CERTIFICATE FOR AADHAAR ENROLMENT OF DESTITUTE PERSON WITH DISABILITY, ABOVE 18 YEARS OF AGE
Instructions: All details to be filled in Block Letters (To be valid for 3 months from date of issue)
To be printed on plain A4 paper size; Not required to be printed on letter head; D D M M Y Y Y Y
Note: To be used as Proof of Identify (PoI) and Proof of Address (PoA) only in the case of destitutes above 18 years with disability.
INDIVIDUAL SEEKING TO ENROL DETAILS
Full Name:
House No./ Bldg./ Apt:
Street/ Road/ Lane:
Landmark:
Area/ Locality/ Sector:
Village/ Town/ City:
Post Office:
Individual Seeking to Enrol
District: Recent Colour Passport-Size
Photograph.
State:
Cross Signed and
Cross Stamped
by District Social Welfare Officer/
Equivalent rank Officer
PIN Code: NB: DO NOT
OVERLAP WITH
TEXT BOXES.
Date of Birth: Signature/ Thumb/ Finger Impression of
(Declared/Estimated) Individual Seeking to Enrol
We jointly certify the credentials of the person stated above and that the person is eligible for obtaining Aadhaar as per section 2(v) and 3 of The Aadhaar (Targeted
Delivery of Financial and Other Subsidies, Benefits and Services) Act, 2016
CERTІFІER’S DETAILS (TO BE FІLLED BY THE HEAD OF THE SHELTER HOME)
Name of the Initiator:
Designation:
Office Address:
Contact Number:
CHECKLIST No overwriting Issue date is filled Resident’s signature Certifier’s details
Signature & Stamp of the
FOR CERTIFIER Resident’s Photo is cross signed and cross stamped (paper to photo or photo to paper) Head of the Shelter Home
CERTІFІER’S DETAILS (TO BE FІLLED BY DISTRICT SOCIAL WELFARE OFFICER/ EQUIVALENT RANK OFFICER)
Name of the Certifier:
Designation:
Office Address:
Contact Number:
CHECKLIST No overwriting Issue date is filled Resident’s signature Certifier’s details
Signature & Stamp of the District Social Welfare Officer/
FOR CERTIFIER Resident’s Photo is cross signed and cross stamped (paper to photo or photo to paper) Equivalent rank Officer
Mera Aadhaar, Meri Pehchaan
