SELF-DECLARATION FROM THE HEAD OF FAMILY (HOF) FOR SHARING ADDRESS
WITH IMMEDIATE FAMILY MEMBER RESIDING AT THE SAME ADDRESS
I, _________________________________________________ (Name as in Aadhaar), resident
of _________________________________________________________________________
____________________________________________________________________ (Address
as provided in Aadhaar) holding Aadhaar Number___________________________________, do
hereby solemnly affirm and declare as under:-
i. That resident Mr./Ms._____________________________ holding Aadhaar number
_______________________ is related to me as my __________________________
___________________________ (Please specify the relation with applicant) and is
residing with me at the above mentioned address.
ii. That I agree to share my address in my Aadhaar with Mr./Ms. __________________
_____________________ for updating his/her address in Aadhaar in my capacity of
Head of the Family (HoF).
iii. That the undersigned undertakes that, the above mentioned information is correct
to the best of my knowledge and belief and at any point of time if any of the said
information is found to be incorrect/fraudulent/false, the Aadhaar of Mr./Ms.
___________________________ and mine can be deactivated and legal action
may be initiated against me, as per the provisions of the Aadhaar (Targeted Delivery
of Financial and Other Subsidies, Benefits and Services) Act, 2016 (18 of 2016) and,
Regulations framed there under and other applicable Acts and Rules, etc.
Date DD/MM/YYYY Name & Signature of Head of the Family (HoF)
Note:
1. This document is valid for Head of Family (HoF) based Aadhaar address update purpose only.
2. This document is valid for 3 months from date of issue
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 be printed 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
Certіfіer’s Details (To be fіlled by the certіfіer 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/ Municipal Councillor
Tehsildar
Head of Recognized Educational Institution
Superintendent/ Warden/ Matron/ Head of Institution
of Recognized shelter homes/ Orphanages
Signature & Stamp of the Certifier
EPFO Officer
INSTRUCTIONS FOR FILLING UP CERTIFICATE FOR AADHAAR ENROLMENT/ UPDATE
?, GENERAL INSTRUCTIONS Please read the below instructions carefully before filling the application form
The Application Form consists of two parts, i.e., Resident details and Certifier details.
A Sample filled form is provided in line with the instructions for reference. Residents are advised to also view the sample filled form
provided after reading these instructions.
Please note: Incomplete or inappropriately-filled application form will not be accepted.
Please follow the instructions given below while filling the form:
• Certificate has to be printed on Plain paper.
• Use CAPITAL LETTERS only, as shown in the image below –
r a m e s h R A M E S H
Incorrect Correct
• Use standard fonts and avoid stylized writing.
• Use black or blue ball point pen only. Do NOT fill the application form with ink-pen or pencil.
• Put a tick marks (✓), in the boxes where you have to select options as your answer and leave the other option(s) blank.
• Write clearly within the boxes without touching the boundaries. Try and write in the centre of the box, as shown in the image below–
Incorrect Correct
• Leave one box blank after each complete word, while filling up the boxes.
R A M E S H G U P T A R A M E S H G U P T A
Incorrect Correct
• Do NOT write “NA” or “N/A” or “NOT APPLICABLE” in any boxes in the form to convey that the column is not relevant for your case.
Leave that column blank.
B. FIELD-WISE GUIDELINES FOR FILLING UP “CERTIFICATE FOR AADHAAR ENROLMENT/ UPDATE”- Resident section
Ensure all the fields are filled properly, as per below instructions.
S No Filed Name General Instructions
1 Date of Issue • Specify the date in DD-MM-YYYY format.
• Ensure the Certificate is submitted within 3 months of date of issue.
• Enrolment or Update Request will be rejected if Date of Issue is blank or Certificate has
expired.
2 Resident Category • Specify the resident is native Resident of India or belongs to Non Resident Indian (NRI)
Category
3 Enrolment type • Specify the current request is either for obtaining a Aadhaar card which is known as
“New Enrolment” or for updating an existing Aadhaar details which is known as “Update
Request”.
4 Aadhaar Number • Mention your Aadhaar Number.
• In case of Enrolment, Kindly leave it blank.
• In case of Update, it is mandatory to specify the Aadhaar number.
5 Full Name • Mention the name of Resident.
• Name shall be mentioned in the format as to be recorded in the Aadhaar.
6 C/o • Mention the Care of (C/o) if required in the address field.
• This field can be left blank as well.
7 House No/ Bldg./ Apt: • Mention the House Number, Building Name or Apartment Name as per the address.
8 Street/Road/ Lane • Mention Street Name, Road & Lane of the address.
9 Landmark • Mention the Landmark near your address.
• This field can be left blank as well, if not required.
10 Area/ Locality/ Sector • Mention Area/ Locality/ Sector of your address.
11 Village/ Town/ City • Mention Village/ Town/ City of your address.
12 Post Office • Mention the nearest post office of your address.
• This filed can be left blank.
13 District • Mention the District of your address.
14 State • Mention the State of your address.
15 Pin Code • Mention the pincode of your address.
16 Date of Birth • Mention the Date of Birth.
17 Signature • Resident shall put his/her Signature in the box specified for signature.
• Illiterate Resident can provide Thumb or Finger impression.
18 Resident Photo • Resident shall paste latest color photograph of size 3.5 cm X 4.5 cm.
• Ensure photo is pasted in the space provided. It shall not overlap in text boxes.
• Photo needs to be cross signed by the certifier.
• Photo needs to be cross stamped by the certifier.
C. FIELD-WISE GUIDELINES FOR FILLING UP “CERTIFICATE FOR AADHAAR ENROLMENT/ UPDATE”- Certifier section
Kindly ensure all the fields are filled properly by the Certifier, as per below instructions.
S No Filed Name General Instructions
1 Name of Certifier • Mention the name of Certifier
2 Designation and office • Specify the designation and office name of the Certifier.
name
3 Office Address • Specify the complete address of the certifier, along with Department name.
4 Contact Number • Specify the contact details of the certifier.
5 Certifier Type • Mention the certifier type by tick (✓) mark on one of the box provided against below
mentioned categories:
o Gazetted Officer - Group A
o Village Panchayat Head or Mukhiya
o Gazetted Officer - Group B
o MP/ MLA/ MLC/ Municipal Councillor
o Tehsildar
o Head of Recognized Educational Institution
o Superintendent/ Warden/ Matron/ Head of Institution of Recognized shelter homes/
Orphanages
o EPFO Officer
6 Checklist for Certifier • Verify the below checklist by putting tick (✓) mark on the boxes:
o No overwriting
o Issue date is filled
o Resident’s signature
o Certifier’s details
o Resident’s Photo is cross signed and cross stamped (paper to photo or photo to
paper)
o Please ensure that complete form is duly filled, and all boxes of checklist all
selected.
7 Sign & Stamp of the • Provide certifier’s signature and stamp in the space specified.
certifier
D. IMPORTANT INSTRUCTIONS
Below are few important steps that resident shall ensure before submitting the form:
• Certificate must be printed on Plain paper.
• Form must be submitted within 3 months of date of issue.
• Ensure No overwriting in the form.
• Date of issue must be filled properly in DD-MM-YYYY format.
• Resident signature or thumb impression is must.
• Certifier details must be filled in properly.
• Latest colored photograph of 3.5cm X 4.5 cm should be pasted within the defined area.
• Certifier cross sign & cross stamp must be available on the resident photograph.
• Certifier complete details must be filled in.
