Application for inclusion of name in electoral roll ApplicationID:12315312

To,
The Electoral Registration Officer
*Assembly Constituency: Pathapatnam
Sir,
I request that my name be included in the electoral roll for the above
Constituency. Particulars in support of my claim for inclusion in the
electoral roll are given below:
I. Applicant's Details:
Name: KRISHNA . రa:
s ష
Surname(if any): BUDIDA ఇంట . రa:
బ¬cద
Dateof birth if you know: Day:21 Month:08 Year:1985 Gender: M
Ageas on 1st J anuary
2013:
Year:27 Months:4
Place of birth Place of birth
Village/ Town: KAGUVADA
District: SRIKAKULAM State: ANDHRAPRADESH
Relation Details
Relation Type
Father's/Mother's
/Husband's:
F
Name: APPA RAO .రa:
అ`ా_oావy
Surname(if any): BUDIDA ఇంట . రa:
బ¬cద
II. Particulars of place of present ordinary Residence(Full address)
House/Door number: 7-17
Street /Area /Locality
/Mohalla /Road:
VASTRAPURI COLONY Dc ·ఏo య··ల'sా0ట:
వస పyo sాల°
Town/ Village: KAGUVADA పట ణం·nా మం:
sాగ:cాడ
Tehsil/ Taluka/Mandal/
Thana:
Pathapatnam c·ల¬క ·మండలం:
`ాతపట_ం
District: SRIKAKULAM Post Office: KORASAVADA
Pin code: 532214
III. Details of member(s) of applicant's family already included in the current electoral roll of the Constitutency:
Name:
Relationship with
applicant:
RPart number of the
roll of the
Constitutency:
Serial number in the
Part:
Elector's Photo Identity
Card Number:
1. 0 0
2. 0 0
Mobile No: 9948465291 Remarks:
Email-Id:

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