SELF DECLARATION
(APPLICABLE FOR UPDATION IN DOB UNDER EXCEPTION HANDLING
                               PROCESS - ONCE IN LIFETIME )
1. I,                                            S/D/W/o                                      , resident of
                                                                                      Holding Aadhaar No
   (Last eight digits only XXXX /_ _ _ _   /_ _ _ _, do hereby solemnly affirm and declare as under:-
   i.      That the deponent is the resident of the above said address.
   ii.     That the correct date of birth of the deponent is            and the date of birth of
           the deponent is wrongly mentioned in the Aadhaar Card bearing Aadhaar
             No.                             as                  .
   iii.     That the deponent wants to get his /her date of birth updated in the Aadhaar Card
            as                      instead of                          even after utilizing the one
            timeoption for DoB update, or which the deponent is submitting
            as document proof.
   iv.      That the Date of Birth in the Aadhaar Card of the deponent was not correct earlier.
   v.       That the deponent further declares that no document in support of proof of birth was
            submitted by him/her at the time of Aadhaar Enrolment. However, if so submitted, the
            document submitted at the time of updation is not the same as the one submitted at the
            time of Aadhaar Enrolment.
2. Kindly select whichever are applicable :
        Sl. No.                           Parameter                         Selection
                                                        st
           (i)    Current DoB update request is the 1 request for DoB
                  update.
          (ii)    Current DoB update request is second (or greater)
                  request for DoB.
          (iii)   Date of birth mentioned in the Aadhaar Card at the
                  time of Aadhaar Enrolment was declared /approximate
                  and was not verified.
          (iv)    Date of birth mentioned in the Aadhaar Card at the
                  time of Aadhaar Enrolment was verified and was not
                  declared / approximate.
3. That the undersigned undertakes that if the document submitted in proof of date of birth is found to
   be fraudulent / false /forged/non-genuine, the corresponding Aadhaar number may be deactivated
   as per Rule 28 of the Aadhaar (Enrolment and Update) Regulations, 2018.
4. I hereby declare that all the information mentioned above is true to the best of my knowledge and
   belief. In case of any discrepancy if arises, the undersigned will be personally held responsible.
Date:                                                                    Name & Signature of Resident
                                                                [Parent/Guardian in case of Minor(Below
                                                                                       18 year's of age)]