Hkkjrh; fofkV igpku izkf/kdj.

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;kstuk vk;ksx] Hkkjr ljdkj

ENROLLMENT FORM (vkosnu i=)

Cost of Form (Free) QkeZ dh dher h

Please use CAPITAL LETTERS ( i;k Li"V v{kjksa esa Hkjsa )

AADHAAR / Enrolment Number : ______________________________________________

vkkkj@ vkosnu la[;k : ____________________________________

Date/ fnukad : _ _ / _ _ / _ _ _ _

PART A : PRIMARY DETAILS / (d) izkFkfed tkudkjh

Name uke : ____________________________________________________________________________________________________________
(Name of Mother/Father/Guardian/is must for children below 5 Years of Age)
(5 okZ ls de mez ds cPpksa ds fy;s ekrk@firk@vfHkkod dk uke vfuok;Z gS)
Mother/ekrk

Father/firk

Husband/ifr

Date of Birth tUe frfFk : _ _ / _ _ / _ _ _ _

Gender :
fyax

Male
iq:k

Guardians Name/vfHkHkkod ________________________

If not known, age ;fn ugha irk rks mez : _________________

Female
L=h

Transgender
vU;

Residential Address : vkoklh; irk

c/o. : ___________________________________________________________________________________________________________________________________________
House No. and Name : _______________________________________________________________________________________________________________________
?kj dk uEcj vkSj uke
Street No. and Name : _______________________________________________________________________________________________________________________
ekSgYyk@xyh uEcj vkSj uke%
Landmark : ___________________________________________________________________________________________________________________________________
eq[; igpku%
Village / City : ________________________________________
Xkzke @kgj
State : jkT;

_______________________________________

District : ___________________________________________________________________
ftyk
PIN CODE: fiu dksM %

PART B : ADDITIONAL INFORMATION / [k vU; tkudkjh

Phone No. / Mobile No. (optional): Qksu uEcj @ eksckby uEcj oSdfYid % ____________________________________________________________________
Email (optional) bZ &esy oSdfYid : ___________________________________________________________________________________________________________

PART C :

FINANCIAL INFORMATION / x fofk; tkudkjh

I want to link my existing Bank A/c to Aadhaar and I have no objection on this issue.
eSa pkgrk@pkgrh gw fd esjs orZeku cSad [kkrs dks vk/kkj ds lkFk tksM+ fn;k tk, ,oa blesa eq>s dksbZ vkifk ugha gSA
Bank name and Branch: cSad dk uke o kk[kk %________________________________________________________________________________________________
A/c No : [kkrk la[;k % ___________________________________________________________________________________________________________________________

KYR + information (optional)

DP ID ________________________________

Client ID _________________________________________

PAN ___________________________________________

Hkkjrh; fofkV igpku izkf/kdj.k

;kstuk vk;ksx] Hkkjr ljdkj

Supporting documents acceptable as Photo Identity QksVks igpku i= ls lacf/kr nLrkost

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Passport ikliksVZ
PAN Card iSu dkMZ
Ration/ PDS Photo Card jkku @ ih-Mh-,l- QksVks
Voter ID ernkrk igpku i=
Driving License Mkbfoax ykblsal
Government Photo ID Cards ljdkjh QksVks igpku i=
NREGS Job Card ujsxk ukSdjh i=
Photo ID issued by Recognized Educational Institution ekU;rk izkIr fk{kk laLFkku }kjk tkjh fd;k x;k igpku i=
Arms License vkXus; vL= dk ykbZll
as
Photo Bank ATM Card cSad ,-Vh-,e- QksVks dkMZ
Photo Credit Card cSad SfMV QksVks dkMZ
Pensioner Photo Card iSaku QksVks dkMZ
Freedom Fighter Photo Card Lora=rk lSukuh igpku i=
Kissan Photo Passbook fdlku QksVks iklcqd
CGHS / ECHS Photo Card lh-th-,p-,l- @bZ-lh-,p-,l- QksVks dkMZ
Address Card having Name and Photo issued by Department of Posts Mkd[kkus }kjk tkjh fd;k x;k irs dk igpku i= vkSj uke
Certificate of Identify having photo issued by Group A Gazetted Officer on letterhead
xzqi , xtsfVM vkfQlj }kjk ySVj gSM ij tkjh fd;k x;k QksVks igpku i=

Supporting documents acceptable as Proof of Address irs dh igpku ls lacf/kr nLrkost

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Passport ikliksVZ
Bank Statement/ Passbook cSad LVsVeSaV @ iklcqd
Post Office Account Statement/Passbook Mkd[kkus ds [kkrs dh tkudkjh dk fooj.k @ iklcqd
Ration Card jkku dkMZ
Voter ID ernkrk igpku i=
Driving License Mkbfoax ykblSal
Government Photo ID cards ljdkjh QksVks igpku i=
Electricity Bill (not older than 3 months) fctyh dk fcy
Water bill (not older than 3 months) ikuh dk fcy & 3 eghu ls T;knk iqjkuk u gks
Telephone Landline Bill (not older than 3 months) VSfyQksu fcy & 3 eghu ls T;knk iqjkuk u gks
Property Tax Receipt (not older than 3 months) lEifk dj dh jlhn & 3 eghu ls T;knk iqjkuk u gks
Credit Card Statement (not older than 3 months) SfMV dkMZ dk fooj.k & 3 eghus ls T;knk iqjkuk u gks
Insurance Policy chek ;kstuk
Signed Letter having Photo from Bank on letterhead ekU;rk izkIr cSad ds ySVj gSM ij QksVks lfgr gLrk{kfjr i=
Signed Letter having Photo issued by registered Company on letterhead iaftr dEiuh ds ySVj gSM ij QksVks lfgr gLrk{kfjr i=
Signed Letter having Photo issued by Recognized Educational Institution on letterhead ekU;rk izkIr fk{kk laLFkku ds ySVj gSM ij QksVks lfgr gLrk{kfjr i=
NREGS Job Card ujsxk ukSdjh i=
Arms License vkXus; vL= dk ykbZll
as
Pensioner Card iSaku dkMZ
Freedom Fighter Card Lora=rk lSukuh dkMZ
Kissan Passbook fdlku iklcqd
CGHS / ECHS Card lh-th-,p-,l- @bZ-lh-,p-,l- QksVks dkMZ
Certificate of Address having photo issued by MP or MLA or Group A Gazetted Officer on letterhead lkaln] fo?kk;d ;k xtSfVM vkfQlj }kjk vius ySVj
gSM ij QksVks lfgr izekf.kr fd;k x;k irk
Certificate of Address issued by Village Panchayat head or its equivalent authority (for rural areas) ljiap ;k mlds led{k fdlh vf/kdkjh }kjk ySVj gSM ij
izekf.kr irk & dsoy xzkeh.k {ks= ds varxZr
Income Tax Assessment Order vk;dj foHkkx }kjk tkjh dh xbZ dj lwph
Vehicle Registration Certificate okgu iathdj.k izek.ki=
Registered Sale / Lease / Rent Agreement iaftr fo;@yht@fdjk;k bdjkjukek
Address Card having Photo issued by Department of Posts Mkd[kkus }kjk QksVks lfgr tkjh fd;k x;k irk igpku i=
Caste and Domicile Certificate having Photo issued by State Govt. jkT; ljdkj }kjk QksVks lfgr tkjh fd;k x;k tkfr ,oa fjgk;kh izek.k i=

Supporting documents acceptable as Date of Birth tUe frfFk ds izek.k i= gsrq ekU; nLrkost
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Birth Certificate tUe izek.k i=

SSLC Book/Certificate ,l-,l-,y-lh dh fdrkc@lfVZfQdsV
Passport ikliksVZ
Certificate of Date of Birth issued by Group A Gazetted Officer on letterhead xzqi , xtsfVM vf/kdkjh }kjk ySVj gSM ij tkjh fd;k tUe frfFk dk izek.k i=