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.
Please follow the instuctions overleaf while filling up the form. Use capital letters only
n case of Correction provide your ED No. here : dd/mm/yyyy/ hh:mm/ss n case of Correction provide your ED No. here : dd/mm/yyyy/ hh:mm/ss
confirm that information (including biometrics) provided by me to the UDA and the information contained herein is
my own and is true, correct and accurate.
Applicant's signature/Thumbprint
Date & time of Enrolment : _________________________________
Gender: Nale ( ) Female ( ) Transgender ( )
Address: Cfo ( ) Dfo ( ) Sfo ( ) Wfo ( ) Hfo ( )
2 NPR ReceiptfT!N Number:
S
NANE
Age: Yrs OR Date of Birth:
Declared verified
StreetfRoadfLane
Areaflocalityfsector
Post Office
Sub-District
Nobile No.
State
P!N CODE
ddfmmfyyyyf hh:mm:ss
Details of : Father ( ) Nother ( ) Guardian ( ) Husband ( ) Wife ( )
For chidren 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.
! have no objection to the U!DA! sharing information provided by me to the U!DA! with agencies
engaged in delivery of welfate services.
YES ( ) NO ( )
b. POA
d. POR
hereby confirm the identity and address of _______________________________ as being true, correct and accurate.
Signature of ntroducer/HOF
(Write Names of the documents produced, Refer back side of this form for list of valid documents)
Verification Type : Document Based ( ) ntroducer Based ( ) Head of Family ( )
Select only one of the above. Select ntroducer or Head of Family only if you do not possess any documentary proof of
identity and/or address. ntroducer and Head of Family details are not required in case of Document based Verification.
Select One of the Below (OPTONAL) (This data cannot be Corrected after Enrolment)
want the UDA to facilitate opening of a new Bank/Post Office Accouunt linked to my
Aadhaar Number and have no objection to sharing my information for this purpose
have no objection to linking my present bank account provided here to My Aadhaar number
Bank Name/Branch
Account No.
For HoF Based -
HoF's EId/Aadhaar No.
Details of : Father ( ) Mother ( ) Guardian ( ) Husband ( ) Wife ( )
dd/mm/yyyy/ hh:mm:ss
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.
Please follow the instuctions overleaf while filling up the form. Use capital letters only
Consent
confirm that information (including biometrics) provided by me to the UDA and the information contained herein is
my own and is true, correct and accurate.
Verifier's Stamp and Signature:
(Verifier must put his/her Name, if stamp is not available)
To be filled by the Enrolment Agency only : Date & time of Enrolment : _________________________________
1 Pre-Enrolment !D :
3 Full Name:
+ Gender: Nale ( ) Female ( ) Transgender ( )
6 Address: Cfo ( ) Dfo ( ) Sfo ( ) Wfo ( ) Hfo ( )
House No.fBldg.fApt.
Landmark
villagefTownfCity
District
E-mail
2 NPR ReceiptfT!N Number:
S
NANE
Age: Yrs OR Date of Birth:
StreetfRoadfLane
Areaflocalityfsector
Post Office
Sub-District
Nobile No.
8
9
7
Name
E!Df Aadhaar No.: ddfmmfyyyyf hh:mm:ss
Details of : Father ( ) Nother ( ) Guardian ( ) Husband ( ) Wife ( )
For chidren 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.
! have no objection to the U!DA! sharing information provided by me to the U!DA! with agencies
engaged in delivery of welfate services.
a. PO
c. DOB
b. POA
d. POR
(Mandatory in case of Verified Date of Birth)
hereby confirm the identity and address of _______________________________ as being true, correct and accurate.
ntroducer/HoF's Name: Signature of ntroducer/HOF
10 For Document Based (Write Names of the documents produced, Refer back side of this form for list of valid documents)
11
Verification Type : Document Based ( ) ntroducer Based ( ) Head of Family ( )
Select only one of the above. Select ntroducer or Head of Family only if you do not possess any documentary proof of
identity and/or address. ntroducer and Head of Family details are not required in case of Document based Verification.
Select One of the Below (OPTONAL) (This data cannot be Corrected after Enrolment)
For Introducer Based - ntroducer's
Aadhaar No.
want the UDA to facilitate opening of a new Bank/Post Office Accouunt linked to my
Aadhaar Number and have no objection to sharing my information for this purpose
have no objection to linking my present bank account provided here to My Aadhaar number
State
FSC Code
Bank Name/Branch
Account No.
For HoF Based -
HoF's EId/Aadhaar No.
Details of : Father ( ) Mother ( ) Guardian ( ) Husband ( ) Wife ( )
dd/mm/yyyy/ hh:mm:ss
Consent
Verifier's Stamp and Signature:
(Verifier must put his/her Name, if stamp is not available)
To be filled by the Enrolment Agency only :
1 Pre-Enrolment !D :
3 Full Name:
+
6
House No.fBldg.fApt.
Landmark
villagefTownfCity
District
E-mail
8
9
7
Name
E!Df Aadhaar No.:
a. PO
c. DOB
(Mandatory in case of Verified Date of Birth)
ntroducer/HoF's Name:
10 For Document Based
11
For Introducer Based - ntroducer's
Aadhaar No.
State
FSC Code
Applicant's signature/Thumbprint
Declared verified
State
P!N CODE
YES ( ) NO ( )
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