Aadhaar Numbe
Full Name:
Wro:
House Ne. / Bids Apt
Steeet/ Road Lane:
Langmark
‘Area/ Locality/ Sector:
Vilage/ Town’ city:
New Enrolment
el
Post Offew
cee, FART ABAD
ae L HARYANA
PIN Cove: [T2toon
Date of ir: 03 joe | [atte
[| tee ee
Nomeottie cerstier |
Designation;
Ofee Adeease:
Contact Nurber:
‘hereby certty above meationed detals ofthe resident
D2secreneiing CTussedatein tea Cliciderts sinature E]cenners terats
‘Citesidet’s Photos cross signed ane rot taped (pap fo hot wrote to paper)
and | ama... [ee aporoniate bor below)
ee nd
‘Checks for Cerifier
(1) sacettes officer Groups
E) vitage Panchayat Heed or Muka
EF carettec ortcer croup 8
(7) mersmar nies muneiba: Counc
Ey tebsiaar
[Head of Recounied Educatisnal Institution
(5) Superintendent/ Warden) Matron/ Head of institution
‘of Recognized shelter homes/ Croharages
[1] erro otter
Jie Ie
‘ unig.
wr 40-40, FA PTA
eters
Saas 8 Stan atthe center
[NOTE This lemat is appiable for BOI docarnante at I. Now 17, 29,21, 22, 34 32; POA documents wt. Nas: 23, 24, 37,3, 448.45, POR document at St Non. 15
‘19 DOM Aacurents at St Nos 4,14 & 15 of Schedule ofthe Aachuor (Ehvobnert and Update) Reguietions, 2015, ax enended fom tre totine.