FORM-6

http://ceoaperms.ap.gov.in/ERMS/Postal/userdetails.aspx

Application for inclusion of name in electoral roll

To, The Electoral Registration Officer *Assembly Constituency: Guntur West 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:

ApplicationID:21302850

I. Applicant's Details:
Name: Surname(if any): Date of birth if you know: Age as on 1st January 2011: Day:24 Year:22 Month:11 Months:1 Year:1989 AMBATIPUDI USHA SRI : : Gender: F

Place of birth Place of birth

Village/ Town: District: GUNTUR GUNTUR State: ANDHRA PRADESH

Relation Details
Relation Type Father's/Mother's /Husband's: Name: Surname(if any): H VENKATA HANUMANTH PRASAD AMBATIPUDI : :

II. Particulars of place of present ordinary Residence(Full address)

House/Door number: Street /Area /Locality /Mohalla /Road: Town/ Village: Tehsil/ Taluka/Mandal/ Thana: District: 26-39-15 6TH LANE AT AGRAHARAM GUNTUR GUNTUR GUNTUR Post Office: Pin code: : : : AT AGRAHARAM 522002 6th .

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:

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4/13/2012 11:42 AM