जन्म तिथि अद्यतन हेतु शपथ पत्र स्वयं द्व

G-A

Annexure-I- For Adults

Affidavit for date of birth updation

1-I, ....................................., aged about ......... years, S/o,D/o,W/o ........................................, resident of Village/Mohalla-...................................................................................., Tehsil-..........................., District-..........................., State-…………………….. Pin-………….. holding Aadhaar number-………………………………………………. do hereby solemnly affirm and declare as under:-

(i)That I am the resident of the above said address.

(ii)That my correct date of birth is……………………………..

That the earlier recorded date of birth in Aadhaar is………………………………….. based on……………………………………………………………. document submitted by me.

(iv)That I have……………………………………………………………… (never/once/more than once) updated my date of birth in Aadhaar.

(v)That currently a corrected version of the same document as mentioned in (iii) above / birth certificate (choose as applicable) is being provided in support of

DoB update request.

(vi)That I wish to get my date of birth updated in the Aadhaar as…………………………………………………… for which I am submitting……………………………………………………………………………………... as proof of date of birth.

(vii)That I further undertake that I shall not be eligible for any further updation of my.

2-I undertake that if the document submitted as proof of date of birth is found to be fraudulent/false/forged/non-genuine or I was not entitled for the said document, my Aadhaar number may be deactivated as per Regulation 28 of the Aadhaar (Enrolment and Update) Regulations, 2016 and I shall be liable to be prosecuted under provisions of the applicable law.

3-I hereby declare that all the information mentioned above is true to the best of my knowledge. In case of any discrepancies, the undersigned will be held responsible.

DATE-

PLACE-

Name & Signature of Resident (Deponent)

NAME-……………………………………….