SELF-DECLARATION FROM THE HEAD OF FAMILY (HOF) FOR SHARING ADDRESS
WITH IMMEDIATE FAMILY MEMBER RESIDING AT THE SAME ADDRESS
I, AMIT ASATI (Name as in Aadhaar), resident
of D-304, BADHWAR APARTMENTS, SECTOR 6, DWARKA, DELHI 110075 (Address
as provided in Aadhaar) holding Aadhaar Number 4628 2662 4616, do
hereby solemnly affirm and declare as under:-
i. That resident Mr./Ms KISHORI DEVI ASATI holding Aadhaar number
7383 9940 4184 is related to me as my MOTHER
(Please specify the relation with applicant) and is residing with me at the
above mentioned address.
ii. That I agree to share my address in my Aadhaar with Mr./Ms. KISHORI DEVI ASATI _
for updating his/her address in Aadhaar in my capacity of Head of the Family (HoF).
iii. That the undersigned undertakes that, the above mentioned information is correct to
the best of my knowledge and belief and at any point of time if any of the said
information is found to be incorrect/fraudulent/false, the Aadhaar of Mr./Ms. KISHORI
DEVI ASATI and mine can be deactivated and legal action may be initiated against
me, as per the provisions of the Aadhaar (Targeted Delivery of Financial and Other
Subsidies, Benefits and Services) Act, 2016 (18 of 2016) and, Regulations framed there
under and other applicable Acts and Rules, etc.
AMIT ASATI
Date 11/10/2023 Name & Signature of Head of the Family (HoF)
Note:
1. This document is valid for Head of Family (HoF) based Aadhaar address update purpose only.
2. This document is valid for 3 months from date of issue