Mukhiya 15
Educational &
in mentioned POl144,5,
Rilled size: box A B Muncipal
or Officer-Group
Gazetted Warden/
GroupHead for
paper appropriate Nos.
applicable
be
Apt: Area/
Locality/
Sector:
shelter
Recognized
to A4
details plain Street/
Road/
Lane: Village/
Town/
City: the
Certifier: above - PanchayatMLC/
Officer Superintendent/ SL.at
Aadhaar
Number: Bldg./
Contact
Number:certify
Recognized
EPFO is documents
Oficer
(For
update
only) (Tick
All on
No./ Date
Birth:
of Office
Address: Gazetted MLA/VTehsildar format
printed
instructions: Office:
Post Designation: a.... of
Full
Name: Landmark: PIN
Code: Village Head
House District: Name
of Ihereby
am MP/ ThisDOB
be C/o:
State: of
To I
and NOTE:
14
&