“FORM 6”
[See rules 13(1) and 26]
Application for inclusion of name in electoral roll
ToThe Electoral Registration Officer,………………………...Assembly/Parliamentary
£
ConstituencySir,I request that my name be included in the electoral roll for the above Constituency. Particulars insupport of my claim for inclusion in the electoral roll are given below:
I
. Applicant’s details
NameSurname (if any)Age as on1
st
January…………..
#
Years:Months:Sex (male/female):Date of Birth, if knownDay:Month:Year:Place of Birth:Village/Town:District :State:
*
Father’sMother’s NameHusband’sName Surname (if any)
II.Particulars of place of ordinary residence (Full address):
House/Door number:Street/Area/Locality/Mohalla/Road:Town/Village:Post Office:Pin CodeTehsil/Taluka/Mandal/Thana:District:
£
In case of Union Territories having no Legislative Assembly and the State of Jammu and Kashmir.# Please give the year i.e. 2003, 2004 etc.* Strike out the inappropriate alternative.……..……………………………………………..(Perforation)……………………………………………………………………
Receipt for application
Received the application in From 6 of ** Shri/Shrimati/Kumari…………………………………………………..** Address……………………………………………………………………………………………………………… Date:…………. Signature of the officer receiving the application onbehalf of the Electoral Registration Officer (Address)………………………………………………………………………………
** To be filled in by the applicant.
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Form 6
Form 6,
“FORM 6”
[See rules 13(1) and 26]
Application for inclusion of name in electoral roll, Electoral Registration Office
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| Upload Date: | 03/12/2009 |
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