Aadhaar Enrollment Form



AADHAAR ENROLMENT / CORRECTION FORM

Aadhaar Enrolment is free and voluntary. Correction within 96 hours of enrolment is also free. No charges are applicable for Form and Aadhaar Enrolment. In case of Correction provide your EID, Name and only that field which needs Correction.

In case of Correction provide your EID No here: |  |  |  |  |  |  |  |  |  |  |  |  |  |  | dd |mm| yyyy|hh: mm: ss|
Please follow the instructions overleaf while filling up the form. Use capital letters only.

1
Pre-Enrolment ID :


2

NPR Receipt/TIN Number :


















3
Full Name:



















4
Gender:
Male ( )   Female (  )   Transgender (  )


5
Age:
Yrs OR
Date of Birth:| DD | MM | YYYY |




Declared

Verified











6
Address:    C/o ( ) D/o ( ) S/o ( ) W/o ( ) H/o ( )
NAME

























House No/ Bldg./Apt.


Street/Road/Lane

















Landmark



Area/locality/sector

















Village/Town/City



Post Office



















District

Sub-District



State













E Mail

Mobile No  |  |
|   |   |
|   |   |   |
|  |
PIN CODE |   |   |   |   |   |  |










7
Details of : Father (  ) Mother (  ) Guardian (  ) Husband ( ) Wife ( )







For children below 5 years Father/Mother/Guardian’s details are mandatory. Adults can opt to not specify this information, if they cannot/do not want to disclose.


Name





















EID/ Aadhaar No.: |  |  |  |  |  |  |  |  |  |  |  |  |  |  | dd |mm| yyyy|hh: mm: ss|











8
I have no objection to the UIDAI sharing information provided by me to the UIDAI
(ü)
/
(×)


with agencies engaged in delivery of public services including welfare services.








9
Select þ one of the below (OPTIONAL) ( This data cannot be Corrected after Enrolment)




I want the UIDAI to facilitate opening of a new Bank/Post Office Account linked to my




Aadhaar Number and have no objection to sharing my information for this purpose




I have no objection to linking my present bank account provided here to my Aadhaar number


State
Bank Name/Branch







IFSC Code
Account No.







Verification Type : Document Based (  )  Introducer Based (  ) Head of Family (  )





Select only one of the above. Select Introducer or Head of Family only if you do not possess any documentary proof of

identity and/or address. Introducer and Head of Family details are not required in case of Document based Verification.

10
For Document Based (Write Names of the documents produced. Refer back side of this form for list of valid documents)














a.  POI



b.  POA


















c.  DOB



d.  POR






(Mandatory in case of Verified Date of Birth)



















For Introducer Based – Introducer’s
For HoF Based - Details of : Father (  ) Mother (  ) Guardian (  )  Husband ( ) Wife ( )

11
HoF’s EId/Aadhaar No.: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |

Aadhaar No. |  |  |  |  |  |  |  |  |  |  |  |  |







dd |mm| yyyy|hh: mm: ss|


I hereby confirm the identity and address of ______________________________as being true, correct and accurate.

Introducer/HoF’s Name:



Signature of Introducer/HOF

Consent

I confirm that information (including biometrics) provided by me to the UIDAI and the information contained herein is my own and is true, correct and accurate.

Applicant’s signature/Thumbprint
Verifier’s Stamp and Signature:

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

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To be filled by the Enrolment Agency only   :                Date & time of Enrolment: ___________________________________

Instructions to follow while filling up the enrolment form

Field 2
Resident may bring his/her National Population Register Survey slip (if available) and fill up the column.


NPR NUMBER










Field 3
Write  full  name  without  salutations/titles.  Please  bring  the  original*  Proof  of  Identity  (POI)  document.  (See  list  A  below).  Variation  in  Resident’s


Name  in  contrast  to  PoI  is  permissible  as  long  as  the  change  is  minor  spelling  only,  without  altering  the  Name  in  PoI  document.  For  Example:  If


NAME


Resident’s PoI reads “Preeti”, then “Priti” can be recorded if Resident wants so.









Field 5
Fill in Date of Birth in DDMMYYYY format. If exact Date of Birth is not known, approximate age in Years may be filled in the  space provided. Please


bring the original Proof of Date of Birth (DoB), if available.(See list D below). Declared checkbox may be selected if Resident does not have a valid


DOB / AGE


proof of Date of Birth document. Verified checkbox is selected where Resident has provided documents as proof of Date of birth.






Write complete address. Please bring the original Proof of Address (POA) document. (See list B below). Please note that the Aadhaar letter will be


Field 6
delivered at the given address only.


·
To include Parent / Guardian / Spouse name as part of the address, select the appropriate box and enter the name of the person.


ADDRESS


·
Minor Corrections / Enhancements are permissible to make the address complete without altering the base address as mentioned  in the POA







document.



·
In case of children below 5 years, it is mandatory to provide father/mother/guardian details with their Aadhaar or EID number.


Field 7
·If  the  resident  is  not  holding  a  Proof  of  Identity  &  using  the  Head  of  the  Family  identity  for  enrolment,  it  is  mandatory  to  provide  Head  of  the


RELATIONSHIP

family’s details with his/her Aadhaar or EID number. Please refer illustration below for filling EID. Please bring the original Proof of Relationship




(POR) document. (See list C below).



·
For other cases, it is optional for the resident to fill up the relationship details.


Field 8
Resident may specifically express willingness / unwillingness by selecting the relevant box.


CONSENT






Field 9
Resident may choose to open a new Aadhaar enabled bank / POSB account or can link existing  bank account to Aadhaar number. Relevant details


BANK ACCOUNT
as requested may be provided. This is an optional field.






Field 10
Write  the  name  of  Documents  for  PoI  and  PoA.  In  case  proof  of  Date  of  Birth  is  available,  then  write  the  name  of  Date  of  Birth  document.  If  the


resident is not holding a Proof of Identity & using the Head of Family based enrolment, then write the name of Proof of Relationship document. For


DOCUMENTS


Valid list of documents, please refer list of Documents below.





Field 11
Resident  who  does  not  have  POI  and  POA  may  get  enrolled  through  an  Introducer/  Head  of  Family.  Pl  contact  nearest  enrolment  centre  or  your


INTRODUCER/HoF
Registrar, for further details.











List A.  POI documents


List B. POA documents








1.
Passport

1.
Passport
21.
Kissan Passbook

2.
PAN Card

2.
Bank Statement/ Passbook
22.
CGHS / ECHS Card

3.
Ration/ PDS Photo Card

3.
Post Office Account Statement/Passbook
23.
Certificate of Address having photo issued by

4.
Voter ID

4.
Ration Card

MP or MLA or Gazetted   Officer or Tehsildar on

5.
Driving License

5.
Voter ID

letterhead

6.
Government Photo ID Cards/ service photo

6.
Driving License
24.
Certificate of Address issued by Village Panchayat head


identity card issued by PSU

7.
Government Photo ID cards/ service photo

or its equivalent authority (for rural areas)

7.
NREGS Job Card


identity card issued by PSU
25.
Income Tax Assessment Order

8.
Photo ID issued by Recognized Educational Institution

8.
Electricity Bill (not older than 3 months)
26.
Vehicle Registration Certificate

9.
Arms License

9.
Water bill (not older than 3 months)
27.
Registered Sale / Lease / Rent Agreement

10.
Photo Bank ATM Card

10.
Telephone Landline Bill (not older than 3
28.
Address Card having Photo issued by Department of

11.
Photo Credit Card


months)

Posts

12.
Pensioner Photo Card

11.
Property Tax Receipt (not older than 3 months)
29.
Caste and Domicile Certificate having Photo issued by

13.
Freedom Fighter Photo Card

12.
Credit Card Statement (not older than 3 months)

State Govt.

14.
Kissan Photo Passbook

13.
Insurance Policy
30.
Disability ID Card/handicapped medical certificate

15.
CGHS / ECHS Photo Card

14.  Signed Letter having Photo from Bank on

issued by the respective State/UT

16.
Address Card having Name and Photo


letterhead

Governments/Administrations


issued by Department of Posts

15.
Signed Letter having Photo issued by registered
31.
Gas Connection Bill (not older than 3 months)

17.
Certificate of Identify having photo issued by


Company on letterhead
32.
Passport of Spouse


Gazetted Officer or Tehsildar on letterhead

16. Signed Letter having Photo issued by Recognized
33.
Passport of Parents(in case of Minor)

18.
Disability ID Card/handicapped medical


Educational Instruction on letterhead









certificate issued by the respective State/UT

17.
NREGS Job Card









Governments/Administrations

18.  Arms License











19.  Pensioner Card











20.  Freedom Fighter Card









List C. POR documents

List D. DOB documents








1.
PDS Card


1.
Birth Certificate








2.
MNREGA Job Card












2.
SSLC Book/Certificate








3.
CGHS/State Government/ECHS/ESIC












3.
Passport









Medical card













4.     Certificate of Date of Birth issued by Group A Gazetted Officer on Letterhead

4.
Pension Card


















5.
Army Canteen Card















6.
Passport

Illustration for filling up EID No.








7.
Birth Certificate issued by Registrar of Birth,
























Municipal Corporation and other notified local















government bodies like Taluk, Tehsil etc.














8.
Any other Central/State government issued















family entitlement document.




















































































*In instances where original documents are not available, copies attested / certified by a public notary / gazetted officer will be accepted.

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