ELECTION COMMISSION OF INDIA

FORM-8 : OPN079763215
(See Rules 13(1) and 26) of Registra on of Electors Rule-1960

Applica on for Correc on to Par culars Entered in Electoral Roll

To, The Electoral Registra on Officer, Raidighi Assembly / Parliamentary Consi tuency
SPACE FOR PASTING ONE
I request that entry rela ng to myself appearing in the electoral roll the above Cons tuency is RECENT PASSPORT SIZE
not correct and it should be corrected. PHOTOGRAPH (3.5 CM X 3.5
CM) SHOWING FRONTAL VIEW
(a)Name Namita OF FULL FACE WITHIN THIS
BOX

(b) Surname(if any) Santara

(c) Details of registra on with electoral roll

Name of Assembly/ Parliamentary Cons tuency 134
Part No. of Electoral Roll 274 Serial No. of Electoral Roll 1122
(d) EPIC No. (If issued) WB/16/123/540641
(e) Please ck the entry which is to be corrected
Name ☑ Photograph ☐ EPIC ☐ Address ☐ Date of Birth ☐
Age ☐ Name of Rela ve ☑ Type of Rela on ☐ Gender ☐
The correct par culars in entry to be corrected are as below:-
Name NAMITA
Surname(if any) SANTRA
Father's/Mother's/
SAMAR
Husband's Name
Father's/Mother's/
SANTRA
Husband's Last Name
(g) Email Id(op onal)
(g) Mobile No.
+918584889569
(op onal)
I hereby declare that the facts and par culars men oned above are true to the best of my knowledge and belief.I am
aware that making a statement or declara on which is false and which I know or believe to be false or do not believe to
be true, is punishable under Sec on 31 of the Representa on of the People Act, 1950 (43 of 1950).
Place : NANDAKUMARPUR
Date : 04/11/2019