This document appears to be an enrollment form for an Indian identification program. It requests basic personal details such as name, gender, address, and contact information. It also requests identity and address verification documents, as well as consent to open a bank account or share data if desired. The form provides instructions to carefully fill it out and check for errors, and notes the enrollment process is free and identification will be provided within 90 days.

1. Hkkjrh; fof'k"V igpku izkf/kdj.k
;kstuk vk;ksx] Hkkjr ljdkj
;g vkosnu i= fu%'kqYd gS
THIS ENROLMENT FORM IS FREE
Ñi;k ,d ckj gh ukekadu djk;s
PLEASE ENROL ONLY ONCE
uksV % Ñi;k Li"V v{kjksa esa Hkjas
fnukad%
Hkkx d & izkFkfed tkudkjh
uke
fyax% iq#"k L=kh vU;
vkoklh; irk%
?kj dk uEcj vkSj uke%
eksgYyk@xyh uEcj vkSj uke%
eq[; igpku%
xzke@’kgj%
ft+yk%
jkT;% fiu dksM%
Hkkx [k & lR;kiu
igpku izek.k nLrkost+% vkokl izek.k nLrkost+%
lwph ihNs ns[ksa% lwph ihNs ns[ksa%
;k@
igpkudÙkkZ dk uke% igpkudÙkkZ ;k ifjokj ds eqf[k;k dk bZvkbZMh ua0@vk/kkj ua0%
;k@
ifjokj ds eqf[;k dk uke% laca/k ds nLrkost%
vuqns’k ihNs ns[ksa% lwph ihNs ns[ksa%
ekrk firk ifr vfHkHkkod dk uke
o"kZ ls de mez ds cPpksa ds fy;s ekrk@firk@vfHkHkkod dk uke vfuok;Z gS
Hkkx x & vU; tkudkjh
Qksu uEcj @ eksckby uEcj ¼bPNk/khu½%
bZesy ¼bPNk/khu½%
tkudkjh lk>¡k djuk% gk¡% uk%
Hkkx ?k & ¼foÙkh; tkudkjh½
eSa vk/kkj uEcj ls tqMk cSad [kkrk [kksyuk pkgrk@pkgrh g¡wA
eSa pkgrk@pkgrh g¡w fd esjs orZeku cSad [kkrs dks vk/kkj uEcj ds lkFk tksM+ fn;k tk, ,oa blesa eq>s dksbZ vkifÙk ugha gSA
cSad dk uke o ’kk[kk%
Note : Please use CAPITAL letters
Date _ _ / _ _ / _ _ _ _
Part A – Primary Details
Name: ______________________________________________________________________________________________
Date of Birth: _ _ / _ _ / _ _ _ _ If not known, Age: _ _ _ Date of Birth Document (List overleaf) _______________________________
Gender: Male Female Transgender
Residential address:
c/o: _______________________________________________________________________________________________________________
House No. and Name: ______________________________________________________________________________
___________________________________________________________________________________________________________________
Street No. and Name: _________________________________________________________________________
___________________________________________________________________________________________________________________
Landmark: _______________________________________________________________________________________________
Village / City: ______________________________________________________________________________________________
District: ______________________________________________________________________________________________________
State: ______________________ Pin code:
Part B - Verification
Proof of Address Document: Proof of Identity Document:
List Overleaf) List Overleaf)
or
Introducer Name: Introducer or Head of Family's EID No./Aadhaar No.:
_______________________________________________ _________________________________________________________________
Head of Family Name: Relationship Document:
_______________________________________________ _________________________________________________________________
Instructions Overleaf) List Overleaf)
Mother Father Husband Guardian's Name
5
(Name of Mother/Father/Guardian is must for children below 5 years of age)
Part C - Additional Information
Phone No. / Mobile No. (optional):
Email (optional): ________________________________________________________________________________________
Information Sharing Consent : Yes No
Part D - Financial Information
I want to open UID enabled bank A/c.
I want to link my existing bank A/c to Aadhaar Number and I have no objection on this issue.
Bank Name and Branch ______________________________________________________________________________
A/c No. ______________________________________________________
:
(
or
( (
%
tUe frfFk% ;fn ugha irk] mez% tUe frfFk nLrkost+ksa ds fy, ¼lwph ihNs ns[ksa½_ _ / _ _ / _ _ _ _ _ _ _ ___________________________
¼
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
[kkrk la[;k%
¼ ½ Version1.1

2. vk/kkj uacj izkIr djuk fu%'kqYd gS&QkWeZ] QksVksdkWih] iathdj.k izfØ;k vFkok igpkudrkZ lsok ds fy, fdlh dks iSls u nsaA
vk/kkj uacj thou esa ,d gh ckj feysxk&nksckjk iathdj.k u djk,saA
vk/kkj lcds fy, gS&uotkr f'k'kq ls ysdj fdlh Hkh vk;q ds O;fDr ds fy,&viuk vkSj vius ifjokj ds lHkh lnL;ksa dk iathdj.k djok,saA
iathdj.k ds le; cSad [kkrk [kksyus] vius eksckby uacj ;k cSad [kkrk uacj dks vk/kkj ls tksM+us vkSj ^MkVk 'ks;fjax* ds fy, viuh lgefr dks lkQ&lkQ
izdV djsaA
Ñi;k izkfIr jlhn dks iqu% tk¡p ysA ;fn dksbZ Hkh xyrh ut+j vk, rks 48 ?kaVs ds Hkhrj vkWijsVj ls lEidZ djsaA
Ñi;k izkfIr jlhn dks lqjf{kr j[ksaA Hkfo"; es lanHkZ ds fy, iathdj.k vkbZ Mh Øekad dk iz;ksx djsaA
iathdj.k ds ckn Mkd }kjk vk/kkj i= vkus esa 90 fnuksa dk le; yx ldrk gSA
The Aadhaar Enrolment process is completely free. Please don’t pay anyone for any services like obtaining/filling form, photocopy, enrolment process or
help of introducer./
Aadhaar is issued only once in your lifetime. Please do not apply for a secondAadhaar number.
Aadhaar number is for everyone – from newborns to persons of any age. Get your whole family enrolled.
Clearly express your CONSENTfor opening of bank account, linking your bank account or mobile number withAadhaar and data sharing.
Please recheck your entries in the acknowledgement slip. In case of any error, please let the operator know within 48 hours of enrolment.
Please keep the acknowledgment slip safely.You can use the Enrolment ID (given in acknowledgment slip) for future reference.
After enrolment yourAadhaar letter can take up to 90 days to reach you by post.
bu ckrksa dk /;ku j[ksa Important Points to Remember
1. Passport
2. PAN Card
3. Ration/PDS Photo Card
4. Voter ID
5. Driving Licence
6. Government Photo ID Cards/Service Photo
identity by PSU.
7. NREGS Job Card
8.
Photo ID issued by Recognized Educational Institution
9. Arms Licence
10. Photo BankATM Card
11. Photo Credit Card
12. Pensioner Photo Card
13. Freedom Fighter Photo Card
14. Kissan Photo Passbook
15. CGHS/ECHS Photo Card
16. Address Card
having Name and Photo issued by Department of Posts
17.
Certificate of Identify having photo issued by any Gazetted Officer on
Tehsildaron letter head
ikliksVZ
isu dkMZ
jk'ku dkMZ@ihMh,l QksVks okyk dkMZ
oksVj vkbZ-Mh-
Mªkbfoax ykblsal
ljdkjh QksVks vkbZ-Mh- dkMZ
,e-th- jkst+xkj xkjaVh dkMZ ¼eujsxk½
ySVjgSM ij ekU;rkizkIr f'k{k.k laLFkku }kjk tkjh gLrk{kfjr i= ¼QksVks
ds lkFk½
'kL= ykblsal
QksVks okyk ,Vh,e dkMZ
QksVks okyk ØsfMV dkMZ
QksVks okyk iSa'kuj dkMZ
QksVks okyk Lora=rk lsukuh dkMZ
QksVks okyh fdlku iklcqd
QksVks okyk lhth,p,l@bZlh,p,l dkMZ
Mkd foHkkx }kjk tkjh vkokl izek.k i= ¼QksVks ds lkFk½
ySVjgSM ij xtsfVM vkWfQlj }kjk tkjh gLrk{kfjr i= ¼QksVks ds lkFk½
1. Passport
2. Bank Statement/Passbook
3. Post OfficeAccount Statement/
Passbook
4. Ration Card
5. Voter ID
6. Driving Licence
7. Government Photo ID Cards
8. Electricity Bill (not older than 3
months)
9. Water Bill (not older than 3
months)
10. Telephone Landline Bill
(not older than 3 months)
11. Property Tax Receipt (not older
than 3 months)
12. Credit Card Statement (not
older than 3 months)
13. Insurance Policy
14. Signed Letter
having Photo From Bank on letterhead
15.
Signed Letter having Photo issued by registered Company on
letterhead
16.
Signed Letter having Photo issued by Recognized Educational
Instruction on letterhead
17. NREGAJob Card
18. Arms License
19. Pensioner Card
20. Freedom Fighter Card
21. Kissan Passbook
22. CGHS/ECHS Card
23.
Certificate ofAddress having photo issued by
MPor MLAor Group 'A' Gazetted Officer on letterhead
24.
Certificate ofAddress issued by Village Panchayat head or
its equivalent authority (for rural areas)
25. IncomeTaxAssessment Order
26. Vehicle Registration Certificate
27. Registered Sale / Lease / Rent
Agreement
28. Address Card
having Photo issued by Department of Posts
29.
Caste and Domicile Certificate having Photo issued by State Govt.
30. Gas Connection Bill (not older
than 3 months)
31. Passport of Spouse
32. Passport of Parents (in
case of minor)
ikliksVZ
cSad LVsVeSaV@iklcqd
iksLV vkWfQl ,dkmaV LVsVeSaV@iklcqd
jk'ku dkMZ
oksVj vkbZ-Mh-
Mªkbfoax ykblsal
ljdkjh QksVks vkbZ-Mh- dkMZ
fctyh dk fcy ¼3 eghus ls iqjkuk ugha½
ikuh dk fcy ¼3 eghus ls iqjkuk ugha½
VsyhQksu ySaMykbu fcy ¼3 eghus ls iqjkuk ugha½
laifÙk dj jlhn ¼3 eghus ls iqjkuk ugha½
ØsfMV dkMZ LVsVeSaV ¼3 eghus ls iqjkuk ugha½
chek ikWfylh
ySVjgSM ij cSad }kjk tkjh gLrk{kfjr i= ¼QksVks ds lkFk½
ySVjgSM ij jftLVMZ dEiuh }kjk tkjh gLrk{kfjr i= ¼QksVks ds lkFk½
ySVjgSM ij ekU;rkizkIr f'k{k.k laLFkku }kjk tkjh gLrk{kfjr i= ¼QksVks
ds lkFk½
,e-th- jkst+xkj xkjaVh dkMZ ¼eujsxk½
'kL= ykblsal
iSa'kuj dkMZ
Lora=rk lsukuh dkMZ
fdlku iklcqd
lhth,p,l@bZlh,p,l dkMZ
ySVjgSM ij laln lnL; ;k oxZ ^ * xStsfVM vf/kdkjh }kjk tkjh vkokl
izek.k i= ¼QksVks ds lkFk½
xk¡o ljiap ;k mlds rqY; izkf/kdkj }kjk tkjh vkokl izek.k i= ¼xzkeh.k
{ks= ds fy,½
vk;dj ewY;kadu vkWMZj
okgu jftLVªs'ku lfVZfQdsV
jftLVMZ lsy @ yht+ @ jsaV ,xfjesaV
Mkd foHkkx }kjk tkjh vkokl izek.k i= ¼QksVks ds lkFk½
jkT; ljdkj }kjk tkjh tkfr ,oa vf/kokl izek.k i= ¼QksVks ds lkFk½
xsl laca/kh fcy ¼3 eghus ls iqjkuk ugha½
ifr dk ikliksVZ
vfHkHkkod dk ikliksVZ ¼vxj ukckfyx gks rks½
A
tUefrfFk izek.k nLrkost+ List of Documents for Vefifying DoB
1. Birth Certificate
2. SSLC Book/Certificate
3. Passport
4.
Certificate of Date of Birth issued by Group A Gazetted Officer on
letterhead
tUe izek.k i=
ek/;fed fo|ky; NksMus dh fdrkc@izek.k i=
ikliksVZ
ySVjgSM ij xtsfVM vkWfQlj }kjk tkjh gLrk{kfjr tUe frfFk dk izek.k
i=
ifjokj ds eqf[k;k ds igpku izek.k nLrkost+
List of Documents for Vefifying Head of Family
1. PDS Card
2. MNREGAJob Card
3.
CGHS/State Government/ECHS/ESIC Medical Card
4. Pension Card
5. Army Canteen Card
6. Passport
7. Any other Central/
State Government issued family entitlement document
8. Address card
having Name and Photo issued by Department of Posts
lkoZtfud foÙkj.k iz.kkyh dkMZ
,e-th- jkst+xkj xkjaVh dkMZ ¼eujsxk½
lhth,p,l@ jkT; ljdkj@ bZlh,p,l @ bZ,lvkbZlh esfMdy dkMZ
iSa'ku dkMZ
lsuk dsUVhu dkMZ
ikliksVZ
dsUnzh;@jkT; ljdkj }kjk tkjh ifjokj ntkZ nLrkost+
Mkd foHkkx }kjk tkjh irk dkMZ ftlesa uke ,oa QksVks gks
igpku izek.k nLrkost+ List of Documents forVefifying Proof of Identity vkokl izek.k nLrkost+ List of Documents forVefifying Proof of Address