No charges are applicable for enrolment form and Aadhaar enrolment.

AADHAAR ENROLMENT FORM - ஆதார் பதிவுப் படிவம் [

Please follow the instructions overleaf while filling up the form. Use capital letters only.

1 Full Name: பனர்

2 Gender: Male ( ) Female ( ) Transgender ( ) ால்: ஆண் பண் திருங்கை

3 Date of Birth | DD | MM | YYYY | OR Age : Yrs ிந்த தததி (அல்து) யனது

4 Address: C/o ( ) S/o ( ) D/o ( ) W/o ( ) NAME/ பனர் யசிப்ிட முையரி

House No/ Bldg யடீ்டு எண்

Street/Road/Lane பதரு பனர்

Village ைிபாநம்

City ைபம்

Taluk தாலுைா

District நாயட்டம்

State நாிம்

Post Office அஞ்சைம்

PIN CODE | | | | | | | அஞ்சல் எண்

Mobile No | | | | | | | | | | | கைப்தசி எண்

E Mail நின்ஞ்சல்

5 Details of : Father ( ) Mother ( ) Husband ( ) Wife ( ) Guardian ( ) தந்கத தானார் ைணயர் நகயி ைாப்ார்

Name பனர்

Aadhaar No. | | | | | | | | | | | | | OR EID No: | | | | | | | | | | | | | | | dd |mm| yyyy|hh: mm: ss| ஆதார் எண் (அல்து) EID எண்

6 Introducer’s name: அிமுைப்டுத்துயர் பனர்

Aadhaar No. | | | | | | | | | | | | | ஆதார் எண்

7 National Population Register (NPR) Survey slip No. ததசின நக்ைள் பதாகை ைணக்பைடுப்பு பதிவு பசீது எண்.

8 I want to: Open Aadhaar enabled Bank/POSB Account ( ) OR Link my existing Bank Account to Aadhaar ( ) எது தற்தாகதன யங்ைி ைணக்கை ஆதார் தையலுடன் இகணக்ை யிரும்புைிதன்.

Bank Name/Branch Account No. யங்ைி பனர் & யங்ைி ைிக ைணக்கு எண்

9 I have no objection to the UIDAI sharing information provided by me to the UIDAI with agencies engaged in delivery of welfare services. ான் UIDAI- யிற்கு அித்துள் தையக, த்திட்டங்ைக அமுல்டுத்தும் அகநப்புைளுடன் ைிர்ந்து பைாள், எக்கு எந்தயித நறுப்பும் இல்க.

YES ( ) NO ( ) உண்டு / இல்க

KYR + Fields – Data collection for India Post / அஞ்சல் துகக்குின தையல்

10

Post Office Savings Bank Account : YES ( ) NO ( ) அஞ்சை தசநிப்பு யங்ைி - தசநிப்பு ைணக்கு உண்டு / இல்க

Select category: SB/ RD/ PPF/NSS/ MIS/ SCSS/TD/NREGS ிரிகய ததர்ந்பதடுக்ை

PO Name அஞ்சை பனர்

A/C No. ைணக்கு எண்

NREGS Job Card No NREGS தயக யாய்ப்பு அட்கட எண்

11 Do you have PLI/RPLI YES ( ) NO ( ) அஞ்சல் ைாப்டீு /ைிபாந அஞ்சல் ைாப்டீு - உண்டு / இல்க

Names of the documents attached:

a. POI ிமற்ட சான்று

b. POA முையரி சான்று

c. DOB ிந்த தததி சான்று

d. ிச்சான்றுைள்

Declaration / உறுதிபநாமி The information provided by me is true to the best of my Knowledge and belief / அிக்ைப்ட்ட தையல் அகத்தும், எது

அிவுக்கும் ம்ிக்கைக்கும் எட்டினயகபனில் உண்கந என்று உறுதி கூறுைிதன்.

Applicant’s signature யிண்ணப்தாபர் கைபனாப்ம்

No charges are applicable for enrolment form and Aadhaar enrolment.

Instructions to follow while filling up the enrolment form

Column 1 NAME

Write full name without salutations/titles. Please bring the original & photocopy of Proof of Identity (POI) document. (See list A below).

Column 3 DOB / AGE

Fill in Date of Birth in DDMMYYYY format. Please bring the original & photocopy of Proof of Date of Birth if available. (See list D below). If exact Date of Birth is not known, declared age in Years may be filled in the space provided.

Column 4 ADDRESS

Write complete address. Please bring the original & photocopy of Proof of Address (POA) document. (See list B below). Please note that the Aadhaar letter will be delivered at the given address only. To include parent / Guardian / Spouse name as part of the address, select the appropriate box and enter the name

of the person. Corrections / enhancements are permissible to make the address complete without altering the base address as

mentioned in the POA document.

Column 5 REALTIONSHIP

In case of children below 5 years, it is mandatory to provide father/mother/guardian details with his/her Aadhaar or EID number.

If the resident is not holding a Proof of Identity & using the Head of the Family identity for enrolment, it is mandatory to provide Head of the family’s details with his/her Aadhaar or EID number. Please refer illustration below for filling EID. Please bring the original & photocopy of Proof of Relationship (POR) document. (See list C below).

For other cases, it is optional for the resident to fill up the relationship details.

Column 6 INTRODUCER

Resident who does not have POI and POA may get enrolled through an introducer. Pl contact nearest enrolment centre for further details. Resident who has POI & POA or using the Head of the Family identity for enrolment should not fill this column.

Column 7 NPR NUMBER

Resident may bring his/her National Population Register Survey slip (if available) and fill up the column.

Column 8 BANK ACCOUNT

Resident may choose to open a new Aadhaar enabled bank / POSB account or can link existing bank account to Aadhaar number. Relevant details as requested may be provided.

Column 9 CONSENT

Resident may specifically express willingness / unwillingness by selecting the relevant box.

Column 10 POSB ACCOUNT

Resident having Post Office Savings Bank Account may select the relevant category of account and provide account number with name of the Post Office. Resident having NREGS account may also provide Job card number.

Column 11 PLI/RPLI

Please select the appropriate box.

List A. POI documents List B. POA documents

1. Passport 2. Bank Statement/Passbook 3. Post Office Account Statement/Passbook 4. Ration Card 5. Voter ID 6. Driving License 7. Government Photo ID Cards 8. Electricity Bill (not older than 3 months) 9. Water Bill (not older than 3 months) 10. Telephone Landline Bill (not older than 3

months) 11. Property Tax Receipt (not older than 3

months) 12. Credit Card Statement (not older than 3

months) 13. Insurance Policy 14. Signed Letter having Photo from Bank on

letterhead 15. Signed Letter having Photo issued by

Recognized Educational Institution on letterhead

16. NREGS Job Card 17. Arms License 18. Pensioner Card 19. Freedom Fighter Card 20. Kissan Passbook 21. CGHS / ECHS Card 22. Certificate of Address having photo issued by

MP or MLA or Group A Gazetted Officer on letterhead

23. Certificate of Address issued by Village Panchayat head or its equivalent authority (for rural areas)

24. Income Tax Assessment Order 25. Vehicle Registration Certificate 26. Registered Sale / Lease /Rent Agreement 27. Address Card having Photo issued by

Department of Posts 28. Caste and Domicile Certificate having Photo

issued by State Govt.

List C. POR documents List D. DOB documents

1. Passport 2. PAN Card 3. Ration/PDS Photo Card 4. Voter ID 5. Driving License 6. Government Photo ID Cards 7. NREGS Job Card 8. Photo ID issued by Recognized

Educational Institution 9. Arms License 10. Photo Bank ATM Card 11. Photo Credit Card 12. Pensioner Photo Card 13. Freedom Fighter Photo Card 14. Kissan Photo Passbook 15. CGHS / ECHS Photo Card 16. Address Card having Name and Photo

issued by Department of Posts 17. Certificate of Identity having photo issued

by Group A Gazetted Officer on letterhead

1. Birth Certificate 2. PDS Card 3. MNREGA Card 4. CGHS/ State Government/ ECHS/ ESIC

Medical Card 5. Pension Card 6. Army Canteen Card 7. Passport 8. Any other Central/ State Govt .issued

family entitlement document duly

approved by the DoP and UIDAI

1. Birth Certificate 2. SSLC Book/Certificate 3. Passport 4. Certificate of Date of Birth issued by Group A Gazetted Officer on Letterhead

Column 5 - Illustration for filling up EID No.