UIDAI REGISTRATION FORM

Those VLE who are interested in UID work and have UID certificate and Machine, Kindly fill this form.

प्रिय VLE , अगर आप UID का काम करने की रुचि रखते हैं और आपके पास UID प्रमाणपत्र और मशीन है कृपया इस फार्म को भरे.

1. OMT ID*
2. SCA NAME*
3. NAME*
4. FATHER'S NAME*
5. DATE OF BIRTH(DOB)*
6. GENDER*
Male Female
7. PAN Card No.*
8. Aadhaar No*
9. MOBILE NO.*
10. e-MAIL ID*
11. STATE*
12. DISTRICT*
13. BLOCK *
14. ADDRESS*
15. PIN CODE*
16 Supervisior UID Certification No*
17. LapTop*
  Yes   No
18. TFT Monitor*
  Yes   No
19. Fingerprint Scanner*
  Yes   No
20. Iris Scanner*
  Yes   No
21. Web Camera*
  Yes   No
22. Printer*
  Yes   No
23. Internet Connectivity*
  Yes   No
VLE Bank Details:
24. Name of Beneficiary
Beneficiary A/C No
25. Bank Name
Bank Branch Name
26. IFSC Code
  
Enclosed VLE Document Details

27. Upload Photo:
Please upload jpeg,jpg file upto 100KB only
28. Upload UID Card:
Please upload jpeg,jpg file upto 100KB only
29. Upload Supervisior Certificate:
Please upload jpeg,jpg file upto 100KB only
Verifier Availability
30. Verifier Name
31. Verifier Address
32. Verifier Department
33. Verifier Post at the time of Reteirement
34. Verifier Mobile No
  
35. Upload Proof of Identity:
Please upload jpeg,jpg file upto 100KB only
36. Upload Proof of Address:
Please upload jpeg,jpg file upto 100KB only
37. Upload Photo:
Please upload jpeg,jpg file upto 100KB only
38. Upload UID No:
Please upload jpeg,jpg file upto 100KB only