SELF-DECLARATION FROM THE HEAD OF FAMILY (HOF) FOR SHARING ADDRESS
WITH IMMEDIATE FAMILY MEMBER RESIDING AT THE SAME ADDRESS
Vishal Lalchand Rajbhar
I, _________________________________________________ (Name as in Aadhaar), resident
of _________________________________________________________________________
806, Adarsh Colonny, Shrikrishna Nagar, Gen A k Vadiya Marg, Near Sharda Hotel,
Goregaon East, Aareymilk Colony, Mumbai, Maharashtra 400065
____________________________________________________________________ (Address
as provided in Aadhaar) holding Aadhaar Number___________________________________,
721665256356 do
hereby solemnly affirm and declare as under:-
Suman Rajbhar
i. That resident Mr./Ms._____________________________ holding Aadhaar number
270130668929 is related to me as my __________________________
_______________________ Spouse
___________________________ (Please specify the relation with applicant) and is
residing with me at the above mentioned address.
Suman Rajbhar
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.
Suman Rajbhar
___________________________ 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 8/12/2024
Name & Signature of Head of the Family (HoF)
विशाल राजभर
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
