THIS FORM IS AVAILABLE FREE OF COST

AADHAAR ENROLMENT FORM( )

Branch Code/Enrolment Form No./ .

1207

For Office use/

Fields marked with * are mandatory requirement

*Date /

PART A1 Primary details for Aadhaar / (

Aadhaar /Enrolment Number/

) )

/ :

*Name / *:

Male( ) Female( ) Transgender ( )

*Date of birth
Residential Address: / ;
C/o: (S/o, W/o, D/o) / (First Name / ) (Middle Name// / / )
( ,
,
*House No / .
*Gender:/ *:

2
3

DD/MM/YYYY Age/

(Last Name / )

Street/Road/Lane/

/ /
4

Landmark/

*Village/Town/City /

* / /
* District /
5

State/ :

PART A2 Other details for Aadhaar

Tel :

(Res)

(M )

Email -
Religion

Nationality

Occupation
Income(per month)

Caste :
Below 5000

SC/ST/OBC/Others / ///
5000-10,000

Above 10,000

PART B Relation Details (compulsory for children below 5 years of age)

(5 - - )
5
6

( )
( )
* Relationship\ :
( )

:
First Name
Middle Name / /
Aadhaar / Enrolment number: / :

( )

( )

Last Name

PART C Financial Information :( )

*Information Sharing Consent \ * .........

7

Do you want UIDAI to open a bank account \ :

If no, Link my existing bank A/c to AADHAAR/ , :

( )

( )

( )

( )

PART D KYR+ INFORMATION (Required only for registrar) + ( )

( )
( )
Do you have relationship with Union Bank of India /
:

A/c. No \

A/c Type:\
( )

Do you want to open No Frill account with us / :

( )

PART E Verification : Attach any one of the following Proof of Identity, Proof of address with xerox and
original of the same for verification. ) ,
.
PROOF OF IDENTITY

Tick any one of the following. /
Passport/
/
Driving Licence
( )

Pancard /



/

/ /

PROOF OF ADDRESS
Tick any one of the following. /

( 3 1)
(3 )

/
( )


/

( 3 1)
( 3 1)
( 3 1)

( )
/
( )

In case of no proof is provided give name of Introducer #

* Name of Introducer
*AADHAAR number of the introducer
:
:
# Introducer is a well know person nominated by registrar (bank) registered by UIDAI and having AADHAAR number.
#

Supervisor,s Signature / Introducer Signature

Citizen's Signature/Thumb Imression

/


Enrolment Form No. / :
: ___/___/________

DD/MM/YYYY

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