Hkkjrh; fof'k"V igpku iz kf/kdj.k;kstuk vk;ksx] Hkkjr ljdkj

;g vkosnu i= fu%'kqYd gSTHIS ENROLMENT FORM IS FREE

Ñi;k ,d ckj gh ukekadu djk;sPLEASE ENROL ONLY ONCE

uksV % Ñi;k Li"V v{kjksa esa Hkjas

fnukad%

Hkkx d & izkFkfed tkudkjh

uke

fyax% iq#"k L=kh vU;

vkoklh; irk%

?kj dk uEcj vkSj uke%

eksgYyk@xyh uEcj vkSj uke%

eq[; igpku%xzke@’kgj%ft+yk%

jkT;% fiu dksM%

Hkkx [k & lR;kiuigpku izek.k nLrkost+% vkokl izek.k nLrkost+%

lwph ihNs ns[ksa% lwph ihNs ns[ksa%;k@igpkudÙkkZ dk uke% igpkudÙkkZ ;k ifjokj ds eqf[k;k dk bZvkbZMh ua0@vk/kkj ua0%

;k@ifjokj ds eqf[;k dk uke% laca/k ds nLrkost%

vuqns’k ihNs ns[ksa% lwph ihNs ns[ksa%

ekrk firk ifr vfHkHkkod dk uke

o"kZ ls de mez ds cPpksa ds fy;s ekrk@firk@vfHkHkkod dk uke vfuok;Z gS

Hkkx x & vU; tkudkjhQksu uEcj @ eksckby uEcj ¼bPNk/khu½%bZesy ¼bPNk/khu½%tkudkjh lk>¡k djuk% gk¡% uk%

Hkkx ?k & ¼foÙkh; tkudkjh½eSa vk/kkj uEcj ls tqMk cSad [kkrk [kksyuk pkgrk@pkgrh g¡wA

eSa pkgrk@pkgrh g¡w fd esjs orZeku cSad [kkrs dks vk/kkj uEcj ds lkFk tksM+ fn;k tk, ,oa blesa eq>s dksbZ vkifÙk ugha gSA

cSad dk uke o ’kk[kk%

Note : Please use CAPITAL letters

Date _ _ / _ _ / _ _ _ _

Part A – Primary Details

Name: ______________________________________________________________________________________________

Date of Birth: _ _ / _ _ / _ _ _ _ If not known, Age: _ _ _ Date of Birth Document (List overleaf) _______________________________

Gender: Male Female Transgender

Residential address:

c/o: _______________________________________________________________________________________________________________

House No. and Name: ______________________________________________________________________________

___________________________________________________________________________________________________________________

Street No. and Name: _________________________________________________________________________

___________________________________________________________________________________________________________________

Landmark: _______________________________________________________________________________________________

Village / City: ______________________________________________________________________________________________

District: ______________________________________________________________________________________________________

State: ______________________ Pin code:

Part B - Verification

Proof of Address Document: Proof of Identity Document:

List Overleaf) List Overleaf)

or

Introducer Name: Introducer or Head of Family's EID No./Aadhaar No.:

_______________________________________________ _________________________________________________________________

Head of Family Name: Relationship Document:

_______________________________________________ _________________________________________________________________

Instructions Overleaf) List Overleaf)

Mother Father Husband Guardian's Name

5

(Name of Mother/Father/Guardian is must for children below 5 years of age)

Part C - Additional Information

Phone No. / Mobile No. (optional):

Email (optional): ________________________________________________________________________________________

Information Sharing Consent : Yes No

Part D - Financial Information

I want to open UID enabled bank A/c.

I want to link my existing bank A/c to Aadhaar Number and I have no objection on this issue.

Bank Name and Branch ______________________________________________________________________________

A/c No. ______________________________________________________

:

(

or

( (

%

tUe frfFk% ;fn ugha irk] mez%  tUe frfFk nLrkost+ksa ds fy, ¼lwph ihNs ns[ksa½_ _ / _ _ / _ _ _ _ _ _ _ ___________________________

¼

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

[kkrk la[;k%

¼ ½V

ers

ion 1

.1

vk/kkj uacj izkIr djuk fu%'kqYd gS&QkWeZ] QksVksdkWih] iathdj.k izfØ;k vFkok igpkudrkZ lsok ds fy, fdlh dks iSls u nsaA

vk/kkj uacj thou esa ,d gh ckj feysxk&nksckjk iathdj.k u djk,saA

vk/kkj lcds fy, gS&uotkr f'k'kq ls ysdj fdlh Hkh vk;q ds O;fDr ds fy,&viuk vkSj vius ifjokj ds lHkh lnL;ksa dk iathdj.k djok,saA

iathdj.k ds le; cSad [kkrk [kksyus] vius eksckby uacj ;k cSad [kkrk uacj dks vk/kkj ls tksM+us vkSj ^MkVk 'ks;fjax* ds fy, viuh lgefr dks lkQ&lkQizdV djsaA

Ñi;k izkfIr jlhn dks iqu% tk¡p ysA ;fn dksbZ Hkh xyrh ut+j vk, rks 48 ?kaVs ds Hkhrj vkWijsVj ls lEidZ djsaA

Ñi;k izkfIr jlhn dks lqjf{kr j[ksaA Hkfo"; es lanHkZ ds fy, iathdj.k vkbZ Mh Øekad dk iz;ksx djsaA

iathdj.k ds ckn Mkd }kjk vk/kkj i= vkus esa 90 fnuksa dk le; yx ldrk gSA

The Aadhaar Enrolment process is completely free. Please don’t pay anyone for any services like obtaining/filling form, photocopy, enrolment process orhelp of introducer./

Aadhaar is issued only once in your lifetime. Please do not apply for a secondAadhaar number.

Aadhaar number is for everyone – from newborns to persons of any age. Get your whole family enrolled.

Clearly express your CONSENT for opening of bank account, linking your bank account or mobile number withAadhaar and data sharing.

Please recheck your entries in the acknowledgement slip. In case of any error, please let the operator know within 48 hours of enrolment.

Please keep the acknowledgment slip safely. You can use the Enrolment ID (given in acknowledgment slip) for future reference.

After enrolment yourAadhaar letter can take up to 90 days to reach you by post.

bu ckrksa dk /;ku j[ksa Important Points to Remember

1. Passport

2. PAN Card

3. Ration/PDS Photo Card

4. Voter ID

5. Driving Licence

6. Government Photo ID Cards/Service Photo

identity by PSU.

7. NREGS Job Card

8.

Photo ID issued by Recognized Educational Institution

9. Arms Licence

10. Photo BankATM 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 Identify having photo issued by any Gazetted Officer onTehsildaron letter head

ikliksVZisu dkMZjk'ku dkMZ@ihMh,l QksVks okyk dkMZoksVj vkbZ-Mh-Mªkbfoax ykblsalljdkjh QksVks vkbZ-Mh- dkMZ

,e-th- jkst+xkj xkjaVh dkMZ ¼eujsxk½ySVjgSM ij ekU;rkizkIr f'k{k.k laLFkku }kjk tkjh gLrk{kfjr i= ¼QksVksds lkFk½'kL= ykblsalQksVks okyk ,Vh,e dkMZQksVks okyk ØsfMV dkMZQksVks okyk iSa'kuj dkMZQksVks okyk Lora=rk lsukuh dkMZQksVks okyh fdlku iklcqdQksVks okyk lhth,p,l@bZlh,p,l dkMZMkd foHkkx }kjk tkjh vkokl izek.k i= ¼QksVks ds lkFk½

ySVjgSM ij xtsfVM vkWfQlj }kjk tkjh gLrk{kfjr i= ¼QksVks ds lkFk½

1. Passport

2. Bank Statement/Passbook

3. Post OfficeAccount Statement/

Passbook

4. Ration Card

5. Voter ID

6. Driving Licence

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 registered Company onletterhead

16.

Signed Letter having Photo issued by Recognized Educational

Instruction on letterhead

17. NREGAJob Card

18. Arms License

19. Pensioner Card

20. Freedom Fighter Card

21. Kissan Passbook

22. CGHS/ECHS Card

23.

Certificate of Address having photo issued by

MP or MLAor Group 'A' Gazetted Officer on letterhead

24.

Certificate ofAddress issued by Village Panchayat head or

its equivalent authority (for rural areas)

25. Income TaxAssessment Order

26. Vehicle Registration Certificate

27. Registered Sale / Lease / Rent

Agreement

28. Address Card

having Photo issued by Department of Posts

29.

Caste and Domicile Certificate having Photo issued by State Govt.

30. Gas Connection Bill (not older

than 3 months)

31. Passport of Spouse

32. Passport of Parents (in

case of minor)

ikliksVZcSad LVsVeSaV@iklcqdiksLV vkWfQl ,dkmaV LVsVeSaV@iklcqd

jk'ku dkMZoksVj vkbZ-Mh-Mªkbfoax ykblsalljdkjh QksVks vkbZ-Mh- dkMZfctyh dk fcy ¼3 eghus ls iqjkuk ugha½

ikuh dk fcy ¼3 eghus ls iqjkuk ugha½

VsyhQksu ySaMykbu fcy ¼3 eghus ls iqjkuk ugha½

laifÙk dj jlhn ¼3 eghus ls iqjkuk ugha½

ØsfMV dkMZ LVsVeSaV ¼3 eghus ls iqjkuk ugha½

chek ikWfylhySVjgSM ij cSad }kjk tkjh gLrk{kfjr i= ¼QksVks ds lkFk½

ySVjgSM ij jftLVMZ dEiuh }kjk tkjh gLrk{kfjr i= ¼QksVks ds lkFk½

ySVjgSM ij ekU;rkizkIr f'k{k.k laLFkku }kjk tkjh gLrk{kfjr i= ¼QksVksds lkFk½

,e-th- jkst+xkj xkjaVh dkMZ ¼eujsxk½'kL= ykblsaliSa'kuj dkMZLora=rk lsukuh dkMZfdlku iklcqdlhth,p,l@bZlh,p,l dkMZySVjgSM ij laln lnL; ;k oxZ ^ * xStsfVM vf/kdkjh }kjk tkjh vkoklizek.k i= ¼QksVks ds lkFk½

xk¡o ljiap ;k mlds rqY; izkf/kdkj }kjk tkjh vkokl izek.k i= ¼xzkeh.k{ks= ds fy,½

vk;dj ewY;kadu vkWMZjokgu jftLVªs'ku lfVZfQdsVjftLVMZ lsy @ yht+ @ jsaV ,xfjesaV

Mkd foHkkx }kjk tkjh vkokl izek.k i= ¼QksVks ds lkFk½

jkT; ljdkj }kjk tkjh tkfr ,oa vf/kokl izek.k i= ¼QksVks ds lkFk½

xsl laca/kh fcy ¼3 eghus ls iqjkuk ugha½

ifr dk ikliksVZvfHkHkkod dk ikliksVZ ¼vxj ukckfyx gks rks½

A

tUefrfFk izek.k nLrkost+ List of Documents for Vefifying DoB

1. Birth Certificate

2. SSLC Book/Certificate

3. Passport

4.

Certificate of Date of Birth issued by Group A Gazetted Officer on

letterhead

tUe izek.k i=ek/;fed fo|ky; NksMus dh fdrkc@izek.k i=ikliksVZySVjgSM ij xtsfVM vkWfQlj }kjk tkjh gLrk{kfjr tUe frfFk dk izek.ki=

ifjokj ds eqf[k;k ds igpku izek.k nLrkost+

List of Documents for Vefifying Head of Family

1. PDS Card

2. MNREGAJob Card

3.

CGHS/State Government/ECHS/ESIC Medical Card

4. Pension Card

5. Army Canteen Card

6. Passport

7. Any other Central/

State Government issued family entitlement document

8. Address card

having Name and Photo issued by Department of Posts

lkoZtfud foÙkj.k iz.kkyh dkMZ,e-th- jkst+xkj xkjaVh dkMZ ¼eujsxk½lhth,p,l@ jkT; ljdkj@ bZlh,p,l @ bZ,lvkbZlh esfMdy dkMZ

iSa'ku dkMZlsuk dsUVhu dkMZikliksVZdsUnzh;@jkT; ljdkj }kjk tkjh ifjokj ntkZ nLrkost+

Mkd foHkkx }kjk tkjh irk dkMZ ftlesa uke ,oa QksVks gks

igpku izek.k nLrkost+ List of Documents for Vefifying Proof of Identity vkokl izek.k nLrkost+ List of Documents for Vefifying Proof of Address