ANNEXURE-III

(For Form-6)

DEGLARATION* (For an elector of 21+ age group seeking fresh registration for the first time)

I , Raj Vardhan Singh, Son/Daughter/wife of Arun Kumar R/o Patna, Bihar , declare as under:

I have applied for registration in the etectorar roll of Digha constituency, as my name does not figure in
electoral rollanywhere in lndia,

2. I have not been issued any EPIC at any time in the past in any constituency.

Place: PATNA RAJ VARDHAN SINGH

Signature of the Applicant:

Date: 12/02/2020

*(Making false declaration in matters related to preparation/revision of electorat roll is an offence

punishable under section 3i of the Representation of the People Act, 1951, and also under the provisions
of the lndian Penat Code)