Please follow the instructions overleaf while filling up the form. Use capital letters only.
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Enrolment ID (If applicable): |
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In case of Update provide Aadhaar Number (UID): |
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Name: |
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Gender: |
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Age: Yr OR DOB: |
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Address: C/o |
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House No./ Bldg./ Apt: |
Street/ Road/ Lane: |
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Landmark: |
Area/ Locality / Sector: |
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Village/ Town/ City: |
Post Office: |
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District: Sub District: State: |
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Email: Mobile: Pin Code: |
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Details of: For children below 5 years Father/Mother/Guardian’s details are mandatory. Adults can opt not to specify this information. |
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Name: |
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EID/Aadhar No.: |
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Verification Type: Select only one of the above. Select Introducer or Head of Family only if you do not possess any documentary proof of identity and/or address. Introducer and Head of Family details are not required in case of Document based verification. |
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For Document Based(Write Names of the documents produced. Refer overleaf of this form for list of valid documents) |
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a. POI (Proof of Identity)
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b. POA (Proof of Address)
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c. DOB (Date of Birth)
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d. POR (Proof of Relationship)
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For Introducer Based –Introducer’s Aadhaar No.: |
For HoF –Details of: |
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I hereby confirm the identity and address of as being true, correct and accurate. Introducer/ HoF’s Name: Signature of Introducer/ HoF________________________ |
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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:
(Verifier must put his/ her Name, if stamp is not available)
Applicant’s signature/ Thumbprint
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To be filled by the Enrolment Agency only:
Date & time of Enrolment: _________________________________
Note: In case of minor, the signature will be done by parent/guardian. In case of incapacitated person, the signature will be done by Legal Guardian of Incapacitated Person * In case of NRI, only Indian Passport will be valid as POI.