Acknowedgmert Number:-U6096080211231200001 Submission Dat :-02-11-2029 FORM 8 (See Rules 13(3) and (26 of the Registration of roRMNo Electors Rules, 1960) G ELECTION COMMISSION OF INDIA Voter Application Form for Shifting of Residence/Correction of Entries in Existing Electoral Roll / Replacement of EPIC / Marking of PwD (obe filed by ofice) 7, ‘The lestoral Registation Ofer, No. and Name of Assembly Constituency Wo. [a5 Name NAUAFGARH oro and Name of Palametary Constancy No ame. (@ ‘en for unen Taare not bang eit 2 assamby) (0 Nemec the sppicart- Rahul Sharwal epee pnisssoz7 ‘adhaat Deals (Pease me spre bx) @ ‘sadhaar umber CI LITt LL. or ] amar eb to fursh my a Number because | donthaveAadhear Number ble no. si LTT CI ble o. of Fate nteaany obras (aac) es C1 ema ot sto mal ido Father Matexny ota lata avalale) () isbnepiaten tr (key anette ong 1.) ontnot sn 2 [ro] comet ter incctng ect) 2. temeattgiecanertne tetcaretn(o) ‘ pepe ornatingat aren ch ay 1. Applian for Shing of Residence {have shite my residence and aquest that my name may be let om the previous acess and shit tthe cure adcess mantaned blow |rquest that replacement EC may ‘belesued tome duet chang in my adress. | eeby tun my og EPC. Present Ordinary [_House/Buiing/Aparment No. Sustsves(Localty/ Mohala/Rose Resdeneeeul [Tonia Post fice ade PIN Code Tesi Teluea Mandal Dist sae ‘Setatestes copy of adres rot eter nto nama of applicant cr anyone ofthe parerts/spouse/ adult chi fread enoted wth a ecto at the eae ado (atch any one of th documents mentioned below) 1 Wise Eeccty Oa ifr that adress (atlas yen) 2) Aadhaar cart a Ccurantpassbook of NatonalzedSchadd Bat/Poct Of 4 Indien Passport 5 Revenue Departments Lend Owning recedsieudng Ksan Bai 6 Rogier ent Lease Deed (n casef tenant) Rerjstered Sele Deedn case of oun house) ny Otar (speci2 Appleton for Crtton of Enis in Existing Electoral Rol ‘Pease corectmy folowing deta Electoral RlVEPIC: (Maman of ernes/paricus canbe coveted) (aca tok antepnaproprate box below) ‘SPACEFOR PASTING Copy of sat atestedOaeunentry Prat in super of clin tobe Dearsnpesor 1 Name 2 7 center a [a] vosiage ‘8ZE UNSIGNED COLOR 4 eaton ype 6 asters PROTOSEAPS S04 — — 250M) SHOWNG 1 edie Number 8 FRONTAL VIEW OF FUL ACE WT WHITE “The comectpartculas inthe erty ob carected ae as nde BACKGROUND (ONLY F PHOTO TO BE CHANGED) 2 [oevornsst b Name of Document support of above lim stached oT naar card b a I request hat areplacenent EPIC may be issued tome due to changein my personal tals ery retry old PI “Applicaton for issue of Replacement EPIC without erection Hequest het replacement EPICmay be isued tomes orginal Cs (Puta tckineppropte bor) 1 Lost 2 ‘Destroyed due to reson beyond conto la foods, rote rates ec 3] wasted te eum my mutate old EPIC (OR Ihave teched copy of FRPole roar or st EPIC undertake toretum th eater EPIC issue to mei he same recovered a later stage “4: Aoplcton for Marking Person with Disabity (etegary af eisai (ik te appropriate box fr category css) [J] tossmetie — [] vis [1 nate oan [1 tray ote ve ceseitin Pecertage of dsabity Js Cericate tice Tike appropiate box) ves No DECLARATION | HEREBY DECLARE that to the best of my knowledge and belt that | am 2 ciizen of India and | am aware thet making a statement or declaration which is false and which | know or beteve toe false or donot belive to be tue, is punishable under Section 21 of Representation of the People Act1950 (42 of 1950) with Imricenment fora term which may extend to one year or wih fae or with both. bate 2-11-2028 Place DELI Accesily stuctans-In the ight of provisions of ight of Persons wih Disabil Act 2076 and Rights of Persons wih Dsaites ules, 2017 n case of persons wihrelletual stilt, ava, cerebcl ply ard multiple ibis ec, signet or fthand tum impression of person wh seit, or of signature or fthand hun impression of his/her legal quran wile resuired " Gubission of sel-aesed copy of mentioned documents wil enue speedy deer of ervces x OK OX ‘AdinonedgementiRecep for application kK OX ‘Acknowedgement uber -U950950800211231200001 Date:02-11-2023, Received the application in Form 8 of StrSmt/M Rahul Sharwal Name/Sinature of ER0/AERO/ELO “This is 2 computer generated document and does not rege signature +