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This document is an Aadhaar enrolment form for an applicant named Raval Sushilaben Narendrabhai, scheduled for an appointment on January 15, 2025. It outlines the required documents for identity, date of birth, and address verification, and confirms the applicant's residency status in India. The form also includes a disclosure statement regarding the use of personal information and biometrics for Aadhaar generation and authentication.

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hardik22222290
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6 views1 page

About Blank

This document is an Aadhaar enrolment form for an applicant named Raval Sushilaben Narendrabhai, scheduled for an appointment on January 15, 2025. It outlines the required documents for identity, date of birth, and address verification, and confirms the applicant's residency status in India. The form also includes a disclosure statement regarding the use of personal information and biometrics for Aadhaar generation and authentication.

Uploaded by

hardik22222290
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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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 : 13-01-
Application Type : Enrolment
2025
Applicant Details Appointment Details

Resident Type: RESIDENT


Full Name: RAVAL SUSHILABEN
NARENDRABHAI
Date Of 01-01-1969
Birth/Age:
Address C/O Raval Narendrabhai, B-21
VISAMO APARTMENT/ A-PART
GHODASAR, GHODASAR,
Ahmadabad City, Ghodasar,
Ahmedabad , Gujarat, 380050
Email hardik22240@gmail.com
Appointment Id: 1736761355340
Gender: Female Aadhaar Seva Shop No 210 231, 2nd floor,
Documents to Carry: Kendra Address:
Maruti Plaza, Sardar
Chowk, Opposite Vijay Park
Bring original documents for Society, Krishna Nagar,
Enrolment/Update. No photocopy Ahemdabad 382345
required. Appointment
15-01-2025 (10:40)
Original documents are scanned and Date and Time:
given back to you.
Carry/Bring appointment print copy.

Proof of identity:
Voter Identity Card Card/e-Voter Identity Card
Proof of date of birth:
Mark sheet/ Certificate issued by recognized Board of
Education/ University
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.

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