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 : 17-10-
Application Type : Enrolment
2024
Applicant Details Appointment Details
Resident Type: RESIDENT
Full Name: PARTHA MUKHERJEE
Date Of 13-03-1979
Birth/Age:
Address C/O Swapan Mukherjee, Ghj/ G5y,
Kuldiha, Kuldiha l, Amlajora,
Amlajora, Paschim Bardhaman ,
West Bengal, 713212
Gender: Male
Documents to Carry:
Appointment Id: 1729112706940
Aadhaar Seva Suryasen Park,170 GT Road,
Bring original documents for Kendra Address:
Kumarpur, Asansol,
Enrolment/Update. No photocopy
required. Opposite Manoj cinema
Original documents are scanned and Hall, Burdwan 713304
given back to you. Appointment
17-10-2024 (10:40)
Carry/Bring appointment print copy. Date and Time:
Proof of identity:
ST/ SC/ OBC Certificate issued by Central Govt./ State
Govt.
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:
ST/ SC/ OBC Certificate issued by Central Govt./ State
Govt.
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.
