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 : 02-12-
Application Type : Enrolment
2024
Applicant Details Appointment Details
Resident Type: RESIDENT
Full Name: AMNA AKRAM
Date Of 14-08-2023
Birth/Age:
Address C/O MD AKRAM, QURAISHI
MOHALLA RAILPAR, ASANSOL,
Asansol (m Corp.), Dakhin Dhadka,
Paschim Bardhaman , West Bengal,
713302
Email mda163031@gmail.com
Guardian Appointment Id: 1733129544003
SUFIA GHAZALA
Name: Aadhaar Seva Suryasen Park,170 GT Road,
Guardian 782902034879 Kendra Address:
Kumarpur, Asansol, Opposite
Aadhaar:
Gender: Female
Manoj cinema Hall,
Burdwan 713304
Documents to Carry: Appointment Date
02-12-2024 (16:10)
and Time:
Bring original documents for
Enrolment/Update. No photocopy required.
Original documents are scanned and given
back to you.
Carry/Bring appointment print copy.
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 Birth Certificate issued by Authorized
relation: 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
I hereby confirm the identity and address of (HOF/Relative Name) (auto populates) as being
true, correct and accurate.
HOF s Name: Signature of HOF
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.
