aadhaar enrolment form english

Card Type:(1)

Address Details: Mandal / Muncipality Name: LPG Connection: LPG Company

Name

Gram Panchayat: FP Shop No: LPG Distributor Name LPG Consumer No:

Village / Ward No: Door No/ Building: NPR TIN: Family Count

Care of: Colony

Street Landmark:

District / State: PIN Code:

Full Name: Mobile No: Email id:

SELF DOB(dd-mm-yyyy): Age: Bank Name with Branch Code Bank A/c No:

DOB Type:(3) Gender: NREGA Card No: Pension ID: SHG No:

Marital Status:(4) Disabled:

Edu.Qualification:(5)

Declaration Form No:xxxxxxxxxxxxxxxxxx

MALE FEMALE TRANSGENDER

Relationship(with Head of the family) :(2)

Mandal Muncipality

YES NO

BPCL HPCL IOCL Others

** Mandatory Fields are in REDHouse Hold General Information

Head of the Family KYR+ Details

* Please Read the Instructions Before filling this Declaration Form

Existing Ration Card No:

YES NO

Signature / Thumb Print

POA:(9):POI:(8):( )

Occupation:(6) Caste Category:(7) Introducer Name: (10) Introducer UID: (11)

Name of Parent / Spouse / Guardian: (12) Relation Name:(13)

Relation Enrolment ID:(14) Relation UID:(15)





Edu.Qualification:(5) POI:(8): POA:(9):






DOB T (3) G d NREGA C d N P i ID SHG N





Family Member 1


Family Member 2

YES NO

( )( )







YES NO

POI:(8): POA:(9):














Edu Qualification:(5) POI:(8): POA:(9):



YES NO

Family Member 4


POA:(9):

YES NO


POI:(8):


Family Member 3




Name of Parent / Spouse / Guardian: (12)

Relation Name:(13)


(1)

(2)

(3)

PLACE: DATE: 6

FOR OFFICE USE:

Enclosures Produced: Verification/Autherization Officer ( RI/ASO/MRO/VRO) Details, Signature & Seal For Enrolment Purpose

1

3

4 Household Enrolment Receipt Issued:

5

2

Incharge Verification Status:

Enrolment Receipt No.

POI:(8):

Data Entry Completion Status:

Biometric Completion Status:

POA:(9):

POA: (Proof of Address) Any of the following supporting Documents should be submittedPassport, Bank Statement/Pass book, Post office a/c statement, Ration Card, Voter ID, Driving Licence, Government Photo ID Card, Electricity Bill, Water Bill, Telephone Landline Bill, Property Tax Receipt, Credit card Statement, Insurance Policy, Signed Letter having Photo from Bank/Registered Company/ Recognized Educational Institute

Card Type : Pink, White, Anthyodaya, AnnapurnaFORM FILLING INSTRUCTIONS

Relationship: Husband, Wife, Son, Daughter, Father, Mother, Grand Son, Grand Daughter, Grand Mother, Grand Father, Daughter-in-Law, Son-in-law, Father-in-law, Mother-in-law, Sister, Brother, Others.

DOB Type: Date of Birth Type: Verified, Declared, Approximate

(4):(5)

(6)

(7)

(10)

(11)(12)

(13)

(14)(15) Version 1.3 (25-08-2010)+Q56+Q5

(8)

Passport, PAN Card, Ration Card/PDS Photo ID, Voter ID, Driving Licence, Government Photo ID Card, NREGA Job card, Photo ID by recognized Educational Institute, Arms Licence, Photo Bank ATM Card, Photo Credit Card, Pention Photo Card, Freedom fighter Photo ID Card, Kisan Pass Book, CGHS/ECHS Photo card, Postal ID card, Certificate of Identity having photo issued by Gestt. A Officer.

POI: (Proof of Identitiy) Any of the following supporting Documents should be submitted.

Relation Name: Wife, Husband, Mother, Father, Guardian

Relation Enrollment ID: Enrollment ID of the Person in Field no. 14 , if he/she not having a

Occupation: Government Service, Private Service, Cultivator, Agriculture Labour / Manual Labour, Doctor/CA/ Lawyer/Consultant/ Shopkeeper, Household duties, Student, Dependent, Pensioner, Begger, Rentier, Others

Caste Category: SC,ST,BC,OC,Others

g g p y gon Letter head, NREGA Job card, Arms Licence, Pentioner Photo Card, Freedom fighter Photo ID Card, Kisan Pass Book, CGHS/ECHS Photo card, Certificate of Address having Photo issued by MP or MLA or Gaztt.A Officer on Letter Head, Certificate of Address issued by Village Panchayat head or its equivalent authority of rural areas, IT Assessment order, Vehicle Registration Certificate, Registration of Sale / lease / Rental Agreement.

(9)

Introducer Name: Name of the Introducer (appointed by Registrar) , if any

Introducer UID: UID Number of Introducer.

Qualification: Illitrate, Literate, SSC, Intermediate, Graduate, Post Graduate, Ph.D.Marital Status: Never Married, Currently Married, Widowed, Separated, Divorced.

Relation UID: UID of the Person in Field no. 14 if he/she is already having UID

Name of the Parent / Spouse / Guardian: Full Name of either Parent or Spouse or Guardia