Digital Register

Jan Sewa Kendra Digital Register

Customer Name:

Customer Address:

Aadhaar Number:

Amount (₹):

Withdrawal / Transaction Mode: AEPS (अंगूठे se nikaasi) UPI QR Code (Scan karke) Micro ATM / Debit Card Cash Deposit (जमा)

📸 Camera & Photo Capture:

Select Camera Type: Front Camera (Selfie) Back Camera (Rear)

Captured Photos Preview:

REF NO:

PRINT DATE:

Jan Sewa Kendra Digital Register

Transaction Verification Proof & Cash Acknowledgement Receipt

Customer & Document Photos:

Transaction Details:

Date & Time
Customer Name
Address
Aadhaar No.
Payment Mode
Amount Paid	₹/-

SEHMATI / DECLARATION (घोषणा):
"Main pramanit karta/karti hoon ki maine uprokt likhi rashi (Amount) cash ke roop me Jan Sewa Kendra sanchalak se purn roop se prapt kar li hai. Yeh transaction meri upasthiti aur meri poori sehmati se mere bank khate se safaltapoorvak kiya gaya hai."

[ Customer ka Sign/Angutha ] Customer Signature

Sanchalak Sign: __________________ Kendra Stamp: ____________________