ELECTION COMMISSION OF INDIA

Office of the Chief Electoral Officer-Karnataka, Bengaluru- 560 001 Website: www.ceokarnataka.kar.nic.in
PREPARATION OF ELECTORAL ROLLS OF KARNATAKA NORTH-WEST TEACHERS AND
KARNATAKA WEST TEACHERS CONSTITUENCIES OF KARNATAKA LEGISLATIVE COUNCIL
Notice under rule 31(3) of the Registration of Electors Rules, 1960 63 Assistant Electoral Somalingappa Tahsildar Kittur Tahsildar Office, Old Govt Hospital, 9945295383 Kittur Taluka
1. In pursuance of rule 31 (3) of the Registration of Electors Rules, 1960 each of the Electoral Registration Officers whose particulars appear in the FIRST SCHEDULE Registration Officer Halagi Somawar Peth, Kittur
below hereby calls upon every person entitled to be registered in the electoral roll of the constituency mentioned in the said Schedule to send to or deliver at his 64 Assistant Electoral Prakash Holeppagol Tahsildar Gokak Tahsildar Office 9916764010 Gokak Taluka
Office, on or before 6th November, 2021 at the latest, an application in Form 19 appended to the Registration of Electors Rules, 1960 and reproduced in the Registration Officer Mini Vidhan Soudha, Gokak
Second Schedule below, for inclusion of his/her name. 65 Assistant Electoral D G Mahat Tahsildar Mudalagi Tahsildar Office, V.B.S School 8105006837 Mudalagi Taluka
2. The applications may also be sent to the Assistant Electoral Registration Officers/ Designated Officers whose particulars are shown in the FIRST SCHEDULE. Registration Officer Compound, Mudalagi
As the electoral rolls for the Teachers’ Constituencies are required to be prepared afresh every time before an election, all persons whose names are 66 Assistant Electoral N B Gejji Tahsildar Chikkodi Tahsildar Office 6366672717 Chikkodi Taluka
included in the existing electoral rolls for these Constituencies should also submit fresh applications in the prescribed form. Registration Officer Mini Vidhan Soudha, Chikkodi
3. Qualifications: Every person who is a citizen of India, and is ordinarily resident in the constituency and has, within the six years immediately before 1st November 67 Assistant Electoral Dr Mohan Basme Tahsildar Nippani Tahsildar Office, 7411808027 Nippani Taluka
2021, been engaged for a total period of at least three years in teaching in any of the educational institutions, within the State specified to be not lower in standard Registration Officer Guest house, Nippani
than that of a Secondary School is eligible to be included in the electoral roll. The list of Educational Institutions so specified is available with the officers mentioned 68 Assistant Electoral Riyazuddin Bagwan Tahsildar Raibag Tahsildar Office 9902030999 Raibag Taluka
in the First Schedule. Registration Officer Mini Vidhan Soudha, Raibag
4. Every application in Form 19 by a person seeking enrolment in Teachers’ Constituency shall be accompanied by a certificate from the Head of the Educational 69 Assistant Electoral Dundappa Komar Tahsildar Athani Tahsildar Office 9845887257 Athani Taluka
Institution certifying the engagement of the person concerned as a teacher for a total period of three years within the last preceding six years. The format for the Registration Officer Mini Vidhan Soudha, Athani
certificate will be as follows:-
70 Assistant Electoral R R Burli Tahsildar Kagwad Tahsildar Office Miraj Road, Kagwad 9448693698 Kagwad Taluka
‘CERTIFICATE’” Registration Officer
5. This is to certify that Shri/Smt./Kum. _______________________________ has been teaching in _____________ (name of the institution) for a total period of three 71 Designated Officer V Mohan Tahsildar Grade-2, Belagavi Tahsildar Office Old Corporation 9448635353 Belagavi Taluka
years within the last preceding six years as shown below against a post on regular / ad-hoc / contract* basis with specified scale of pay of Rs. ............... / Building, Risaldar Galli, Belagavi
Consolidated pay.
72 Designated Officer Kiran Belavi Tahsildar Grade-2, Hukkeri Tahsildar Office 9900236392 Hukkeri Taluka
1. (a) *As per the records of the Institution , He / She has been engaged in this institution continuously from _____(date) to _____(date), without any break. Mini Vidhan Soudha, Hukkeri
OR 73 Designated Officer K Y Bidari Tahsildar Grade-2 , Khanapur Tahsildar Office 9448248534 Khanapur Taluka
(b) *As per the records of the Institution, He/She has been engaged in this institution for the following periods of service:- From ______ to ______ Mini Vidhan Soudha, Khanapur
From ______ to ______From ______ to ______ 74 Designated Officer M A Choudhari Tahsildar Grade-2, Bailhongal Tahsildar Office, Murgod Road 9986801506 Bailhongal Taluka
2. The dates of commencement of service and retirement of the teacher: (a) The dates of commencement of service; (b) The date of retirement. Bailhongal
(Signature, Name & Seal of the Head of Institution) 75 Designated Officer M V Gundappagol Tahsildar Grade-2, Saundatti Tahsildar Office 9448875175 Saundatti Taluka
(** Strike out whichever is not applicable) Mini Vidhan Soudha, Saundatti
6. In the case of a person who is not engaged in teaching on the date of application, the Certificate should be signed by the Head of the Institution, in which he last 76 Designated Officer Rukmini Tukaram Tahsildar Grade-2, Ramdurg Tahsildar Office 9880250234 Ramdurg Taluka
served. Mini Vidhan Soudha, Ramdurg
7. Applications in bulk whether submitted in person or by post, shall not be considered for inclusion by the ERO. However, the Head of the Institutions may forward 77 Designated Officer Ravindra Nesargi Tahsildar Grade-2, Kittur Tahsildar Office, Old Govt Hospital, 9448859226 Kittur Taluka
the applications of all his staff together. One member of a family may also submit the Form 19 of other members of the same family and may get the certificate Somawar Peth, Kittur
verified by producing original certificates in respect of each member. 78 Designated Officer L H Bhoovi Tahsildar Grade-2, Gokak Tahsildar Office 8088607181 Gokak Taluka
8 It should be noted that any person who makes a Statement or declaration in the application which is false and which he either knows or believes to be false, or does Mini Vidhan Soudha, Gokak
not believe to be true will be punishable under Section 31 of the Representation of People Act, 1950. 79 Designated Officer S A Babali Tahsildar Grade-2, Mudalagi Tahsildar Office, V.B.S School 9008227763 Mudalagi Taluka
9. Printed applications of Form 19 may be obtained from the Offices of ERO/ AERO/ Designated Officers or Manuscript, typewritten, cyclostyled or privately printed Compound Mudalagi
forms will also be accepted. 80 Designated Officer C A Patil Shirastedar Tahsildar Office 8310078340 Chikkodi Taluka
FIRST SCHEDULE Mini Vidhan Soudha, Chikkodi
81 Designated Officer Praveen Karande Tahsildar Grade-2, Nippani Tahsildar Office, 7337616387 Nippani Taluka
Name of Constituency: Karnataka North-West Teachers’ Constituency Guest house, Nippani
Extent: Bijapur, Bagalkot and Belgaum Districts. 82 Designated Officer P M Kalloli Tahsildar Grade-2, Raibag Tahsildar Office 9740039777 Raibag Taluka
Sl. Particulars of Name Designation Office Address Contact Telephone / Extent of Jurisdiction Mini Vidhan Soudha, Raibag
No. Election Officers Smt./Sri Mobile Numbers 83 Designated Officer M V Biradarpatil Shirastedar Tahsildar Office 9449558582 Athani Taluka
1 Electoral Registration Amlan Aditya Biswas Regional Commissioner Regional Commissioner office 0831-2404007, Bijapur, Bagalkot Mini Vidhan Soudha, Athani
Officer Belagavi 9483961000 Belgaum 84 Designated Officer S D Asode Tahsildar Grade-2, Kagwad Tahsildar Office Miraj Road, Kagwad 9901733343 Kagwad Taluka
Fax 0831-2404008
85 Designated Officer H B Peerjade Assistant Council City Corporation Office, Belagavi 9035522897 City Corporation
Bijapur District
Secretary CCB Belagavi Belagavi Area Ward
2 Assistant Electoral P. Sunilkumar, IAS District Election Officer and Office of District Election officer and 08352-250021, Vijayapura District
No 01 to 58
Registration Officer District Magistrate Vijayapura District Magistrate Vijayapura, 9448140021
Darbar Hall, Vijayapura FIRST SCHEDULE
3 Assistant Electoral Balaram Lamani, Assistant Commissioner Office of Assistant commissioner 08352-2295286, Vijayapura Name of Constituency : Karnataka West Teachers’ Constituency
Registration Officer KAS Vijayapura, Vijayapura Division Vijayapura, 9449199140 Sub Division
4 Assistant Electoral Rahul Shindhe, IAS Assistant Commissioner Indi, Office of Assistant Commissioner 08359-225003, Indi Sub Division Extent: Dharwad, Haveri, Gadag and Uttara Kannada Districts
Registration Officer Indi Division Indi 7483511799 Sl. Particulars of Name Designation Office Address Contact Telephone / Extent of Jurisdiction
5 Assistant Electoral Siddaray Bhosagi Tahsildar Grade-1, Vijayapura Tahsildar office, Vijayapura 08352-278707, Vijayapura taluk No. Election Officers Smt./Sri Mobile Numbers
Registration Officer 9945310918 1 Electoral Registration Amlan Aditya Regional Commissioner Regional Commissioner office 0831-2404007, Dharwad, Haveri,
6 Assistant Electoral Santosh Myageri Tahsildar Grade-1, Tikota Tahsildar office, Tikota 8050069316 Tikota taluk Officer Biswas Belagavi 9483961000 Gadag,
Registration Officer Fax 0831-2404008 Uttara Kannada
7 Assistant Electoral M S Arakeri Tahsildar Grade-1, Babaleshwar Tahsildar office, Babaleshwar 9538385106 Babaleshwar taluk Dharwad District
Registration Officer
2 Assistant Electoral Nitesh K Patil, IAS Deputy Commissioner Deputy Commissioner Office 0836-2233888 Dharwad District
8 Assistant Electoral M N Baligar Tahsildar Grade-1, Tahsildar office, 08358-245226, Basavan Bagewadi
Registration Officer Dharwad Dharwad 8867025124
Registration Officer Basavan Bagewadi Basavan Bagewadi 9482502884 taluk
3 Assistant Electoral Dr Gopalakrishna B, Assistant Commissioner, Assistant Commissioner Office, 7018897824 Dharwad Sub-Division
9 Assistant Electoral Satish Kudalagi Tahsildar Grade-1, Nidagundi Tahsildar office, Nidagundi 8970766642 Nidagundi taluk
Registration Officer Registration Officer IAS Dharwad Sub-Div. Dharwad Dharwad 0836-2233860 (Except Hubli-
Dharwad Corporation)
10 Assistant Electoral S D Mural Tahsildar Grade-1, Kolhar Tahsiladar office, Kolhar 9845248555 Kolhar taluk
Registration Officer 4 Assistant Electoral Dr Suresh Itnal B, Commissioner, Hubli- Dharwad Hubli-Dharwad Mahanagara 9482610537 Hubli-Dharwad
11 Assistant Electoral B S Kadakabhavi Tahsildar Grade-1, Muddebihal Tahsiladar office, Muddebihal 08356-220227, Muddebihal taluk Registration Officer IAS Mahanagara Palike, Hubli Palike Office, Hubli 0836-2213833 Mahanagr Palike Area
Registration Officer 9902748240 0836-2213860
12 Assistant Electoral Anil Dhavalagi Tahsildar Grade-1, Talikoti Tahsildar office, Talikoti 9449560422 Talikoti taluk 5 Assistant Electoral Basavaraj F Ziddi Revenue Officer, Zone No 8, Hubli-Dharwad Mahanagara Palike 9342418260 72 Hubli Dharwad
Registration Officer Registration Officer Hubli-Dharwad Mahanagara Office, Hubli East
13 Assistant Electoral C S Kulakarni Tahsildar Grade-1, Indi Tahsildar office, Indi 08359-225020, Indi taluk Palike, Hubli
Registration Officer 9449832573 6 Assistant Electoral Prakash D Zonal Assistant Commissioner Hubli-Dharwad Mahanagara 9448267664 73 Hubli Dharwad
14 Assistant Electoral Suresh Chavlar Tahsildar Grade-1, Chadachan Tahsildar office, Chadachan 9449943022 Chadachan taluk Registration Officer Galemmanavar No-7, Hubli-Dharwad Palike Office, Hubli Central
Registration Officer Mahanagara Palike, Hubli
15 Assistant Electoral C A Gudadinni Tahsildar Grade-1, Tahsildar office 8123123194 Devar Hipparagi taluk 7 Assistant Electoral Umesh Savanur Office Assistant, Hubli-Dharwad Hubli-Dharwad Mahanagara Palike 9844271166 74 Hubli Dharwad
Registration Officer Devar Hipparagi Devar Hipparagi Registration Officer Mahanagara Palike, Dharwad Office, Dharwad West
16 Assistant Electoral Sanjeevkumar Tahsildar Grade-1, Sindagi Tahsildar office, Sindagi 08488-221235 Sindagi taluk
8 Assistant Electoral Yallappa Tahsildar Kalaghatagi Tahsildar Office, Kalaghatagi 9916565459 Kalaghatagi Taluk
Registration Officer Dasar 9972951095
Registration Officer Gonennanavar
17 Assistant Electoral Sanjeevkumar Tahsildar Grade-1, Tahsildar office, Alamel 9972951095 Alamel taluk
Registration Officer Dasar Alamel (incharge) 9 Assistant Electoral P M Nashi Tahsildar Hubli Tahsildar Office, Hubli 9448751210 Hubli Taluk
Registration Officer
18 Designated Officer Y H Narayanakar Tahsildar Grade-2, Vijayapura Tahsildar office, Vijayapura 9972073900 Vijayapura taluk
19 Designated Officer S H Arakeri Tahsildar Grade-2, Tikota Tahsildar office, Tikota 9036069684 Tikota taluk 10 Assistant Electoral Naveen Hullur Tahsildar Navalgund Tahsildar Office, Navalgund 9945862004 Navalgund Taluk
Registration Officer
20 Designated Officer S H Melligeri Tahsildar Grade-2, Babaleshwar Tahsildar office, Babaleshwar 7899893060 Babaleshwar taluk
21 Designated Officer P G Pawar Tahsildar Grade-2, Tahsildar office, Basavan Bagewadi 9449121641 Basavan Bagewadi 11 Assistant Electoral Ashok Shiggavi Tahsildar Kundgol Tahsildar Office, Kundgol 9448006853 Kundgol Taluk
Basavan Bagewadi taluk Registration Officer
22 Designated Officer S H Rathod Tahsildar Grade-2, Nidagundi Tahsildar office, Nidagundi 8660345294 Nidagundi taluk 12 Assistant Electoral Dr Santosh S Tahsildar, Dharwad Tahsildar Office, Dharwad 9980028572 Dharwad Taluk
23 Designated Officer H T Badami Election Shirastedar, Kolhar Tahsildar office, Kolhar 6361599100 Kolhar taluk Registration Officer Biradar
24 Designated Officer D G Kallimani Tahsildar Grade-2, Muddebihal Tahsildar office, Muddebihal 9731539306 Muddebihal taluk 13 Assistant Electoral Amaresh Pammar Tahsildar, Alnavar Tahsildar Office, Alnavar 959197182 Alnavar Taluk
25 Designated Officer A N Sharma Election Shirastedar Tahsildar office, Talikoti 9591237239 Talikoti taluk Registration Officer
26 Designated Officer R S Revadigar Tahsildar Grade-2, Indi Tahsildar office, Indi 9448783811 Indi taluk 14 Assistant Electoral Manjunath Amasi Tahsildar Annigeri Tahsildar Office, Annigeri 8310877356 Annigeri Taluk
27 Designated Officer S R Patil Tahsildar Grade-2, Chadachan Tahsildar office, Chadachan 9036901219 Chadachan taluk Registration Officer
28 Designated Officer I M Balaganur Election Shirastedar Tahsildar office, Devar Hipparagi 8296371591 Devar Hipparagi taluk 15 Assistant Electoral Shashidhar Madyal Tahsildar Hubli Nagara Tahsildar office, Hubli Nagara 9449289995 Hubli Nagar Taluk
29 Designated Officer Prakash sindagi Tahsildar Grade-2, Sindagi Tahsildar office, Sindagi 9945856274 Sindagi taluk Registration Officer
30 Designated Officer C B Babanagar Election Shirastedar (incharge) Tahsildar office, Alamel 9945945505 Alamel taluk 16 Designated Officer Suresh Adavi Shirastedar Tahsildar Office, Kalaghatagi 8884863339 Kalaghatagi Taluk
Bagalkot District 17 Designated Officer H A Kocharagi Tahsildar Grade-2, Hubli Tahsildar Office, Hubli 9844500562 Hubli Taluka
31 Assistant Electoral Captain. Deputy Commissioner District Complex, Bagalkot 08354-235091 Bagalkot District 18 Designated Officer M J Hokrani Tahsildar Grade-2, Navalgund Tahsildar Office, Navalgund 8971326486 Navalgund Taluk
Registration Officer Dr: K Rajendra 19 Designated Officer V A Mulgundmath Tahsildar Grade-2, Kundgol Tahsildar Office, Kundgol 9448515659 Kundgol Taluka
32 Assistant Electoral Dr. Siddu Hullolli Assistant Commissioner, Assistasnt Commissioner Office 9731303048 Jamkhandi
20 Designated Officer S P Hebballi Tahsildar Grade-2, Dharwad Tahsildar Office, Dharwad 8073199654 Dharwad Taluk
Registration Officer Jamkhandi Sub Division Jamkhandi, Mini Vidhan Soudha Sub-Division
Jamakhandi-587301 21 Designated Officer V G Kadakol Tahsildar Grade-2 Hubli Nagara Tahsildar office, Hubli Nagara 9945346340 Hubli Nagar Taluk
33 Assistant Electoral M Gangappa Assistant Commissioner, Assistasnt Commissioner Office 9845457614 Bagalkot Sub-Division 22 Designated Officer A I Nadaf Shirastedar Hubli-Dharwad Mahanagara Palike, 9916185324 72 Hubli Dharwad
Registration Officer Bagalkot Sub Division Bagalkot, Mini Vidhan Soudha Hubli East
Bagalkot-587103 23 Designated Officer S S Khadri Shirastedar Hubli-Dharwad Mahanagara Palike, 9986776876 73 Hubli Dharwad
34 Assistant Electoral Gurusiddayya Tahsildar Bagalkot Tahsildar, Taluka office, 9731683910 Bagalkot Taluk Hubli Central
Registration Officer S Hiremath Bagalkot-587103 24 Designated Officer Vinayak Salunke Office Manager Hubli-Dharwad Mahanagara Palike, 9902281059 74 Hubli Dharwad
35 Assistant Electoral S.B.Badagi Tahsildar Mudhol Tahsildar, Taluka office, 8050979076 Mudhol Taluk Dharwad West
Registration Officer Mudhol-587313
25 Designated Officer S C Yalburgimath Shirastedar Tahsildar Office, Annigeri 7760387549 Annigeri Taluk
36 Assistant Electoral S.B.Ingale Tahsildar Rabkavi-Banahatti Tahsildar, Taluka office, 9900776009 Rabkavi-Banahatti
Registration Officer Rabkavi-Banahatti Taluk 26 Designated Officer M G Pattar Shirastedar Tahsildar Office, Alnavar 9902720082 Alnavar Taluk
37 Assistant Electoral P S Chanagond Tahsildar Jamkhandi Tahsildar, Taluka office, 9482896370 Jamkhandi Taluk Haveri District
Registration Officer Jamkhandi-587301 27 Assistant Electoral S.B.Shettennavar, Deputy Commissioner Haveri Deputy Commissioner Office 08375-249044 Haveri District
38 Assistant Electoral Shankar Goudi Tahsildar Bilagi Tahsildar, Taluka office, 9164874231 Bilagi Taluk Registration Officer IAS Haveri 9448484413
Registration Officer Bilagi-587116 28 Assistant Electoral Shivananad B Assistant Commissioner, Assistant Commissioner Office, 08375-232468 Haveri Sub-Division
39 Assistant Electoral S.S.Ingale Tahsildar Badami Tahsildar, Taluka office, 9901505090 Badami Taluk Registration Officer Ullagaddi Haveri Sub-Division, Haveri Haveri 7899004174 Haveri
Registration Officer Badami-587201 29 Assistant Electoral Annapuarana Assistant Commissioner, Assistant Commissioner Office, 08378-241646 Savanur Sub-Division,
40 Assistant Electoral Basalingappa Tahsildar Hungund Tahsildar, Taluka office, 9945103885 Hungund Taluk Registration Officer Mudakkammanavar Savanur Sub-Division, Savanur Savanur 8147998913 Savanur.
Registration Officer Nayakodi Hungund-587118
30 Assistant Electoral Girish M Swadi Tahsildar Haveri Tahsildar Office, Haveri 9844090555 Haveri Taluk
41 Assistant Electoral Basalingappa Tahsildar Ilkal Tahsildar, Taluka office, Ilkal 9945103885 Ilkal Taluk
Registration Officer 08375-232445
Registration Officer Nayakodi
31 Assistant Electoral R N Koravar Tahsildar Byadgi Tahsildar Office, Byadgi 9606658411 Byadgi Taluk
42 Assistant Electoral G .M.Kulkarni Tahsildar Guledagudda Tahsildar, Taluka office, 8971702189 Guledagudda Taluk
Registration Officer Guledagudda Registration Officer 08375-228428
43 Designated Officer S.S. Ramadurg Election Shirastedar Tahsildar, Taluka office, 9972706711 Bagalkot Taluk 32 Assistant Electoral G S Shankar Tahsildar Ranebennur Tahsildar Office, Ranebennur 8431280115 Ranebennur Taluk
Bagalkot-587103 Registration Officer 08373-266450
44 Designated Officer H Narasimhayya Tahsildar Grade-2, Mudhol Tahsildar, Taluka office, 6363597049 Mudhol Taluk 33 Assistant Electoral Ku. Uma. K Tahsildar Hirekerur Tahsildar Office, Hirekerur 9343760161 Hirekerur Taluk
Mudhol-587314 Registration Officer 08376-282231
45 Designated Officer S.B.Kambale Tahsildar Grade-2, Tahsildar, Taluka office, 9880545504 Rabkavi-Banahatti 34 Assistant Electoral Arunkumar Kargi Tahsildar, Rattihalli Tahsildar Office, Rattihalli 9986080809 Rattihalli Taluk
Rabkavi-Banahatti Rabkavi-Banahatti Taluk Registration Officer
46 Designated Officer G.Satishkumar Tahsildar Grade-2, Tahsildar, Taluka office, 7975567240 Jamkhandi Taluk 35 Assistant Electoral Anilkumar Tahsildar, Savanur Tahsildar Office, Savanur 9741416941 Savanur Taluk
Jamkhandi Jamkhandi-587302 Registration Officer 08378-241626
47 Designated Officer A R Kolhar Tahsildar Grade-2, Tahsildar, Taluka office, 9900863399 Bilagi Taluk 36 Assistant Electoral Manjunath Tahsildar Shiggaon Tahsildar Office, Shiggaon 9606522365 Shiggaon Taluk
Bilagi Bilagi-587116 Registration Officer Munohalli 08378-255044
48 Designated Officer S F Bommannavar Tahsildar Grade-2, Tahsildar, Taluka office, 8123394774 Badami Taluk
37 Assistant Electoral Yareswami Tahsildar Hanagal Tahsildar Office, Hanagal 9740626037 Hangal Taluk
Badami Badami-587202
Registration Officer 08379-262241
49 Designated Officer R S Hiremath Tahsildar Grade-2, Tahsildar, Taluka office, 9901105958 Hungund Taluk
Hungund Hungund-587119 38 Designated Officer P S Kumbar Tahsildar Grade-2, Haveri Tahsildar Office, Haveri 9731061522 Haveri Taluk
50 Designated Officer A Ratnamma Tahsildar Grade-2, Ilkal Tahsildar, Taluka office, Ilkal 7795210667 Ilkal Taluk 39 Designated Officer Gavisiddappa Tahsildar Grade-2, Byadagi Tahsildar Office, Byadagi 9886298208 Byadgi Taluk
51 Designated Officer Veeresh Y Badiger Tahsildar Tahsildar, Taluka office, 9449433211 Guledagudda Taluk Dyamannavar
Guledagudda Guledagudda 40 Designated Officer Shivanagoud Tahsildar Grade-2 Ranebennur Tahsildar Office, Ranebennur 9986998208 Ranebennur Taluk
Belgaum District siddanagoudar
52 Assistant Electoral M G Hiremath Deputy Commissioner, Deputy Commissioner Office 9480017222 Belagavi District 41 Designated Officer R N Shattar Tahsildar Grade-2 Hirekerur Tahsildar Office, Hirekerur 9964828898 Hirekerur Taluk
Registration Officer Belagavi Belagavi 42 Designated Officer M S Bennurmath Shirastedar Tahsildar Office, Rattihalli 8748850211 Rattihalli Taluk
53 Assistant Electoral Ukesh Kumar Assistant Commissioner Assitant Commissioner Office, 8147840880 Chikkodi Sub Division 43 Designated Officer Ganesh Savanur Tahsildar Grade-2 Savanur Tahsildar Office, Savanur 9535676886 Savanur Taluk
Registration Officer Chikkodi Sub Division Mini Vidhan Soudha Chikkodi
44 Designated Officer Basavaraj Shirastedar Tahsildar Office, Shiggaon 9449549986 Shiggaon Taluk
54 Assistant Electoral Rudresh Ghali Commissioner City City Corporation Office Belagavi 8277911530 City Corporation
Honkannavar
Registration Officer Corporation Belagavi Belagavi Area Ward
No 01 to 58 45 Designated Officer Basavaraj S Angadi Shirastedar Tahsildar Office, Hanagal 8073867072 Hangal Taluk
55 Assistant Electoral Shashidhar Bagali Assistant Commissioner Assitant Commissioner Office, 9448392149 Bailhongal Sub Gadag District
Registration Officer Bailhongal Sub Division Murgod Road, Bailhongal Division 46 Assistant Electoral M. Sundaresh Babu Deputy Commissioner, Gadag Office of the Deputy Commissioner, 6361186356 / Gadag District
56 Assistant Electoral Ravindra Assistant Commissioner Assistant Commissioner office, 9986047290 Belagavi Sub Division Registration Officer Gadag 08372-237300
Registration Officer Karalinganavar Belagavi Sub Division Court Compound, Belagavi 47 Assistant Electoral Rayappa Hunasagi Assistant Commissioner, Office of the Assistant 9481215001/ Gadag Sub Division
57 Assistant Electoral R K Kulkarni Tahsildar Belagavi Tahsildar Office, Old Corporation 9980894189 Belagavi Taluka Registration Officer Gadag Commissioner, Gadag 08372-238506
Registration Officer Building, Risaldar Galli, Belagavi 48 Assistant Electoral Ramesh Vatagal Commissioner, CMC, Office of the Commissioner, CMC, 9880611099/ Gadag-Betageri City
58 Assistant Electoral Doddappa Hugar Tahsildar Hukkeri Tahsildar Office 7022294555 Hukkeri Taluka Registration Officer Gadag-Betageri Gadag-Betageri 08372-259932 limit
Registration Officer Mini Vidhan Soudha, Hukkeri
49 Assistant Electoral Kishan Kalal Tahsildar, Gadag Office of the Tahsildar, Gadag 9686159542/ Gadag Taluka
59 Assistant Electoral Reshma Talikoti Tahsildar Khanapur Tahsildar Office 8095678645 Khanapur Taluka
Registration Officer 08372-278532
Registration Officer Mini Vidhan Soudha, Khanapur
50 Assistant Electoral J B Majjagi Tahsildar, Shirahatti Office of the Tahsildar, Shirahatti 9620972112/ Shirahatti Taluka
60 Assistant Electoral Basvaraj Nagaral Tahsildar Bailhongal Tahsildar Office, 9611646161 Bailhongal Taluka
Registration Officer 08487-242430
Registration Officer Murgod Road, Bailhongal
61 Assistant Electoral Prashant Patil Tahsildar Saundatti Tahsildar Office 9902851000 Saundatti Taluka 51 Assistant Electoral G B Jakkanagoudar Tahsildar, Ron Office of the Tahsildar, Ron 8970001517/ Ron Taluka
Registration Officer Mini Vidhan Soudha, Saundatti Registration Officer 08381-267239
62 Assistant Electoral Mallikarjun Tahsildar Ramdurg Tahsildar Office 8971117438 Ramdurg Taluka 52 Assistant Electoral A D Amaravadagi Tahsildar, Nargund Office of the Tahsildar, Nargund 9482268533/ Nargund Taluka
Registration Officer Hegganavar Mini Vidhan Soudha, Ramdurg Registration Officer 08377-245265
53 Assistant Electoral Ashappa Pujare Tahsildar, Mundargi Office of the Tahsildar, Mundargi9036675008/ Mundargi Taluka SECOND SCHEDULE
Registration Officer 08371-262237
54 Assistant Electoral Bhramaramba Tahsildar, Laxmeshwar Office of the Tahsildar, Laxmeshwar 9741625229/ Laxmeshwar Taluka FORM 19
Registration Officer Gubbishetti 08487-273273 Photo of the
(See rule 31)
55 Assistant Electoral R.D. Kengeri Tahsildar, Gajendragad Office of the Tahsildar, Gajendragad 9880655756/ Gajendragad Taluka Applicant
Registration Officer 08381-262131 Claim for inclusion of name in the electoral roll for a Teachers’ Constituency
56 Designated Officer P.C. Kalal Tahsildar Grade-2, Gadag Office of the Deputy Commissioner, 9986455696/ Gadag District To
Gadag 08372-237300 The Electoral Registration Officer,
57 Designated Officer Vijayalakshmi Tahsildar Grade-2, Gadag Office of the Assistant 9108239622/ Gadag Sub Division
Vastrad Commissioner, Gadag 08372-238506 ...................................................................(Teachers’) Constituency
58 Designated Officer D.S. Marigoudar Assistant Executive Engineer City Municipal Council Office, Gadag 9916457551/ Gadag-Betageri Sir,
08372-259932 City limit I request that my name be registered in the electoral roll for the .......................................................................................................................... (Teachers’) Constituency.
59 Designated Officer R.G.Balehosur Tahsildar Grade-2, Gadag Office of the Tahsildar, Gadag 9916546497/ Gadag Taluka The particulars are:-
08372- 250009
60 Designated Officer K. S. Mane Tahsildar Grade-2, Shirahatti Office of the Tahsildar, Shirahatti 9945121231/ Shirahatti Taluka Name (in full) ......................................................................................................................................Sex ...................................................................
08487-242100 Father’s/Mother’s/Husband’s name (in full) .........................................................................................................................................
61 Designated Officer S.C. Guler Shirastedar Office of the Tahsildar, Ron 8970758850/ Ron Taluka House Address (Place of ordinary residence) ...........................................................................................................................
08381- 267006
House No. ................................................................................................................................................................................
62 Designated Officer S.H. Bhajantri Tahsildar Grade-2, Nargund Office of the Tahsildar, Nargund 7899972947/ Nargund Taluka
08377-241343 Street/Mohalla ..........................................................................................................................................................................
63 Designated Officer K. Radha Tahsildar Grade-2, Mundargi Office of the Tahsildar, Mundargi 7899295105/ Mundargi Taluka Town/Village .............................................................................................................................................................................
08371- 262235
Post Office ................................................................................................................................................................................
64 Designated Officer Manjunath Shirastedar Office of the Tahsildar, 9448337063/ Laxmeshwar Taluka
Dasappanavar Laxmeshwar 08487-273273 Police Station/Tahsil/Taluka/Moiza ..........................................................................................................................................
65 Designated Officer C.R. Shivakumar Tahsildar Grade-2, Office of the Tahsildar, Gajendragad 9620657641/ Gajendragad Taluka District ......................................................................................................................................................................................
Gajendragad 08381-262131 Age ...........................................................................................................................................................................................
Uttara Kannada District
Whether registered as on elector for any assembly constituency ...............................................................................................
66 Assistant Electoral Mullai Muhilan M P Deputy Commissioner Mini Vidhan Soudha 9481127766 Uttar Kannada District
If yes, then mention the following :-
Registration Officer Uttar Kannada Uttar Kannada Karwar
67 Assistant Electoral Vidyashree Assistant Commissioner AC Office, Karwar 7829254231 Karwar Sub-Division a) Number and name of the assembly constituency .............……………………… b) Part / polling station No. (If known) .............………………………
Registration Officer Chandargi Karwar Sub Division c) Date of birth .............……………………… d) EPIC Number (if any) .............………………………
68 Assistant Electoral Rahul R Pande Assistant Commissioner A C Office, Kumta 9910155424 Kumta Sub-Division Contact Number - (i) Mobile .............……………………… (ii) Land line .............……………………… E-mail ID (if any) .............………………………
Registration Officer Kumta Sub Division
2. During the last six years I have been engaged in teaching for a total period of more than three years as follows:
69 Assistant Electoral Mamatadevi G S Assistant Commissioner A C Office, Bhatkal 8123338589 Bhatkal Sub-Division
Registration Officer Bhatkal Sub Division Name of Educational Institution From (Date) To (Date) Period
70 Assistant Electoral Akruti Bansal Assistant Commissioner A C Office, Sirsi 6398052697 Sirsi Sub-Division 1)
Registration Officer Sirsi Sub Division
2)
71 Assistant Electoral Praveen C Tahsildar Haliyal Tahsildar Office, Haliyal 9845613247 Haliyal Taluka
Registration Officer Huchannanavar 3)
72 Assistant Electoral Shailesh Parmanand Tahsildar Dandeli Tahsildar Office, Dandeli 9481050536 Dandeli Taluka 4)
Registration Officer In support of the above, I submit herewith ---------------------------------------------------------------------------------------------
73 Assistant Electoral S M Kamble Tahsildar Joida Tahsildar Office, Joida 9480246917 Joida Taluka
3. *My name has not been included in the electoral roll for this or any other Teachers’ Constituency.
Registration Officer
74 Assistant Electoral N F Narohna Tahsildar Karwar Tahsildar Office, Karwar 9740099576 Karwar Taluka OR
Registration Officer * My name has been included in the electoral roll for the ----------------------------------------------------------------------------------------------------------------------- Teachers’
75 Assistant Electoral Uday Kumbar Tahasihildar Ankola Tahsildar Office, Ankola 9448325166 Ankola Taluka Constituency under the address given below and I request that it be deleted from that roll : ---------------------------------
Registration Officer
4. I declare that I am citizen of India and that all the particulars given above are true to the best of my knowledge and belief.
76 Assistant Electoral Vivek Shenvi Tahsildar Kumta Tahsildar Office, Kumta 8050429183 Kumta Taluka
Registration Officer
77 Assistant Electoral Nagaraj Naykad Tahsildar Honnavar Tahsildar Office, Honnavar 9449454147 Honnavar Taluka Place : ------------------------- Date : --------------------------- (Signature of Claimant)
Registration Officer NOTE : Any person who makes a statement or declaration which is false and which the either Knows or believes to be false or does not believe to be true is
78 Assistant Electoral Ravichandran S Tahsildar Bhatkal Tahsildar Office, Bhatkal 7349453154 Bhatkal Taluka punishable under section 31 of the Representation of the People Act, 1950.
Registration Officer
* Strike out the paragraph not applicable.
79 Assistant Electoral Madhusudan Kulkarni Tahsildar Sirsi Tahsildar Office, Sirsi 9986835589 Sirsi Taluka
Registration Officer ---------------------------------------------------------------------------------------------(Perforation) ------------------------------------------------
80 Assistant Electoral Prasaad S A Tahsildar Siddapur Tahsildar Office, Siddapur 9113535365 Siddapur Taluka INTIMATION OF ACTION TAKEN
Registration Officer
The application in Form 19 of Shri / Shrimati / Kumari ----------------------------------- Address -------------------------------------------------------------------- has been-
81 Assistant Electoral S. N. Kamkar Tahsildar Yellapur Tahsildar Office, Yellapur 9901140551 Yellapur Taluka
Registration Officer (a) Accepted and the name of Shri /Shrimati / Kumari --------------------------------------------------------------------------has been registered at Serial No. ------------------------
82 Assistant Electoral Shridhaar Tahsildar Mundagod Tahsildar Office, Mundagod 8800149169 Mundagod Taluka ---------------------------------- in part No ----------------------------------------------------------
Registration Officer Mundalamane (b) Rejected for the reason ----------------------------------------------------------
83 Designated Officer Ratnakar K Tahsildar Grade-2, Haliyal Tahsildar Office, Haliyal 9449897358 Haliyal Taluka Electoral Registration Officer
84 Designated Officer Gopi Chawan Election Shirastedar Dandeli(IN) Tahsildar Office, Dandeli 7022892289 Dandeli Taluka (Address)---------------------------------------------------------------------------
85 Designated Officer Sanjeev Bajantri Election Shirastedar, Joida Tahsildar Office, Joida 9743581933 Joida Taluka Date --------------------------------------------------- ----------------------------------------------------------------------------------------
86 Designated Officer Shridevi Bhat Tahsildar Grade-2, Karwar Tahsildar Office, Karwar 9448391114 Karwar Taluka -------------------------------------------------------------------------------------------- (Perforation) --------------------------------------------------------------------------------------------
87 Designated Officer Amar Naik Election Shirastedar Tahsildar Office, Ankola 7019286082 Ankola Taluka
Receipt for application
88 Designated Officer Satish Gouda Tahsildar Grade-2, Kumta Tahsildar Office, Kumta 9008492003 Kumta Taluka
Received the application in Form 19 from Shri/Shrimati/Kumari* ---------------------------------------------------------------------------------------------------------------------------------
89 Designated Officer B R Naik Election Shirastedar Tahsildar Office, Honnavar 9480508691 Honnavar Taluka
Address * -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
90 Designated Officer Vijayalaxmi Mani Election Shirastedar Tahsildar Office, Bhatkal 7019711723 Bhatkal Taluka
91 Designated Officer Ramesh Hegde Tahsildar Grade-2, Sirsi Tahsildar Office, Sirsi 9449176409 Sirsi Taluka Electoral Registration Officer
92 Designated Officer Usha G Pawaskar Tahsildar Grade-2, Siddapur Tahsildar Office, Siddapur 9008124768 Siddapur Taluka (Address) --------------------------------------------------------------------------
93 Designated Officer C G Naik Tahsildar Grade-2, Yellapur Tahsildar Office, Yellapur 9900429717 Yellapur Taluka Date --------------------------------------------------- ---------------------------------------------------------------------------------------
94 Designated Officer G B Bhat Shirastedar Tahsildar Office, Mundagod 9448685752 Mundagod Taluka * To be filled in by the applicant.