Aadhaar Home Services

Full Name of the Bedridden Individual:

Date of Birth:

Address

Gender

Male Female Other

Contact Information:

Contact Person's Name (if applicable):

Relationship to Bedridden Individual:

Phone Number of Contact Person:

Email Address (if available):

Details of Disability and Bedridden Condition:

Type of Disability:

Brief Description of Bedridden Condition:

Essential Documents Required:

Please ensure the following documents are available for the Aadhaar home service visit:

Medical Certificate confirming the individual's disability and bedridden condition.
Proof of Identity (if available): Any government-issued ID document such as Passport, Voter ID, PAN Card, etc.
Proof of Address: Any valid document containing the individual's address such as Passport, Driving License, Utility Bill, etc.

Availability:

Preferred Date for Home Visit: [Provide a preferred date for the home visit]

Preferred Time for Home Visit: [Provide a preferred time range for the home visit, e.g., morning, afternoon, evening]

Additional Information:

Any Additional Information or Special Requirements: [Include any additional information or special requirements for the home visit]

Declaration:

I, hereby declare that the information provided above is true and accurate to the best of my knowledge. I understand that providing false information may lead to rejection of my request.

Signature (or Thumbprint if unable to sign): [Signature or Thumbprint]