CERTIFICATE R AADHAAR ENROLMENT/.

U PDATE BEU SED ONLY AS PROOF OF AD

lnstructions:All de&ils to be filled in Block Letters (To be valid for 3 months from date of t-ssue)

To be pinted on plain A4 Wper she; Not requircd ta be pinted on lelter head; c 4 o 4 // (l *o 4

[l nesioent n Non-Resident tndian(NRl) n r.r"* Enrolment M upout" Request

Aadhaar Number:
(For update only) I 6 I 6 0 2 4 3 2 0 9 8
Full Name: P A R A M I T A M U R M U

CIo: R A M E S H T U D U
HouseNoJ [Link];

StreeU Roadl Lane:

LandMark:

Area/ Locality/ Sector: S A R I S A D U L I

Village/ Town/ Gity; B A R A B A R I

Post Offtce: M A L I P A R A
District: M A L D A
State: T E G A L
W E S B N

PIN Code: 3 2 2 4
7 1

Wre!,t^ifu- t^/r;it-ff\b- \
Signature of the Residentr
I Raniqani -1 GF
Disu
Date of Birth 2 2 0 0 4 Thumb/ Finger Impression [rlaro.o-,Giole,
2 3 1

Name of the Certifierl K A M A N D A L S A R K A R

S E B I

Designation: PiR o D H A N R A N I G A N J 1 G P
Office Address:
S A R I S H A D U L I M A L I P A.R A
tJ A Z o L E M A L D A 7 3 2 1 2 4
Contact Number: I 0 0 2 4 5 4 3 3 7

I hereby certify above mentioned details of the resident Checklist for Certifier
and I am a.... (Tick appropriate box below) M M
Z No overwriting M ,rrr" date is filled Resioenrs signalure
""n,fi"r,
l-l Gazetted Officer - Group A 7l Resident's Photo is cross signed and cross stamped (Paper to photo or photo to pape/

M vilt"g" Panchayat Head or Mukhiya

n CazetteO Officer - Group B

f] nrel MLtu MLc/ Municipal councillor

l-l run"iu".
l-l UeaO of Recognized Educational lnstitution L ,f
l-l SuperintendenU Warden/ Matron/ Head of lnstitution -1 G]
Recognized shelter homes/ Orphanages
?
fl eero om"",
* To be used as Proof of ldentify (Pol) only in speciific cases as mentioned in the list of applicable supporting documents.
Signature & Stamp of the Certifier