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    of 2

    AADHAAR ENROLMENT

    FORM

    (Aadhaar Enrolment is free &


    भारतीय विशिष्ट पहचान प्राधिकरण भारत सरकार Voluntary)
    Under Section 3 of THE AADHAAR (TARGETED DELIVERY OF FINANCIAL AND OTHER SUBSIDIES, BENEFITS AND
    SERVICES) ACT,2016 (Aadhaar Act)
    Submission Date : 23-11-
    Application Type : Enrolment
    2024
    Applicant Details Appointment Details

    Resident Type: RESIDENT


    Full Name: RISHI
    NAVYAKUMAR RAJAK
    KUMARI
    Date Of 23-04-2016
    Birth/Age:
    Address C/O BABLU KUMAR RAJAK, Road No.-
    15E, Rajeev Nagar, Jagdamba Sadan,
    Rajeev Nagar, Keshari Nagar, Keshari
    Nagar, Patna , Bihar, 800024
    Guardian
    BABLU KUMAR SINGH
    RAJAK
    Name:
    Guardian 772600890251 Appointment Id: 1732346075949
    Aadhaar: Aadhaar Seva 1st Floor Sai Tower New Dak
    Gender: Female Kendra Address:
    Bunglow Road Patna Bihar
    Documents to Carry: Appointment Date
    25-11-2024 (12:30)
    and Time:

    Bring original documents for


    Enrolment/Update. No photocopy required.
    Original documents are scanned and given
    back to you.
    Carry/Bring appointment print copy.

    Proof of date of birth:


    Birth Certificate issued by Authorized Authority (in the
    respective States) under the Registration of Births and
    Deaths Act, 1969 read with Registration of Births and
    Deaths Rules 1999/2000/2002 of respective States
    Proof of Birth Certificate issued by Authorized
    relation: Authority (in the respective States)
    under the Registration of Births and
    Deaths Act, 1969 read with
    Registration of Births and Deaths
    Rules 1999/2000/2002 of respective
    States
    I hereby confirm the identity and address of (HOF/Relative Name) (auto populates) as being
    true, correct and accurate.

    HOF s Name: Signature of HOF


    Disclosure under section 3(2) of THE AADHAAR (TARGETED DELIVERY OF FINANCIAL
    AND OTHER SUBSIDIES, BENEFITS AND SERVICES) ACT, 2016
    I confirm that I have been residing in India for at least 182 days in the preceding 12 months / I am Non Resident
    Indian (NRI) & information (including biometrics) provided by me to the UIDAI is my own and is true, correct and
    accurate. I am aware that my information including biometrics will be used for generation of Aadhaar and
    authentication. I understand that my identity information (except core biometric) may be provided to an agency
    only with my consent during authentication or as per the provisions of the Aadhaar Act. I have a right to access my
    identity information (except core biometrics) following the procedure laid down by UIDAI.

    Verifier's Stamp and Signature Signature/Thumbprint


    Applicant's Signature/Thumbprint
    (Verifier must put her/his name if stamp is not avaliable.)

    Note: In case of Child(< 5 Yrs) or Guardian based application, Guardian/Relative will be required to accompany the
    applicant. In case of incapacitated person, the signature will be done by Legal Guardian of Incapacitated Person.

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