Scribd Logo
Upload

Welcome to Scribd!

  • Form 6

    Uploaded by

    sajid
    6 views3 pages
    Tabasum Begum has submitted an application for inclusion in the electoral roll for the first time. She provides her personal details including her name, father's name, date of birth, address, and contact information. She declares that she is a citizen of India born in Bidar, Karnataka and has been residing ordinarily at the provided address since 2000. She further states that she does not possess any documents as proof of her date of birth and has enclosed an alternative age proof. She is aware that making false declarations in her application is punishable by law.

    Original Description:

    Original Title

    Untitled

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    Tabasum Begum has submitted an application for inclusion in the electoral roll for the first time. She provides her personal details including her name, father's name, date of birth, address, and contact information. She declares that she is a citizen of India born in Bidar, Karnataka and has been residing ordinarily at the provided address since 2000. She further states that she does not possess any documents as proof of her date of birth and has enclosed an alternative age proof. She is aware that making false declarations in her application is punishable by law.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    6 views3 pages

    Form 6

    Uploaded by

    sajid
    Tabasum Begum has submitted an application for inclusion in the electoral roll for the first time. She provides her personal details including her name, father's name, date of birth, address, and contact information. She declares that she is a citizen of India born in Bidar, Karnataka and has been residing ordinarily at the provided address since 2000. She further states that she does not possess any documents as proof of her date of birth and has enclosed an alternative age proof. She is aware that making false declarations in her application is punishable by law.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 3

    4/9/23, 2:09 PM form6

    form6
                                                            ELECTION COMMISSION OF INDIA
                                                                        FORM-6
                                                                                                                                         (See Rules 13(1) and 26)

                                                                                            Application form for New Voters


    To, The Electoral Registration Officer,
    Karnataka Bidar
     Assembly / Parliamentary Consitituency
    Personal Details
    First name followed by Middle ತಬಸುಮ್ ಬೆಗಮ
    Tabasum Begum
    Name
    Surname(if any)
    Father ☐      Mother ☐      Husband ☑      Wife ☐      Legal Guardian in case of orphan/Guru in case
    Type of Relation
    of Third Gender ☐
    Name and surname of of any one of ಮೊಹಮ್ಮೆದ ಅಬ್ಡುಲ್ ಫೇರೋಜ ಕé್ಹರೈಶೀ   
    Mohammed Abdul feroz Qhuraishi   
    the relatives
    Mobile No. of Self (if available) 7676905830 Relative ☐
    Email id of Self(If available) Relative ☐
    Aadhaar Number
    Gender Male ☐      Female ☑      Third Gender ☐
    Date of Birth (in DD/MM/YYYY format) 14/04/1995
    Document for proof of Date of Birth Aadhaar Card
    House/Building/Apartment
    Present Ordinary Residence 2-1-233 2-1-233
    No.
    Street/Area/Locality/Mohalla/Road Mustaid Pura Siddiq Sha Taleem ಮುಸ್ಟೈದ ಪೂರಾ ಸಿದ್ದಿಕ್ ಶಾಹ ತಅಲೀಮ

    Town/Village Bidar ಬಿದಾರ

    Post Office Bidar ಬಿದಾರ Pin Code 585401

    Tehsil/Taluqa/Mandal Bidar ಬಿದಾರ

    District BIDAR State/UT Karnataka


    Proof of Residence Aadhaar Card
    Category of disability if any(Optional)
    Locomotive ☐    Visual ☐    Deaf & dumb ☐    Percentage
    Disability (if any) Certificate Attached ☐
    Other _________ of disability
    Name of family member Mahmad Ab Feroz Qhuraishi
    Relationship with Father ☐      Mother ☐      Husband ☐      Wife ☐      Legal Guardian in case of orphan/Guru in case
    applicant of Third Gender ☑
    His/Her Epic No. WHI0800029
    DECLARATION - I HEREBY DECLARE that to the best of knowledge and belief –
    (i) I am a citizen of India and place of my birth is Village/Town Bidar District BIDAR State Karnataka
    (ii) I am ordinarily resident at the address mentioned at Sr. No. 8(a) in Form 6 since 01/01/2000 .
    (iii)I am applying for inclusion in Electoral Roll for the first time and my name is not included in any Assembly
    Constituency/Parlimentary Constituency.
    (iv)I don't posses any of the documnets mentioned as proof of Date of Birth/Age. Therefore, I have enclosed in support of age proof.
    (v)I am aware that making the above statement or declaration in relation to this application which is false and which I know or

    about:blank 1/3
    4/9/23, 2:09 PM form6
    believe to be false or do not believe to be true, is punishable under Section 31 of Representation of the People Act,1950 (43 of 1950)
    with imprisonment for a term which may extend to one year or with fine or with both.

    about:blank 2/3
    4/9/23, 2:09 PM form6

    Applicant Place Bidar


    Applicant Date 09/04/2023

    about:blank 3/3

    You might also like