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AADHAAR ENROLMENT / CORRECTION FORM

Aadhaar Enrolment is free and voluntary. Correction within 96 hours of enrolment is also free. No charges are applicable for Form and Aadhaar Enrolment. In case of Correction provide your EID, Name and only that field which needs Correction.

In case of Correction provide your EID No here: | | | | | | | | | | | | | | | dd |mm| yyyy|hh: mm: ss|

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

1

 

Pre-Enrolment ID :

 

 

2

 

NPR Receipt/TIN Number :

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3

Full Name: AJAY SINGH CHAUHAN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4

Gender: Male ( ) Female ( ) Transgender ( )

 

 

5

Age:

Yrs OR

Date of Birth:| 15 | 04 | 1979 |

 

Declared

Verified

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6

 

Address: C/o ( ) AJAY SINGH CHAUHAN

NAME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

House No/ Bldg./Apt.: HIG-26

 

 

 

Street/Road/Lane: 3rd STAGE HEBBAL

 

 

 

 

 

 

 

 

 

 

 

 

 

Landmark: OPP CITB CHAULTRY

 

 

 

Area/locality/sector

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Village/Town/City: MYSORE

 

 

 

Post Office : METAGALLI

 

 

 

 

 

 

 

 

 

 

 

 

 

 

District: MYSORE

Sub-District

 

 

State: KARNATAKA

 

 

 

 

 

 

 

 

E Mail: ajaysingh_chauhan@yahoo.com

Mobile No : 7259588889

 

PIN CODE : 570016

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7 Details of : Father ( ) Mother ( ) Guardian ( ) Husband ( ) Wife ( )

For children below 5 years Father/Mother/Guardian’s details are mandatory. Adults can opt to not specify this information, if they cannot/do not want to disclose.

Name

 

EID/ Aadhaar No.: | | | | | | | | | | | | | | | dd |mm| yyyy|hh: mm: ss|

8 I have no objection to the UIDAI sharing information provided by me to the UIDAI with agencies YES ( ) NO ( )

engaged in delivery of welfare services.

 

9 Select One of the Below (OPTIONAL) ( This data cannot be Corrected after Enrolment)

I want the UIDAI to facilitate opening of a new Bank/Post Office Account linked to my

Aadhaar Number and have no objection to sharing my information for this purpose

I have no objection to linking my present bank account provided here to my Aadhaar number

State: MAHARASHTRA

Bank Name/Branch IDBI BANK LTD/NIGDI PUNE

IFSC Code: IBKL0000087

Account No. 087104000080963

Verification Type : Document Based ( ) Introducer Based ( ) Head of Family ( )

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.

10 For Document Based (Write Names of the documents produced. Refer back side of this form for list of valid documents)

 

a. POI: PASSPORT

 

b. POA: PASSPORT

 

 

 

 

 

 

c. DOB: PASSPORT

 

d. POR

 

(Mandatory in case of Verified Date of Birth)

 

 

 

 

 

 

For Introducer Based – Introducer’s

For HoF Based - Details of : Father ( ) Mother ( ) Guardian ( ) Husband ( ) Wife ( )

 

11

HoF’s EId/Aadhaar No.: | | | | | | | | | | | | | | |

 

Aadhaar No. | | | | | | | | | | | | |

 

 

 

 

dd |mm| yyyy|hh: mm: ss|

I hereby confirm the identity and address of ______________________________as being true, correct and accurate.

Introducer/HoF’s Name:

Signature of Introducer/HOF

Consent

I confirm that information (including biometrics) provided by me to the UIDAI and the information contained herein is my own and is true, correct and accurate.

Applicant’s signature/Thumbprint

Verifier’s Stamp and Signature:

(Verifier must put his/her Name, if stamp is not available)

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To be filled by the Enrolment Agency only : Date & time of Enrolment: ___________________________________

Instructions to follow while filling up the enrolment form

 

Field 2

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

 

NPR NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Field 3

Write full name without salutations/titles. Please bring the original* Proof of Identity (POI) document. (See list A below). Variation in Resident’s

 

Name in contrast to PoI is permissible as long as the change is minor spelling only, without altering the Name in PoI document. For Example: If

 

NAME

 

Resident’s PoI reads “Preeti”, then “Priti” can be recorded if Resident wants so.

 

 

 

 

 

 

 

 

 

 

Field 5

Fill in Date of Birth in DDMMYYYY format. If exact Date of Birth is not known, approximate age in Years may be filled in the space provided. Please

 

bring the original Proof of Date of Birth (DoB), if available.(See list D below). Declared checkbox may be selected if Resident does not have a valid

 

DOB / AGE

 

proof of Date of Birth document. Verified checkbox is selected where Resident has provided documents as proof of Date of birth.

 

 

 

 

 

 

Write complete address. Please bring the original Proof of Address (POA) document. (See list B below). Please note that the Aadhaar letter will be

 

Field 6

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.

 

ADDRESS

 

Minor Corrections / Enhancements are permissible to make the address complete without altering the base address as mentioned in the POA

 

 

 

 

 

 

document.

 

 

 

 

 

 

 

 

 

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

 

Field 7

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

 

RELATIONSHIP

family’s details with his/her Aadhaar or EID number. Please refer illustration below for filling EID. Please bring the original Proof of Relationship

 

 

 

(POR) document. (See list C below).

 

 

 

 

 

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

 

 

 

Field 8

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

 

CONSENT

 

 

 

 

 

 

 

 

 

Field 9

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

 

BANK ACCOUNT

as requested may be provided. This is an optional field.

 

 

 

Field 10

Write the name of Documents for PoI and PoA. In case proof of Date of Birth is available, then write the name of Date of Birth document. If the

 

resident is not holding a Proof of Identity & using the Head of Family based enrolment, then write the name of Proof of Relationship document. For

 

DOCUMENTS

 

Valid list of documents, please refer list of Documents below.

 

 

 

 

 

 

 

 

Field 11

Resident who does not have POI and POA may get enrolled through an Introducer/ Head of Family. Pl contact nearest enrolment centre or your

 

INTRODUCER/HoF

Registrar, for further details.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

List A. POI documents

 

 

List B. POA documents

 

 

 

1.

Passport

 

 

1.

 

Passport

21.

Kissan Passbook

 

2.

PAN Card

 

 

2.

 

Bank Statement/ Passbook

22.

CGHS / ECHS Card

 

3. Ration/ PDS Photo Card

 

3. Post Office Account Statement/Passbook

23.

Certificate of Address having photo issued by

 

4.

Voter ID

 

 

4.

 

Ration Card

 

MP or MLA or Gazetted Officer or Tehsildar on

 

5.

Driving License

 

 

5.

 

Voter ID

 

letterhead

 

6. Government Photo ID Cards/ service photo

 

6.

 

Driving License

24.

Certificate of Address issued by Village Panchayat head

 

 

identity card issued by PSU

 

7.

Government Photo ID cards/ service photo

 

or its equivalent authority (for rural areas)

 

7.

NREGS Job Card

 

 

 

 

identity card issued by PSU

25.

Income Tax Assessment Order

 

8. Photo ID issued by Recognized Educational Institution

 

8. Electricity Bill (not older than 3 months)

26.

Vehicle Registration Certificate

 

9.

Arms License

 

 

9.

Water bill (not older than 3 months)

27.

Registered Sale / Lease / Rent Agreement

 

10. Photo Bank ATM Card

 

10.

Telephone Landline Bill (not older than 3

28.

Address Card having Photo issued by Department of

 

11. Photo Credit Card

 

 

 

 

months)

 

Posts

 

12. Pensioner Photo Card

 

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

29.

Caste and Domicile Certificate having Photo issued by

 

13. Freedom Fighter Photo Card

 

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

 

State Govt.

 

14. Kissan Photo Passbook

 

13.

 

Insurance Policy

30.

Disability ID Card/handicapped medical certificate

 

15. CGHS / ECHS Photo Card

 

14. Signed Letter having Photo from Bank on

 

issued by the respective State/UT

 

16. Address Card having Name and Photo

 

 

letterhead

 

Governments/Administrations

 

 

issued by Department of Posts

 

15.

Signed Letter having Photo issued by registered

31.

Gas Connection Bill (not older than 3 months)

 

17. Certificate of Identify having photo issued by

 

 

 

Company on letterhead

32.

Passport of Spouse

 

 

Gazetted Officer or Tehsildar on letterhead

 

16. Signed Letter having Photo issued by Recognized

33.

Passport of Parents(in case of Minor)

 

18. Disability ID Card/handicapped medical

 

 

 

Educational Instruction on letterhead

 

 

 

 

certificate issued by the respective State/UT

 

17. NREGS Job Card

 

 

 

 

List C. POR documents

 

 

 

 

 

 

 

 

Governments/Administrations

 

18. Arms License

 

 

 

 

 

 

 

 

 

 

 

 

19. Pensioner Card

 

 

 

 

 

 

 

20. Freedom Fighter Card

 

 

1.PDS Card

2.MNREGA Job Card

3.CGHS/State Government/ECHS/ESIC

Medical card

4.Pension Card

5.Army Canteen Card

6.Passport

7.Birth Certificate issued by Registrar of Birth,

Municipal Corporation and other notified local government bodies like Taluk, Tehsil etc.

8.Any other Central/State government issued family entitlement document.

List D. DOB documents

1.Birth Certificate

2.SSLC Book/Certificate

3.Passport

4.Certificate of Date of Birth issued by Group A Gazetted Officer on Letterhead

Illustration for filling up EID No.

*In instances where original documents are not available, copies attested / certified by a public notary / gazetted officer will be accepted.

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