CERTIFICATE FOR AADHAAR ENROLMENT OF CHILDREN IN CHILD CARE INSTITUTIONS TO BE ISSUED BY DCPO
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:
1. The certificate shall be used as a Proof of Identity (PoI) and a Proof of Address (PoA) for Aadhaar enrolment of Children in Child Care Institutions.
2. In addition to this certificate, Order of Placement of Child in the CCI issued by CWC in Form 18 of the Juvenile Justice Model Rules, 2016 (as
amended) is also required to be submitted.
INDIVIDUAL SEEKING TO ENROL DETAILS
Full Name:
House No./ Bldg./ Apt:
Street/ Road/ Lane:
Landmark:
Area/ Locality/ Sector:
Village/ Town/ City:
Post Office:
District: Individual Seeking to Enrol
Recent Colour Passport-Size
Photograph.
State:
Cross Signed and
Cross Stamped
by the Certifier.
PIN Code: NB: DO NOT
OVERLAP WITH
TEXT BOXES.
Date of Birth:
(Declared/Estimated) Signature/ Thumb/ Finger Impression of
Individual Seeking to Enrol
CERTІFІER: TO BE FІLLED BY THE DISTRICT CHILD PROTECTION OFFICER (DCPO)
Name of the Certifier:
Designation:
Office Address:
Contact Number:
CHECKLIST FOR CERTIFIER
No overwriting
Issue date is filled
Resident’s signature
Certifier’s details
Resident’s Photo is cross signed and cross stamped (paper to photo or photo to paper)
I certify to the best of my knowledge that the particulars of the child stated above are
true and accurate, and that the child is eligible for obtaining Aadhaar as per section 2(v)
and 3 of The Aadhaar (Targeted Delivery of Financial and Other Subsidies, Benefits and Signature & Stamp of the
Services) Act, 2016. District Child Protection Officer (DCPO)
Mera Aadhaar, Meri Pehchaan