Residence Certificate Application.pdf

It consists of three parts:

1. Personal Details of the Applicant:
- Applicant's name, address, relation to the beneficiary, and beneficiary's personal data (name, gender, date of birth, age, place of birth, parents' names, address, PIN code, district, marital status, spouse's name, email ID, contact phone number, voter ID card number, Aadhaar number).

2. Service Details:
- Mode of delivery (Sewa Kendra or By Post), application processing office, period of residence for which the certificate is required (from and to), verification certificate number, and details of the verification authority.

3. List of Required Documents:
- Copy of Ration Card's first and second pages, voter card, Aadhaar card, driving license, or passport; copy of proof of date of birth; copy of verification certificate; copy of school certificate (optional); any other attachment (optional).

The applicant confirms that they have resided in India for at least 182 days in the preceding 12 months and that the information provided is true, correct, and accurate. They also confirm their understanding of how their information will be used and their rights regarding access to their identity information.

The form concludes with a self-declaration by the applicant, stating their residence details and confirming the authenticity of the information provided. They also acknowledge the consequences of providing false information. The applicant's signature is required at the end of the form.