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    Residence

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    jaivictory047
    This document is a Central Identity Database Repository (CIDR) registration form that collects personal details such as name, gender, date of birth, address, and identity documentation for the purpose of registering applicants in the CIDR system. The multi-page form requests information like family details, economic status, contact information, and requires signatures for self-declaration and verification.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Residence

    Uploaded by

    jaivictory047
    48 views3 pages
    This document is a Central Identity Database Repository (CIDR) registration form that collects personal details such as name, gender, date of birth, address, and identity documentation for the purpose of registering applicants in the CIDR system. The multi-page form requests information like family details, economic status, contact information, and requires signatures for self-declaration and verification.

    Original Title

    Residence (1)

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    © © All Rights Reserved

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    This document is a Central Identity Database Repository (CIDR) registration form that collects personal details such as name, gender, date of birth, address, and identity documentation for the purpose of registering applicants in the CIDR system. The multi-page form requests information like family details, economic status, contact information, and requires signatures for self-declaration and verification.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    48 views3 pages

    Residence

    Uploaded by

    jaivictory047
    This document is a Central Identity Database Repository (CIDR) registration form that collects personal details such as name, gender, date of birth, address, and identity documentation for the purpose of registering applicants in the CIDR system. The multi-page form requests information like family details, economic status, contact information, and requires signatures for self-declaration and verification.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    Central Identity Database Repository (CIDR) Registration Form

    Applicant Name( In English) *


    (In Hindi)
    Gender * Male , Female , Transgender
    Date of Birth * D D / M M / Y Y Y Y
    Marital Status * Single , Currently Married , Never Married
    Caste Category * General , SC , BC , OBC
    Father’s Name (In English) *
    (In Hindi)
    Mother’s Name (In English) *
    (In Hindi)
    Family Economic Status * APL , BPL
    Ration Card No. #
    Address Permanent
    House Name/No. *
    Landmark/Locality/Colony *
    Ward No. *
    Town/Village Name *
    Tehsil Name *
    District Name *
    PIN
    E-Mail Address
    Phone No. (Landline)
    Mobile No.

    Proof Attached:
    Proof of Identity Yes No
    Write name of the document e.g. Voter card, Govt Id Card etc.
    Proof of Birth Yes No
    Write name of the document e.g. Birth Certificate, Matric Certificate etc.
    Proof of Address Yes No
    Write name of the document e.g. Ration Card, Voter Card etc.
    Proof of Caste (if SC/BC/OBC) Yes No
    #
    Note: * Should not be blank, Should not be blank if BPL

    Self Declaration

    I _____________________, son/daughter of Sh. ____________________ r/o ___________________________


    ______________________ do here by solemnly affirm and declare that all the above information given is
    true and correct to the best of my knowledge and belief. In the event that any of the details are proved to
    be false, I am liable for punishment under the Indian Penal Code.

    [APPLICANT’S SIGNATURE]

    Verification Details:
    Verifier Name
    Verifier CIDR No.
    Date of Verification D D / M M / Y Y Y Y
    Verifier’s Signature & Stamp

    For Office Use (To be filled by Data Entry Operator)

    User Id of Data Entry Operator


    Date of Registration D D / M M / Y Y Y Y
    CIDR No. of Applicant
    Data Entry Operator’s Signature &
    Stamp

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    अतः उपरो पाथ का रहायशी माण प जारी करने क िसफा रश क जाती है |

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    Secy. / E.O. / Tehsildar

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