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): Passport, Voter ID, PAN Card, etc.
Proof of Address: Passport, Driving License, Utility Bill, etc.

Upload Documents

Availability

Preferred Date for Home Visit

Preferred Time for Home Visit

Additional Information

Any Additional Information or Special Requirements

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)

Upload Signature/Thumbprint

Request Form for Aadhaar Home Services (For Bedridden Individuals with Disabilities)