Self Declaration
1. I,______________________________________________________________________
_
S/D/W/o _________________________________________________________ resident
of ________________holding Aadhaar No ________________ do hereby solemnly
affirm and declare as under:-
i. That the deponent is the resident of the above said address.
ii. That the correct date of birth of the deponent is _______________________and the
date of birth of the deponent is wrongly mentioned in the Aadhaar Card
bearing Aadhaar No _________________________ as __________________.
iii. That the deponent wants to get his / her date of birth updated in the Aadhaar
Card as ______________________instead of _________________________ even
after utilizing the one time option for DoB update, for which the deponent is
submitting _______________ as document proof.
iv. That the date of Birth in the Aadhaar Card of the deponent was not correct earlier.
v. That the deponent further declares that no document in support of proof of
birth was submitted by him at the time of Aadhaar Enrolment. However, if so
submitted, the document submitted at the time of updation is not the same as the
one submitted at the time of Aadhaar Enrolment.
2. Kindly select whichever are applicable (ü):
[Link]. Parameter Selection
(i) Current DoB update request is the1st request for DoB update.
(ii) Current DoB update request is second (or greater) request for
DoB.
(iii) Date of birth mentioned in the Aadhaar Card at the time of
Aadhaar Enrolment was declared/ approximate and was not
verified.
(iv) Date of birth mentioned in the Aadhaar Card at the time of
Aadhaar Enrolment was Verified and was not declared/
approximate.
2. That the undersigned undertakes that if the document submitted in proof of date of
birth is found to be fraudulent/false/forged/non-genuine, the corresponding
Aadhaar number may be deactivated as per Rule 28 of the Aadhaar (Enrolment
and Update) Regulations, 2018. I hereby declare that all the information mentioned
above is true to the best of my knowledge and belief. In case of any discrepancies if
arises, the undersigned will be personally held responsible.
Date Name & Signature of Resident.
(Parent /Guardian in case of Minor)