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AADHAAR ENROLMENT FORM -

1 2 4 Full Name:

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

Gender:
:

Male (

) Female ( ) Transgender ( )

Date of Birth | DD | MM | YYYY | OR Age :

()

Yrs

Address: C/o ( ) S/o ( ) D/o ( ) W/o ( ) NAME/

House No/ Bldg

Street/Road/Lane

Village

City

Taluk

District

State

Post Office

PIN CODE | | | | | | |

Mobile No | | | | | | | | | | |

E Mail

Details of : Name

Father (

) Mother (

) Husband (

) Wife (

Guardian ( )

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

()

EID

6 7 8

Introducers name:

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

National Population Register (NPR) Survey slip No.

.

I want to: Open Aadhaar enabled Bank/POSB Account ( ) Bank Name/Branch

&

OR

Link my existing Bank Account to Aadhaar ( ) Account No.

I have no objection to the UIDAI sharing information provided by me to the UIDAI with agencies engaged in delivery of welfare services.
UIDAI- , , .

YES ( ) NO ( )
/

KYR + Fields Data collection for India Post /

10 Post Office Savings Bank Account : YES ( ) NO ( )

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

- /

PO Name

A/C No.

NREGS Job Card No

NREGS

PLI/RPLI 11 Do you have/

YES ( ) NO ( )
- /

Names of the documents attached: a. POI

b. POA

c. DOB

d.

Declaration /
The information provided by me is true to the best of my Knowledge and belief /
. ,

Applicants signature

No charges are applicable for enrolment form and Aadhaar enrolment.

Instructions to follow while filling up the enrolment form

Column 1 NAME Column 3 DOB / AGE Column 4 ADDRESS Write full name without salutations/titles. Please bring the original & photocopy of Proof of Identity (POI) document. (See list A below). 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. 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. 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 familys 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. 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. Resident may bring his/her National Population Register Survey slip (if available) and fill up the column. 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 5 REALTIONSHIP

Column 6 INTRODUCER Column 7 NPR NUMBER Column 8 BANK ACCOUNT

Column 9 Resident may specifically express willingness / unwillingness by selecting the relevant box. CONSENT Column 10 Resident having Post Office Savings Bank Account may select the relevant category of account and provide account POSB ACCOUNT number with name of the Post Office. Resident having NREGS account may also provide Job card number. Column 11 Please select the appropriate box. PLI/RPLI List A. POI documents List B. POA documents
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. Passport PAN Card Ration/PDS Photo Card Voter ID Driving License Government Photo ID Cards NREGS Job Card Photo ID issued by Recognized Educational Institution Arms License Photo Bank ATM Card Photo Credit Card Pensioner Photo Card Freedom Fighter Photo Card Kissan Photo Passbook CGHS / ECHS Photo Card Address Card having Name and Photo issued by Department of Posts Certificate of Identity having photo issued by Group A Gazetted Officer on letterhead 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. Passport Bank Statement/Passbook Post Office Account Statement/Passbook Ration Card Voter ID Driving License Government Photo ID Cards Electricity Bill (not older than 3 months) Water Bill (not older than 3 months) Telephone Landline Bill (not older than 3 months) Property Tax Receipt (not older than 3 months) Credit Card Statement (not older than 3 months) Insurance Policy Signed Letter having Photo from Bank on letterhead Signed Letter having Photo issued by Recognized Educational Institution on letterhead 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. NREGS Job Card Arms License Pensioner Card Freedom Fighter Card Kissan Passbook CGHS / ECHS Card Certificate of Address having photo issued by MP or MLA or Group A Gazetted Officer on letterhead Certificate of Address issued by Village Panchayat head or its equivalent authority (for rural areas) Income Tax Assessment Order Vehicle Registration Certificate Registered Sale / Lease /Rent Agreement Address Card having Photo issued by Department of Posts Caste and Domicile Certificate having Photo issued by State Govt.

List C. POR documents

1. 2. 3. 4. 5. 6. 7. 8. Birth Certificate PDS Card MNREGA Card CGHS/ State Government/ ECHS/ ESIC Medical Card Pension Card Army Canteen Card Passport Any other Central/ State Govt .issued family entitlement document duly approved by the DoP and UIDAI 1. 2. 3. 4.

List D. DOB documents

Birth Certificate SSLC Book/Certificate Passport Certificate of Date of Birth issued by Group A Gazetted Officer on Letterhead

Column 5 - Illustration for filling up EID No.

No charges are applicable for enrolment form and Aadhaar enrolment.