AADHAAR

ENROLMENT FORM
Aadhaar Enrolment is free & Voluntary.

Under Section 3 of THE AADHAAR (TARGETED DELIVERY OF FINANCIAL AND OTHER SUBSIDIES, BENEFITS AND SERVICES)
ACT,2016 (Aadhaar Act)

Submission Date : 20/01/2024 Application Type : NEW ENROLMENT

Application Details Appointment Details

Full Name: CHATLA SIRICHANDANA

Gender: FEMALE
DOB/Age: 03-06-2016
Address: , C/O, CHATLA PRAVEEN
KUMAR, 3-37, Chelpaka,
Chelapka, Eturngaram,
Eturnagaram, Eturunagaram,
Mulugu, Telangana - 506165
Mobile No.: +91-9491633368
Resident Type.: Indian Resident

Appointment ID: 1705739314624

Documents to Carry
1. POI: Certificate of Identity having photo issued by MP orMLA or MLC or Municipal Councilor on UIDAI standardcertificate
format for enrolment/ update
2. POA: Certificate of identity containing Name, DOB andPhotograph issued by Employees’ Provident FundOrganisation (EPFO)
on UIDAI standard certificateformat for enr
3. DOB: Certificate of identity containing Name, DOB andPhotograph issued by Employees’ Provident FundOrganisation (EPFO)
on UIDAI standard certificateformat for enr

I hereby confirm my identity and address as being true, correct and accurate.

Guardian/Relative Name: Signature of Guardian/Relative

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 & 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: Applicant's signature/Thumbprint

(Verifier must put his/her Name, if stamp is not available)

Note: In case of Child(< 5Yrs) or Guardian/Relative 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
Instructions

Please reach 15 min early at Aadhaar Seva Kendra and carry printed copy of this Application Form.
Do not damage the QR Code by folding the Application form across it.
Carry all the original Document(s) selected while filling up the form.
Get the printed copy of final application form before leaving the center. Also, please fill the feedback form at the exit counter to
serve you better next time.

List of POI Documents

1. Address Card having Name and Photo issued by

Department of Post
2. Arms License
3. Bank Pass Book having name and photo
4. Bhamashah Card
5. Certificate from Superintendent/ Warden/ Matron/ Head of
Institution of recognized shelter homes for orphanages,
homes etc on their official letter head
6. Certificate of Identity containing name and photo issued
by Recognized Educational Institution signed by Head of
Institute
7. Certificate of identity containing Name, DOB and
Photograph issued by Employees’ Provident Fund
Organisation (EPFO) on UIDAI standard certificate format
for enr
8. Certificate of Identity having photo issued by Gazetted
Officer or Tehsildar on letterhead
9. Certificate of Identity having photo issued by MP or MLA
or MLC or Municipal Councilor on UIDAI standard
certificate format for enrolment/ update
10. Certificate of Identity having photo issued by village
panchayat head or mukhiya or its equivalent authority (for
rural areas)
11. CGHS / ECHS Photo Card
12. Disability ID Card/handicapped medical certificate issued
by the respective State/UT Governments/Administrations
13. Driving License
14. Extract of School Records issued by Head of School
containing name and photo
15. Freedom Fighter Photo Card
16. Gazette notification for name change (with separately
affixed photo)
17. Government Photo ID Cards/ service photo identity card
issued by PSU
18. Kissan Photo Passbook
19. Marriage Certificate with photo
20. NREGS Job Card
21. PAN Card
22. Passport
23. Pensioner Photo Card
24. Photo Bank ATM Card
25. Photo Credit Card
26. Photo ID issued by Recognized Educational Institution
27. Ration/ PDS Photo Card
28. RSBY Card
29. School Leaving Certificate (SLC) / School Transfer
Certificate (TC), containing name and photo
30. SSLC book having candidates photo
31. ST/ SC/ OBC Certificate with photo
32. Voter ID
 List of POA Documents List of POR Documents

1. Address Card having Photo issued by Department of Post 1. Address card having name and photo issued by
2. Allotment letter of accommodation issued by Central/State Department of Post
Govt. (not more than 3 years old) 2. Any other Central/State government issued family
3. Arms License entitlement document.
4. Bank Statement/Passbook 3. Army Canteen Card
5. Bhamashah card 4. Bhamashah card
6. Caste and Domicile Certificate having Photo issued by 5. Birth Certificate issued by Registrar of Birth, Municipal
State Govt. Corporation and other notified local government bodies like
7. Certificate from Superintendent/ Warden/ Matron/ Head of Taluk, Tehsil etc.
Institution of recognized shelter homes for orphanages 6. Certificate of ldentity having photo and relationship with
etc. on letter head HOF issued by village panchayat head or mukhiya or its
8. Certificate of Address having photo issued by MP or MLA equivalent authority (for rural areas)
or MLC or Gazetted Officer or Tehsildar on letterhead 7. Certificate of ldentity having photo issued by MP or MLA or
9. Certificate of address having photo issued by Municipal MLC or Municipal Councilor or Gazette Officer on
Councilor on letterhead letterhead
10. Certificate of Address issued by Village Panchayat head 8. CGHS/State Government/ECHS/ESIC Medical card
or its equivalent authority (for rural areas) 9. Discharge card/ slip issued by Government hospitals for
11. Certificate of Identity containing Name, Address and birth of a child
Photo issued by Recognized Educational Institution 10. Marriage Certificate issued by the government
signed by Head of Institute 11. NREGS Job Card
12. Certificate of identity containing Name, DOB and 12. Passport
Photograph issued by Employees’ Provident Fund 13. PDS Card
Organisation (EPFO) on UIDAI standard certificate format 14. Pension Card
for enr
13. CGHS/ECHS Card List of DOB Documents
14. Credit Card Statement (not older than 3 months)
1. Birth Certificate
15. Disability ID Card/handicapped medical certificate issued
2. Central Government Health Service Scheme Photo Card
by the respective State/UT Governments/Administrations
or Ex-Servicemen Contributory Health Scheme Photo card.
16. Driving License
3. Central/State Pension Payment Order
17. Electricity Bill (not older than 3 months)
4. Certificate of Date of Birth issued by Group A Gazetted
18. Extract of School Records containing Name, Address and
Officer on Letterhead
Photo issued by Head of School
5. Certificate of identity containing Name, DOB and
19. Freedom Fighter Card
Photograph issued by Employees’ Provident Fund
20. Gas Connection Bill (not older than 3 months)
Organisation (EPFO) on UIDAI standard certificate format
21. Government Photo ID cards/ service photo identity card
for enr
issued by PSU
6. Certificate of Identity containing Name, DOB and Photo
22. Income Tax Assessment Order
issued by Recognized Educational Institution signed by
23. Insurance Policy
Head of Institute
24. Kissan Passbook
7. Extract of School Records issued by Head of School
25. ldentity Card issued by recognized educational institutions
containing Name, Date of Birth and Photo
26. Marriage Certificate Issued by the Govt, containing name
8. Government issued certificate (or card) having photo and
and address
duly signed by the signing authority
27. NREGS Job Card
9. Government Photo ID Card/ Photo Identity Card issued by
28. Passport
PSU containing DOB
29. Passport of Parents (in case of Minor)
10. Mark sheet issued by any Government Board or
30. Passport of Spouse
Recognized University
31. Pensioner Card
11. PAN Card
32. Post Office Account Statement/Passbook
12. Passport
33. Property Tax Receipt (not older than 1 year)
13. Photo ID having Date of Birth issued by Recognized
34. Ration Card
Educational Institution
35. Registered Sale/Registered Lease/Registered Rent
Agreement
36. School ldentity Card 14. School Leaving Certificate (SLC)/School Transfer
37. School Leaving Certificate (SLC) / School Transfer Certificate (TC), containing Name and Date of Birth
Certificate (TC), containing Name and Address 15. SSLC Book/Certificate
38. Signed Letter having Photo from Bank on letterhead
39. Signed Letter having Photo issued by Recognized
Educational Institution on letterhead or Photo ID having
address issued by Recognized Educational Institution.
40. Signed Letter having Photo issued by registered Company
on letterhead
41. SSLC book having photo
42. Telephone Landline Bill (not older than 3 months)
43. Vehicle Registration Certificate
44. Voter ID
45. Water bill (not older than 3 months)