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Poonam Devi RC 430, Mahalaxmi Garden, Khora Colony, Khora, Ghaziabad, Uttar Pradesh - 201309 407376746587 | PDF
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Poonam Devi RC 430, Mahalaxmi Garden, Khora Colony, Khora, Ghaziabad, Uttar Pradesh - 201309 407376746587

This document is a self-declaration by Poonam Devi, the Head of Family (HoF), affirming her relationship with Kunal Kumar Roshan and agreeing to share her Aadhaar address for updating his Aadhaar details. It includes a declaration of the accuracy of the information provided and the consequences of providing false information. The document is valid for address updates for three months from the date of issue.

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10K views1 page

Poonam Devi RC 430, Mahalaxmi Garden, Khora Colony, Khora, Ghaziabad, Uttar Pradesh - 201309 407376746587

This document is a self-declaration by Poonam Devi, the Head of Family (HoF), affirming her relationship with Kunal Kumar Roshan and agreeing to share her Aadhaar address for updating his Aadhaar details. It includes a declaration of the accuracy of the information provided and the consequences of providing false information. The document is valid for address updates for three months from the date of issue.

Uploaded by

tej.narayansingh650
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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SELF-DECLARATION FROM THE HEAD OF FAMILY (HOF) FOR SHARING ADDRESS

WITH IMMEDIATE FAMILY MEMBER RESIDING AT THE SAME ADDRESS

Poonam Devi
I, _________________________________________________ (Name as in Aadhaar), resident

of Rc 430, Mahalaxmi Garden, Khora Colony,


_________________________________________________________________________
Khora, Ghaziabad, Uttar Pradesh - 201309
____________________________________________________________________ (Address
407376746587
as provided in Aadhaar) holding Aadhaar Number___________________________________, do

hereby solemnly affirm and declare as under:-

Kunal Kumar Roshan holding Aadhaar number


i. That resident Mr./Ms._____________________________
601733400026 is related to me as my __________________________
_______________________ Son
___________________________ (Please specify the relation with applicant) and is

residing with me at the above mentioned address.


Kunal
ii. That I agree to share my address in my Aadhaar with Mr./Ms. __________________
Kumar Roshan
_____________________ 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.


Kunal Kumar Roshan
___________________________ 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.

30/01/2025
Date DD/MM/YYYY  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

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