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                                       ELECTION COMMISSION

OF INDIA
                                                 FORM-8
                                                                  (See Rules 13(1) and 26) of Registration of

Electors Rule-1960

Application for Correction to Particulars Entered in

Electoral Roll
To, The Electoral Registration Of cer, Assam HOJAI

Assembly / Parliamentary Consitituency

I request that entry relating to myself

SPACE FOR
appearing in the electoral roll the above
PASTING ONE
Constituency is not correct and it should be
RECENT PASSPORT
corrected.
SIZE
(a)Name Joya জয়া

(b) Surname(if
Sarkar Das সৰকাৰ দাস
any)

(c) Details of registration with electoral roll

Name of Assembly/ Parliamentary Constituency HOJAI
Part No. of Electoral Roll 95                 Serial No. of Electoral Roll    133

(d) EPIC No.

CBD0108548
(If issued)

(e) Please tick the entry which is to be corrected

Name ☑                    Photograph ☐                                EPIC ☐            Address ☑          
Date of Birth ☐     
Age     ☐          Name of Relative ☐           Type of Relation ☐             Gender ☐

The correct particulars in entry to be corrected are as below:-

Name JOYA জয়া

https://www.nvsp.in/Verification/GetCorrectionView?epicNo=CBD0108548&verificationRequestType=V 1/3
11/7/2019 Correct Details

Surname(if
DAS দাস
any)

House No 193 193

STATION ROAD, WARD

Street/Area/Locality শন ৰাড, ওয়াড নং . 4
NO . 4

Town/Village HOJAI হাজাই

Post Of ce HOJAI হাজাই Pin Code 782435

(g) Email
Id(optional)

(g) Mobile No.

(optional)

I hereby declare that the facts and particulars mentioned above are
true to the best of my knowledge and belief.I am aware that making a
statement or declaration which is false and which I know or believe to
be false or do not believe to be true, is punishable under Section 31 of
the Representation of the People Act, 1950 (43 of 1950).

Place : HOJAI

Date : 07/11/2019

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