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CIDR

The document is a Central Identity Database Repository (CIDR) Registration Form that collects personal information from applicants, including name, gender, date of birth, marital status, caste category, and economic status. It also requires proof of identity, birth, address, and caste if applicable, along with a self-declaration statement. The form includes sections for verification details and data entry by an operator for official use.

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gjaglan95
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77 views

CIDR

The document is a Central Identity Database Repository (CIDR) Registration Form that collects personal information from applicants, including name, gender, date of birth, marital status, caste category, and economic status. It also requires proof of identity, birth, address, and caste if applicable, along with a self-declaration statement. The form includes sections for verification details and data entry by an operator for official use.

Uploaded by

gjaglan95
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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Central Identity Database Repository (CIDR) Registration Form

Applicant Name( In English) *


(In Hindi)
Gender * Male , Female , Transgender
Date of Birth * D D / M M / Y Y Y Y
Marital Status * Single , Currently Married , Never Married
Caste Category * General , SC , BC , OBC
Father’s Name (In English) *
(In Hindi)
Mother’s Name (In English) *
(In Hindi)
Family Economic Status * APL , BPL
Ration Card No. #
Address Permanent
House Name/No. *
Landmark/Locality/Colony *
Ward No. *
Town/Village Name *
Tehsil Name *
District Name *
PIN
E-Mail Address
Phone No. (Landline)
Mobile No.

Proof Attached:
Proof of Identity Yes No
Write name of the document e.g. Voter card, Govt Id Card etc.
Proof of Birth Yes No
Write name of the document e.g. Birth Certificate, Matric Certificate etc.
Proof of Address Yes No
Write name of the document e.g. Ration Card, Voter Card etc.
Proof of Caste (if SC/BC/OBC) Yes No
#
Note: * Should not be blank, Should not be blank if BPL

Self Declaration

I _____________________, son/daughter of Sh. ____________________ r/o ___________________________


______________________ do here by solemnly affirm and declare that all the above information given is
true and correct to the best of my knowledge and belief. In the event that any of the details are proved to
be false, I am liable for punishment under the Indian Penal Code.

[APPLICANT’S SIGNATURE]

Verification Details:
Verifier Name
Verifier CIDR No.
Date of Verification D D / M M / Y Y Y Y
Verifier’s Signature & Stamp

For Office Use (To be filled by Data Entry Operator)

User Id of Data Entry Operator


Date of Registration D D / M M / Y Y Y Y
CIDR No. of Applicant
Data Entry Operator’s Signature &
Stamp

e-DisHa 1

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