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 : 16-10-
Application Type : Enrolment
2024
Applicant Details Appointment Details
Resident Type: RESIDENT
Full Name: MOHD KHURSHEED
Date Of 10-10-1960
Birth/Age:
Address C/O Ameer ali, 28/ Mughalpura, Lal
school, Mughalpura, Moradabad,
Peerghaib, Moradabad , Uttar
Pradesh, 244001
Email maazgadgetsstore@gmail.com
Gender: Male
Documents to Carry: Appointment Id: 1729090268892
Aadhaar Seva A-17 Commercial Building,
Kendra Address:
Near ICICI Bank ,Gandhi
Bring original documents for Nagar, Rampur Road,
Enrolment/Update. No photocopy required.
Original documents are scanned and given Moradabad
back to you. Appointment Date
17-10-2024 (10:00)
Carry/Bring appointment print copy. and Time:
Proof of identity:
Voter Identity Card Card/e-Voter Identity Card
Proof of date of birth:
Service Photo Identity Card issued by Central Govt./
State Govt./ PSU/ Regulatory Bodies/ Statutory Bodies
Proof of address:
Voter Identity Card Card/e-Voter Identity Card
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.
