°. NDIA 0. @ ELTON coammgsion OF! fermneonerascnes: | FORM-6 i e360 icatic Le aes ay sotone 08 7 Application for Tnehas; = 131) and 26 ot Rei a i for First time Voter OR on pauting from One tituen To. he ecto Reparation Sey Stituency to Another CMS Pha — |equest hat my name be ingiageee ee arama cso (first time voter (c) Name and surname of [Applicant [see item (ay) | ve OF Husband O [30 years 5 months [Bo years moms a /MINA/YYYY Format) known) [26/07/1980 (6) Gender of Applicant (Tick appropriate boxy [wig fie Tarde Male Female Cl Third Gender (h)current address where applicant is ordina it is ordinarily resident House No. {House No.88,Ward No.16 A Street/area ss os Locality. Dr.Pyara Hakeem Street,Tehsil Mohalla own Vilage Dh Post Office Dhuri Pin Code | 148024 District |SANGRUR [State/UT = ean address of Iitouse No |House No.88,Ward No.t6 A Street/Area/Localty [De Pyara Hakeem Sret Ths Wehola Town/Village Ohuri post Office hur —_Jfncsae [soon Distict _[SANGRUR Sat [ponise _—-— (i)EPIC No. (if issued) Optional Particulars Olsen ae ee iv pared speach hewing atc ability (ifany) (Visually DB bocor isabilit 7 (e) ois Er ahmita2607@gmallcom mover dsabiiv) other iy Emad option) |monsbmieneerenmeteon — _ (mm) Mobile No- 491981532362 [‘eotons The best of knowledge and 7 ‘declare that 2 mae DECLARATION -Theteby 3s ace of YB Vege/TONM Dh yy Fano etizen of lo 200 7 gy aver a (h above sce 26/oyigeANGRUR State Puno t 7 rinariy resident Ot tHe oor my name in the electoral oy jee 1290 (3) 1am ordi ed for the Mes 20 other consi {ii hove not ap?! tency. Scanned with CamScannerForm No, : OMF2IS 97564 — SSS Fe 31) ana orpgannent nemo irst time Voter on ~~ Application for inclusio for First time Voter OR on n of Ne ; ‘al Roll. [Shifting from One Constituen oi” Elect" : jtuency. tituency to another constitu! se ts nS Raa ie [request that my name be includ eet Peay conse) _——————} | | request that my name be included in gy situency. inthe electer Cons (first time voter lectoral rll for the above C (b)Surnametif any) [(eisumametfan | ee (c) Name and surname of Relative of ‘Applicant [see item (d)) VINOD KumaR, [(3) Type of Relation [rather @ omer DHusband wife Steurrentcalendar year] [ao years @ months 20 years 4 months (f) Date of Birth (in DD/MM/YYY. format)(if known) 13/08/1999 (¢) Gender of Applicant (Tick appropriate box) Male@ Female (Third Gender O (a)Name [DEEPAK Gakg ™ ees een | (e) Age [as on 1st January (h)Current address where applicant is ordinarily resident House No | HOUSE NO 289 WARD NO 168 Street/Area/Locality | NEAR OBC BANK DHURI {Town/Village DHURI Post Office DHURI PinCode 148024 District [SANGRUR State/ur (i) Permanent address of applicant Street/Area/Locality Town/Village Post Office House No District (DEPIC No. (if issued) (Optional Particulars zech hearing disaby, (4) Disability (ifany) [Visually Impared O)_SPe SO locomotor dsabinny Other __— (1) Email id (optional) Ot (m) Mobile No. 917087792777 (optional) arto the bes of knowledge and iejer— - thereby declare th is viloge/Town OH DECLARATION. nop my bit : a it India and place 3 (h) above since op, shun se i ) lea a eae eee te ares given ath nt e/a ate Punjab am ordina jon of my name [OF any ot (iil have not applied for the inclusion of e ther constituency Scanned with CamScannerELECTION comissiON® FoRM-6 - : ppl jor First time Voter OR on ‘Application for Inclusion of Name in Elector! qeuency- shifting from One Constituency to Anothet con eS ] ae [rrequest that my name be inclu [U/) fist time voter ulats in support of my claim for inclusion in (Mandatory Particulars fayvame CHINAR - jatame rer {b)surname(it any) _ __———— {c) Name and surname of Relative of Applicant [see item (d)} SAR MAR —_———— + eeO [a type of Relation — [Father (2 Mother] Husband 7 fe) Age [as on Lt January of current calendar yea" | (1) Date of Birth (in DD/t (g) Gender of Applicant (Tick apo" (h)Current address where apphcant resident i Street/Area/Locality _ [HOUSENO 289 WARD "0 168 - HOUSENO - — j Town/Village NEAR 0 0 ¢ BANK DMUR! i Post Office HURT District [SANGRUR v (i) Permanent address of applicant Street/Area/Locality Town/Village Post Office District {(JEPIC No. it issued) [Optional Particulars T {k) Disability (ifany) | Visualiy tres (1) Email id (optional) en) Mobile No. +91904n388375 (optional) [DECLARATION - | hereby declare that 10% The best of krowles eee i) tam acitizen of tndia and place of eae rip om ordinarily resident at the address 9% ot (7) ebo%e S572 ( 2 s {it have not applied forthe inclusion of my oe <— red Speen tease 2 teometer 5 ‘Scanned with CamScannerELECTION commssion OF INDIA Form No, : ESF582837794 QY FORM-6 so ules 131 pec A Erbin atno angen ater OR on aie Application for Inclusion of Name in Electora! Roll for [from One Constituency to Another Constituency. tthe Electoral Registration Office, Ohurl Assembly Pariamenary Coster request that my name be included in the electoral roll for the above constituenY (V)first time voter Particulars are given below ‘support of mxclaim for inclusion in the electoral rollare ven PEP [Mandatory Particulars - [fewame NIMARTA |(b)Surname(if any) |GOYAL (c) Name and surname of Relative of Applicant [see iter (d)] GAGANDEEP GARG [(@) Type of Relation [Father Mother Husband @] wife] (e) Age [as on 1st January of current calendar year 2021) |30 years 1 months (f) Date of Birth (in DD/MM/YYYY format)(iF known) [17/14/1990 (g) Gender of Applicant (Tick appropriate box) [MaleC) Female @ Third Gender eae address where applicant is ordinarily House No, {108/250 |Street/Area/Locality BUS STAND STREET, SHIVPURI MOHALLA Town/Village HURL _ [Post omice DHURI ‘[rincode [zaaoza District |SANGRUR [State/uT i) Permanent address of House No }10B/250 1 apalicant |Street/Area/Locality [BUS STAND STREET, SHIVPURI MOHALLA Town/vilage HURL Post ortce HURT District [SANGRUR Sapp ote _Yaagone EPIC No. (itiesued) Punjab | Optional Particulars Ch Diaby any) [vauatiyimpared speech HEBrPe di S~— (i Emaitid (optional) | * Roter disability Other == (re) obite no /sx9463008603 ene ro te best of knowledge ang Thereby declare that DECLARATION. "Hereby declare ther Voth, jess given ot sy nae Fe vlge/ Ton Degg — {i above since go SANG 11am a ctzen of Indio ond place a ine electoral 204 2" State Punjon, (i) | am ordinorly resident at the 0 (ul have not applied for the Inclusion orn Mother constiven Scanned with CamScanner———— _ ELECTION Commission OF INDIA Form No, : OUR637727957 FORM-6 (See Rules 234 e390 112d 26 ot egitratono HE9 pw = . Application for Inclusion of, Name in Electoral Roll. for First time Voter OR on Shifting lect a i [from One’ Constituency to Another Constituency. othe stort Region OF har Atemty a sentery Goaihiwehef — fanaa stration Officer, hurl rllamentary Conte | request that my name be included in the electompmern acre (J) first time voter Meine lester fhe abne Coste (a)Name lakshay (b)Surnametif any) {c) Name and surname of | Relative of [Applicant (see item (d)] rakesh kumar | (d) Type of Relation Father@ MotherO) Husband) Wife) (e) Ate [as on tst January of current calendar year) a8 year 4 monthe : (8 Date of Birth (in DD/MIM/YYYY format)lif known) '28/08/2002 (e) Gender of Applicant (Tick. appropriate box) Male@ FemaleO Third Gender O (h)Current address where applicant is ordinarily, estan House No. house no.87,ward no, 14/a Stréet/Area/locality —_[shivpuri mohalla Town/Village [dhuri, sangrur Post Office” dhuri Pin ode aagone District |SANGRUR [State/UT Petre areas ce House No |house no.87,ward no, 14/a | ‘applicant | ‘Street/Area/Locality |shivpuri mohalla | Town/Village dhuri, sangrur Post Office dhuri Eom [fincoeepasage ———-—] | District ISANGRUR: Punjab (i)EPIC No. (if issued) c = hearing disableg 5 t Speech (K) Disability (ifany) _| Visually Impared Scomotor disal lity O other (i) Email id (optional) | fm} Mobile No. 417814756103 (optional) waito the best of knowledge and bear that hur 0 illage/TOwn "sti above sine 2/097 SANGRUR ray, A the electoral rol 2002, fe Punjab 2°Y other, | DECLARATION - / hereby declare nen (i) 1am a citizen of India and place a hale ‘ven ) (ii) |am ordinarily resident at the a iil have not applied for the incl me it Scanned with CamScanner{= 2 a KYA ' FLECTION conayaissiON OF Form No. : 0062981685 ELECTION commission OF inola FORM-6 (40 Pies 143 ar8.26 ot pegaacan d OO Application for Inclusion of Name in Electoral Roll, |from One Constituency to Another Constituency- To The corel egsvation Of, DR ASEM / Priory coset ies Baad iy name be included in the electoral ofr the above consttuen Particulars in support of my claim for inclusion in the electoral roll ate éiven CEO [Mandatory Particulars |(a)Name- ~ MANDEEP- “e fo for First time Voter OR on "Shifting {b)surname(if any) [KAUR (cae aaa an Relative of HARISH KUMAR [{a) Type of Relation [rather Mother Wusbana@ wile) {e) Age [as on Ast January of current calendar year) [22 years 5 months (f) Date of Birth (in DD/MM/YYYY format){if known) [06/07/1998 (g) Gender of applicant (Tick appropriate box) [MaleC) Female(@ Third Gender C1 {(h)Current address where applicantis ordinarily |isou io, |yw025 WARD NOIS resident |Street/Area/Locality TEHSIL MOHALLA Town/Village DHURI Post Office TEH DHURI Pincode ]aasona District _[SANGRUR [starr (i) Permanent address of, House No [HNO 25 WARD NOs applicant /Street/Area/Locality TEHSIL MOHALLA Frown/Vilage fowuR Post Office Ten DHURI ap nce [ona District [SANGRUR Punjab [Ontional Particulars jecen nesting bea Jo 5 Lecomoy (k) Disability (if any) visualy impasse aby Other () Email id (optional) 79 (m) Mobile No. 4517009941 = (optional) ciate bet oT ona ran 4 jare tho ur . DECLARATION I hereby decors BY yp ars iil ois a rn tam octisen of India and place, ena cru Melted a /220,. UR Stote Punjoy i 2 athe, (it finarily res : i " in! have not opalied forthe indus jan of my ms Scanned with CamScanner= p19 824 oS ¥ ELECTION commission oO Jye-/S) FORM-G ait / {5c Rules 121 ane ern scans time Voter OR on | 2 for First time Voter OR on Application for Inclusion of Name in Electoral poll ‘Shifting from One Constituency to Another constituency | Teer eatin Of OH ASS / anny nies) ————— | lieeanet usin ane be RGNGS Ives rn request that my name be included in the electoral ol forthe above consstueny (V) first time voter 7 NDIA Form No. : OVS527404347 Particulars in support of my claim for inclusion inthe electra oare ¥en BOM [Mandatory Partcul (a)Name JEENA, (b)Sumnamelif any) (c) Name and surname of Relative of Applicant see item (d] a (a)Type of Relation _|FatherO Mother Husband@ Wife c) Age [as on Is January of current calendar year aa! ” 765 Tae yeas © mont {f) Date of Birth (in DD/MM/YYYY format)(if known) _ [01/01/1987 (g) Gender of Applicant (Tick appropriate box) Male Female@ Third Gender (h)Current address where applicant is ordinarily resident House No. ward number 6 Street/Area/Locality [JOGIBASTI applicant — | ‘Street/Area/Loc | | Town/Village [ Post Office District tate/UuT poo [EPICNo. (fissued) Onions Parclacs _ae acaaanenenenes dL Speech hearing di (k) Disability (fany) [Visually impared CI_ Speech NESANE eablag SoMotor disability Hy () Email id (optional) disability 9 |(m) Mobile No. (optional) Other }+919781604260 mop knowledge on DECLARATION - I hereby declare that to the beste irelTown oie beep (i) lam o citizen of India and place of Lede Men a ( BOVE since! tri san {inom ordinary resident o the 22560 he tng YY/sg AUGRUR tote puny (ii)! have not applied for the inclusion of Uf via OF any of ' Other. Constituency, Scanned with CamScannerELECTION COMMISSION OF inDIA Form No. : OPL104443117 FORM-6 (See es 3 426 aguas Cees Set reeen OS First time Voter OR on \pplication for Inclusion of Name in Electoral Roll for shifting from One Constituency to another constituency» roth fecoral Registration Officer, hur As 'mbly / Parliamentary consitituency 7 rea pee fatlamentary consittvensd — [request that my name be included in the electoral roll for the above constituency (V/) first time voter particulars in support of my claim for inclusion in the electoral roll are given DelOW:= ee iON in ve [Mandatory Particulars fa)Name KALA WANTI [o)sumametif any) {¢) Name and surname of Relative of Applicant [see item (d)] RAJESH (d)TypeofRelation [Father] Mother) Husband @ Wife] (e) Age [as on Ast January of current calendar aaa Veer 38 years 0 months (f) Date of Birth (in DD/MM/YYYY format)(iF known) _[o1/01/1983 (g) Gender of Applicant (Tick appropriate box) MaleQ_female@ Third Gender {1 eae rere House No. |23/6b a Street/Area/Locality _ [DHOBI GHAT Town/Village DHURI Post Office DHURI Pin Code [aagoza District [SANGRUR seate/UT (Permanent address of — |sscuce No _ TI applicant street/Area/Locality ——__—$~~___ —— [Town/Village oo Post Office District (EPIC No. (ifissued) tional Particulars ech hearing dsaia (H9 Disabitty ifany) [Visually pared SPS 0 (i) Emailid (optional) (cn) Mobile No. 917934237318 (optional) [pssmeuess an T pest of i DECLARATION - | hereby declare that to th: i vitage/TOWN DHp, nf Oi ‘my bir ‘above since gy strict, {fam a citizen of india and place of mY BI att Sanaa fi) om ordinarily cesident atthe address 967 i te eltorel ay 198 State Punjab ii) have not opplied forthe inclusion of any, Scanned with CamScanner— ELECTION connigsion OF INDIA Form No. OX927151053 FORM-6 Sees tan epepatonel Hea plication for Inclusion of Name in Electoral Roll fo" sifting from One Constituency to Another Constituency: Ith Eecoral Registration Officer, Oh First time Voter OR on I fembly / Parliamentary Consitituen’y request that my name be included inthe electoral ral forte above COM (Vist time voter the a artcularsin support of my claim for inclusion in the electoral roll are given Below Pe ion in the electoral roll are give” OE [Mandatory Particulars SS | Name MANPREET SINGH meme (b]surname(if any) [e) Name and surname of Relative of Applicant [see item (d)] CHARANJIT SINGH (4) Type of Relation Father MotherQ Husband) wife 0 (e) Age [as on Ast lanuary of current calendar year] (Date of Birth (in DO/MM/YYYY format)if known) (g) Gender of Applicant (Tick appropriate box) 24 years 4 months 13/08/1998 Male @ Female Third Gender 0. (h}Current address where applicant is ordinarily resident Houseno. |17/6¢ Street/Area/Locality [Town/Village DHURI : Post Office DHURI DHOBI GHAT ROAD Pin Code 148024 District [SANGRUR state/uT (i) Permanent address of | applicant Street/Area/tocality Town/Village Post Office House No — foo District Stateyoy (JEPIC No. (if issued) Optional Particulars —— (k) Disability (if any) Visually Impared (Speech hearing disabieg p, (1) Email id (optional) motor disability other__—__| (rm) Mobile No. +919041016208 (optional) S DECLARATION: (hereby declare that to the best of knowledge and bej=-~ _ 7 vince of India and place of my birth is Village/Town DHUR; , Af ma es (1am @ dinar resident atthe address given at (h) above since 13g It Say Scanned with CamScannerForm No. OS€04301796 ELECTION Conjmmission OF INO FORM-6 {See Rules i960 A 2 an 26 ot ego HC ‘irst time Voter OR on lapplication for Inclusion of Name in Electoral Roll. ‘for Fi shifting from One Constituency to Another constituency: Fa The Electoral Refstration Officer, Dhurl Assembly /Pariamentary conateneY request that my name be included in the electoral rll for he above comsttueny- (/) first time voter Particulars in support of my claim for inclusion in the electoral rll are given Below! rv Particulars Mandaton (aiName [CHARANIIT (b)sumamelifany) [SINGH (c) Name and surname of Relative of Applicant [see item (4)] RAM LAL (d) Type of Relation Father MotherO Husband) wife {e) Age [as on Ast January of current calendar year | [33 years 2. months {Date of Birth (in DD/MIM/YYYY format)(if known) 19/10/1986 (g) Gender of Applicant (Tick appropriate box) Male @ Female( Third Gender O (h)Current address where applicant is ordinarily House No. HOUSE NUMBER #34/6 resident street/Area/Locality Town/Village Tonos Gwar monauia OHI Post Office DHURI PinCode 148024 District [SANGRUR state/uT applicant (i) Permanent address of House No Street/Area/Locality Frown/village Post Office District Statefup ] pasteebesESSEEsESTESSEESRESESSEOSEEIES™| (j)EPIC No. (if issued) (kq Disability (if any) Visually impared Speech hearing disabieg = ————___ ~ (1) Email id (optional) (v/) frst time voter Particulars in support of my claim for inclusion in the electoral ollae ven BelOW! Mandatory P rticulars ARSHDEEP SINGH. b}Surname(if any) _ () Name and surname of Relative of () 'V° OF | CHARANIEET SINGH Applicant {see item (d)] (d) Type of Relation | Father @ Mother Husband Wife (e) Age [as on Ist January of current calendaryear] [19 years 0 months (f Date of Birth (in DD/MM/YYYY formatytifknown) [01/01/2001 (@) Gender of Applicant (Tick appropriate box) Male@ FemaleC] Third Gender 1 (h)current address where applicant is ordinarily aa House No. |17/6c resider Street/Area/Locality _ |DHOBI GHAT ROAD [Town/Village DHURI Post Office DHURT [Pin code [aaso2a District [SANGRUR State/uT i) Permanent address of applicant frown Street/Area/Locality ee [Town/Village Post Office District EPIC No. (ifissued) [Optional particulars (%) Dicabitny any) [visually impared C1_ Speech hearing cabjeg > Loco [CL Emadid optional) _| ritordksuiny Ow (en) Mobile Wo inaaamee OT (optional) 919041016208 a ; wedge a DECLARATION | hereby declare that tothe best of kno aaa {i) 1am a chizen of india and place of my birth is Vilage/ Town DHyp, on, _ = {i) am ordinarily resident atthe address given at (h) above since oy 5 cts aa {it have not applied forthe inclusion of my name Inthe SIeCtal oy 7209 Scanned with CamScannerA ELECTION Commission OF ino FORMS 0 ___ Bee anda ong aaa \application for Inclusion of Name in Electoral poll for eet time Voter OR on shifting from One Constituency to Another Constitue” — Fo-tac ceca Regtavon ocr, Dhar Assembiy/ Paramenany Conse) | sues that my name be included inthe electoral ra for the above cO"s*™ (u)firsttime voter eee Particulars in support of my claim for inclusion in the electoral rol are Form No, 00074153459 uency (alName GGEETA RANI [(a)Name __ {(ojsurnametif any) [casurnametiramy) | | [Name and surname of Relative of |, ay Applicant [se item (A)] ae (d) Type of Relation [Father Mother) Husband @ Wife (e) Age [as on 1st January of current calendar year] [34 years 3 months [) Date of Birth (in DD/MM/YYYY format)(if known) [02/10/1985 (g} Gender of Applicant (Tick appropriate box) MaleCi Female @ Third Gender C1 (h)current address where applicant is ordinarily resident House No. |13/A,7-8 Street/Area/Locality _ [AMBEDKAR CHOWK Town/Village DHURI Post Office DHURI [Pin code 148024 istrict [SANGRUR State/UT () Permanent address of applicant | Street/Area/Locality FrownNillage — District StateyuT ——] (EPIC No. if issued) ——T (i) Disabitty (any) [visually impared (Speech Nearing dlsabjeg = i) emai (optionah Comotor disability I Other = in aie Wo [cona ¢51903 768707 eS eee mnowledge Ong pep — DECLARATION - I hereby declare that to the best of Know NMS Nill bei of ———_ 1) 1070 a citizen of India and place of my birth Is raster strip {i)1a1 ordinarily resident at the address given at (h) avon * Ore i) ly resident at the address give! inthe electoralgy 09s INGRUR State Punjab {iil have not applied for the inclusion of my name I any Sther constituency, Scanned with CamScanner1A ELECTION Conaaiggion OF NO FORM-6 {See Rls 130) and 26 of epacen of eC pplication for Inclusion of Name in Electoral F0!! 12 shifting from One Constituency to another constitue othe lecoa Regisation Office Ou Assembly / Pariomenan cone request that my name be included in the electoral rit for the above CO" (/) first time voter ven belo Particulars in support of my claim for inclusion in the electoral oll ar® [Mandatory Particulars _— (a)Name_ | Diksha ___} fiaeme _{Dhg (osurnamelifany) [gare [tis (@) Name and surname of Relative of [Applicant [see item (d)] Form No, OPV n 60 i First time Voter oR on icy: uency- Rajesh kumar garg (d) Type of Relation Father@ = MotherO Husband] wife (e) Age [as on 1st January of current calendar year) [19 years 1_ months () Date of Birth (in DD/MM/YYYY format}if known) [30/33/2000 (g) Gender of Applicant (Tick appropriate box) MaleCl female@ Third Gender O (h)Current address where applicant is ordinarily House No. |184 resident [street/Area/tocality _[Wno 16b, Sangrur road dhuri Frown/Village hurt Post Office dhuri PinCode {148024 District _[SANGRUR [staterur () Permanent address of 7 House No 184 applicant - a — Street/Area/locality [Who 16b, Sangrur road dhuri ost —————_——] District SANGRUR: State/uT F ——| | a {DEPIC No. fifissvea) ria |Qutonal Panis Tic ars Wt eee —- (k) Disability (ifany) visually impared Speech hearing disabjeg = _ comotor (1) Email id (optional) dikshagarg732@gmail.com Stor disability Other _———= (m) Mobile No. eee ennieaa _ 0 . itera }+91980333610 ge an DECLARATION - / hereby declare that to the best Ciacan "bet — (am ize of ni cn pace of birth i bove since 4 tay - ii) !am ordinarily resident at the address given ie electorg Ot IGRUR s¢ r (ii)! have not applied for the inclusion of my name ia th ectoral ray 2/2000 "ete Punjab ra MY other, Constituency, Scanned with CamScannere 1A ELECTION coMmssion Of (see Rules 130) and 26) of Res I for Application for Inclusion of Name in Electoral RO from Gre Constituency to Another Constituen“- ‘Registration Officer, Dhuri Assembly / Parliamentary Consist¥6OD. Electoral rat that my name be included in the electoral rll for the abov® const uency requ Vu) fist time voter von wen belo eoerlatsin support of my claim for inclusion in the electoral lacs —— Fe ‘orm No, xt [Mandatory Particulars (aname ojsurname(if any) (c) Name and surname of Relative of [Applicant (see iter (d)} Rajvir [singh JAngrej singh witeO best of knowledge and bey JDECLARATION-- hereby declare that to th ith is Village/Town Dhuri pi. (i) ! am a citizen of india and place of my bi 1 (h) above since O1/y (i) 0m ordinarily resident atthe address given © m win the electoral ro [eTypeof Relation [Father Mother) Husband O) (e) Age [as on 1st January of current calendar year } 22 years 4 months | (f) Date of Birth (in DD/MM/YYYY format)(if known) 19/08/1998 (@) Gender of Applicant (Tick appropriate box) Male] Female Third Gender ae address where applicant is ordinarily. House to. {492 Street/Area/Locality |Shivpuri mohala dhuri Town/Village Dhuri Post Office 148024 PinCode | 148024 District SANGRUR [stare/UT (i) Permanent address of applicant House No {492 Street/Area/Locality [Shivpuri mohala dhuri Town/Village Dhuri Post Office asoza Pncaae — in Code District [SANGRUR stateray jagzozs DEPICNo.(ifissued) Punjab Optional Particulars | (k) Disability (ifany) | Visually Impared CI Speech hearing disableg 7) Tha [ty €maitia (optional) —_[rajveersingh.45456@gmalLcom Motor disability Other ___— (m) Mobile ni et [m)Nobieno, | sonasszea700 ct Say 12003 PUR State Punjab (iit have not applied for the inclusion of my nam for ony, Sther coy nstituency, Scanned with CamScanner29] wo 190.8 ELECTION Commission OF INDIA FORM-6 a (See Rules 132) 25426) or pega of lector Ru ASCO mans Application for Inclusion of Name in Electoral Roll for First time Voter OR on Shifting from One Constituency to Another Constituency. Ff, The Electoral Registration Officer, Dhuri Assembly / Parliamentary Constituency Form No, : 016825583983 | request that my name be included in the electoral roll for the above Constituency. (V) first time voter | Particulars in support of my claim for inclusion in the electoral roll are given below:- Mandatory Particulars (a)Name RUPALI (b)Surnametif any) [VERMA (c) Name and surname of Relative lof Applicant [see item (d)} [remoen SINGH (¢) Type of Relation [Father Mother Husband) Wife O) (e) Age [as on Ast January of current calendar year 2021 21 years 0 months (0) Date of Birth (in DD/MM/YYYY formaty(if known) [04/12/1999 (g) Gender of Applicant (Tick appropriate box) Male] Female Third Gender 0 (h)Current address where applicant is | ordinarily resident House No, | NO. 10¢/68 W.NO 10 [street/Area/Locality | SHIVPURI MOHALLA Town/Village DHURI Post Office TEH DHURI Pincode [148024 District |SANGRUR state/UT (i) Permanent address of House No applicant Street/Area/Locality Town/Village Post Office Pin Code District peer | (EPIC No. (if issued) ia [Optional Particulars 1 (Hp Disability if any)_|Visually IiPared Speech hearing disabled Locomotor disability. Gener () Email id (optional) (rm) mobile No. +9198140737a1 — (optional) [DECLARATION | hereby declare that to the best of knowledge and belief — mana fi) Lom a citizen of India and place of my birth sVillage/Town DHURI District SANGRUR State p, fi) am ordinarily resident a the oddress given a (h) above sine 04/12/1999. unjab fiyinave not oppied forthe Inclusion of my name nthe electoral oll for any ete 2PSttueng, Scanned with CamScannerELECTION COMMISSION OF INDIA FORM-6 {Se ules 31) 37426) of regs eters EID pplication for Inclusion of Name in Electoral Roll for First time Voter OR on shifting from One Constituency to Another Constituency. Fo, he electoral Registration Office, Ohuri Assembly / Parliamentary constituency Form No. : OMT119687862 request that my name be included in the electoral roll for the above Constituency. (first time voter Particulars in support of my claim for inclusion in the electoral roll are given below: Mandatory Particulars {a)Name Hiteshi | (bjSurnamefif any) _|Modi |(c) Name and surname of Relative 5, 1 of Applicant {see item (d)] Hetinder a Med (d)Type of Relation —_|Father@ Mother() Husband) Wife (e) Age (as on ist January of current calendar year 19 years 11. months (f) Date of Birth (in DD/MM/YYYY format){if known) [31/01/2001 (g) Gender of Applicant (Tick appropriate box) Male) Female @ Third Gender 0 (h)Current address where applicant is ordinarily resident Pegi ls Street/Area/Localty — [Pipian wall gall, shivpuri mohalla, warrd no, 14 FTown/Vilage DHURT Post Office DHURI [Pin Code al 148024 District [SANGRUR [state/UT. (i) Permanent address of e House No applicant [Street/Area/Locality Town/Village Post Office Pin Code District Sauur (EPIC No. (if issued) el hides [Optional Particulars a (W Disability (ifany) Visually Impared 1 Speech hearing disabled) Locomotor disability {(y Emailid (optional) _|yuktimodl29@gmail.com they ioew——ecom (im) Mobile No. 4917528962256 es (optional) : clore that to the b DECLARATION I hereby de est of knowledge and beli - ind place of my bir lief ~ {i} Lam acitizen of Inco ond place of my births Viloge/Town DHURI Distct SANGRUR Stay (i) | am ordinarily resident ot 6h" 23 ldress given at (h) above since 31/12/2001 © Punjab {it have nat applied forthe Inclusion of my name inthe electoral rll for ony othe? COPSttven, Scanned with CamScannerForm Na“ OFFInDLUr Um ELECTION COMMISSION OF INDIA FORM-6 Geers) meng olen ei ta \Application for Inclusion of Name in Electoral Roll for First time Voter OR on Shifting |from One Constituency to Another Constituency. To, The Electoral Registration Officer, Dhuri Assembly / Parliamentary CO! Form No. : EYL621564628 uency || request that my name be included in the electoral roll for the above Constituency. (¥) first time voter Particulars in support of my claim for inclusion in the electoral roll are given below: ” [Mandatory Particulars (a)Name Lovish (b}surmametif any) [Singla (c) Name and surname of Relative of Applicant (see item (d)] Lakshya Kumar (a) Type of Relation _|Father(Z Mother() Husband Wife (c) Age [as on 1st January of current calendar year 2023) |20 years 3 months (f] Date of Birth (in DD/MM/YYYY format](ifknown) [17/08/2000 (@) Gender of Ap; int (Tick appropriate box) Male@ FemaleC] Third Gender C1 (n}Current address where applicantis ordinarily |ioceno, aap resident ' [Street/Area/Locality __|Pathshalla mohalla Town/Village Dhuri Post Office Dhuri PinCode [148024 District [SANGRUR state/UT () Permanent address of House No |240 applicant Street/Area/Locality __|Pathshalla mohalla Hrown/Village Dhuri Post Office Dhuri District [SANGRUR EPIC No. (ifissued) Optional Particulars (k) Disability (if any) () Email id (optional) m) Mobile No. (].20 oo. in nee | optional) i pxcuaRaTion 1 hereby declare ee to id ‘best of knowledge and belief ~~~ _| () oma citizen of india and place of my birth is Village/Town Dhuri Distr istrict SANGRUR State Punj 1am ordinary resident at the addres Given at (h) above since 17/09/s0eq ee iit have not applied forthe Inclusion af my name inthe electoral rel fr any other constituency. Ritiave not applied for the incisor mmname in the electoral roll st L PinCode [148024 [State/UT 'unjab — ally impared Ol Speech hearing disabled C) Locomotor disability Egy er Scanned with CamScanneruy - WI BD say Nhe ps9 5 pt rare die tin, $ ELECTION ConmmssiON OF INDIA “2758 Ne Up FORM-6 Form No. : OEF165107622 ‘ {Sets 3) at neat oer Rle60 Application for Inclusion of Name in Electoral Roll for First time Voter OR on Shifting from One Constituency to another Constituency. Fo, The Hector Regivation Ofer, Dhurl Assembly / Parliamentary Consitituency I request that my name be included in the electoral rall for the above Constituency, (V/) fist time voter Particulars in support of my claim for inclusion in the electoral roll ae given below: | Mandatory Particulars (ayvame MANINDER KAUR (b)Surnamelif any) (c) Name and surname of Relative of Applicant [see item (d)] ees EH EED (@) Type of Relation |Father @ Mother) Husband) wife) (c} Age [as on 1st January of current calendar year] [18 years 0. months (f) Date of Birth (in DD/MM/YYYY format)(if known) [01/02/2002 (e) Gender of Applicant (Tick appropriate box) [Male Female @ Third Gender 0 Ihcurentadaress where applicants ordinary Paosse yo, Joan Street/Area/Locality | PATHSHALLA MOHALLA ~ Town/Village ~ [onuRT a Post Office DHUR Pin Code [148024 District [SANGRUR state/UT (Permanent addressof—rssucano applicant street/Area/Locality ~ Town/Village Post Office Pin Code District State/UT a (EPIC No. (iftssued) [Optional Particulars [4 (e) Disability if any) [Visually mpared C1 Speech hearing disabled CI Locomotor disability) ogner (I) Email id (optional) bsbedi@khalsa.com (m) Mobile No. (optional) DECLARATION hereby declare that to the best of knowledge and belief ~ - (i)! 0m a citizen of India and place of my birth is ilage/Town DHURI District SANGRUR Stote Punjgy fi) am ordinarily resident at the address glven at (h) above since 01/03/2002 . (i)! have not opplied for the inclusion of my name in the electoral roll for any other constituency, }+918427423300 Scanned with CamScannerForm No, QAFTSS793265 | tion is asia f Name in Electoral Roll for First time voter OR on fro e ‘Onstituency to Another Constituency. Trequest that my name be included in the e (2) fist time voter Particulars in support of my claim for inclusion in th, [Mandatory Particulars = { | (a)Name Kamaldeep Singh — | (b)Surname(if any) 4 | {c) Name and surname of Relative of | = . j Applicant [sce item (a Nirankar singh | MN | (a) typeof Relation |Father@ Mother Husband) Wife | (e} Age [as on 1st January of current calendar year] [18 years 5_ months ~ {f) Date of Birth (in DD/MAM/YYYY format)if known) [04/08/2001 1 {g) Gender of Applicant (Tick appropnate bor) Twalec female[) Thied Gender (h)Current address where applicant is ordinar ] bo! resident jiis0$7, Wino 7 [street/Arca/Locality _[Pathshala Mohatla _ | Town/Village Dhuri i Post Office Dhuri Pin€ode [iasozt 1 District [SANGRUR [saterur —_— | (Wrermanentaddressof — Trrouse no | applicant | Streat/Area/Locality | Town/Village Post Office Pin Code —— District seate/UT (VEPIC No. (ifissued) [Optional Particulars (i Disability (any) __ [Visually mparedO) speech hearing ssbled OD Locome’ to > {) Email id (optional) __[jamkamalsopal@gmail.com —- - (rm) Mobile No. 4919465303700 (optional) DECLARATION: Thereby declare thatthe best of knowledge ond be fi) 1m a citizen of india and place of my birth is Village/Town Dhuri District SANGRUR St2%® Punjab | ii) 10m ordinarily resident ot the address given at (h) above since 01/03/2001 {iit have not applied for the inclusion of my name in the electoral other consstuency, ‘Scanned with CamScanner