7/13/24, 2:21 PM about:blank
AADHAAR ENROLMENT
FORM
(Aadhaar Enrolment is free &
भारतीय विशिष्ट पहचान प्राधिकरण भारत सरकार
Voluntary)
Under Section 3 of THE AADHAAR (TARGETED DELIVERY OF FINANCIAL AND OTHER SUBSIDIES, BENEFITS AND
SERVICES) ACT,2016 (Aadhaar Act)
Submission Date : 13-07-2024 Application Type : Enrolment
Applicant Details Appointment Details
Resident Type: RESIDENT
Full Name: RAJKUMARI
Date Of 01-01-1947
Birth/Age:
Address C/O Praveen Awasthi, Vllage Birampur/
Post Trilokpur Usmanpur, Near Khanipur,
Haidergarh Barabanki-225126, Birampur,
Tilokpur Usmanpur, Bara Banki , Uttar
Pradesh, 225126
Email awasthijyoti051994@gmail.com
Gender: Female Appointment Id: 1720860653681
Documents to Carry: Aadhaar Seva Ground Floor, Ratan Square
Kendra Address: Mall, Lucknow
Appointment Date
15-07-2024 (12:50)
Bring original documents for Enrolment/Update. and Time:
No photocopy required.
Original documents are scanned and given back
to you.
Carry/Bring appointment print copy.
Proof of identity:
Voter Identity Card Card/e-Voter Identity Card
Proof of date of birth:
Birth Certificate issued by Authorized Authority (in the
respective States) under the Registration of Births and Deaths
Act, 1969 read with Registration of Births and Deaths Rules
1999/2000/2002 of respective States
Proof of address:
Photograph Identity Card / Certificate with Photograph issued
by Central Govt./ State Govt. like Bhamashah, Domicile
Certificate, Resident Certificate, JanAadhaar, MGNREGA/
NREGS Job Card, Labour Card etc.
Disclosure under section 3(2) of THE AADHAAR (TARGETED DELIVERY OF FINANCIAL AND
OTHER SUBSIDIES, BENEFITS AND SERVICES) ACT, 2016
I confirm that I have been residing in India for at least 182 days in the preceding 12 months / I am Non Resident Indian (NRI) &
information (including biometrics) provided by me to the UIDAI is my own and is true, correct and accurate. I am aware that my
information including biometrics will be used for generation of Aadhaar and authentication. I understand that my identity
information (except core biometric) may be provided to an agency only with my consent during authentication or as per the
provisions of the Aadhaar Act. I have a right to access my identity information (except core biometrics) following the procedure laid
down by UIDAI.
Verifier's Stamp and Signature Applicant's Signature/Thumbprint
(Verifier must put her/his name if stamp is not avaliable.)
Note: In case of Child(< 5 Yrs) or Guardian based application, Guardian/Relative will be required to accompany the applicant. In
case of incapacitated person, the signature will be done by Legal Guardian of Incapacitated Person.
about:blank 1/1
