G FORM-6 Acknoaledgement (seefules 121) nd 26) fhe Registration of ctr Rules, 860) tax ELECTION COMMISSION OF INDIA (Tobe tied ofc) Application Form for New Voters , ‘The Electoral Rejtation Ofer, No.8 Name of AsebyConstivency (Fi. 8 Nae of arena Consiency@ (€0ny or Union Terie not ang Legit Asem) | submit ppleation forincuson of my nari te elt No, No, Name Sharpton) 3] F ba Hal orth ove onsen (1a) Nae (nfl Languapeo Stat) Fratnanealnedby dee name %.r0 Sienane (fan) Sess (110) Name ish in BL0c LETTERS) Firstname foley Mae Name SIVA RAM ‘Suma (ay) DEVARUPPULA Dislame frame no file innit be tantra y ota (0a) Name and sumame nef lanquge of Sse) anyone ofthe relies: ater J] or Moher [)] or tushand [] v egal Guten incase of orphan Thr Gender om Wile o (2) Name and suare (neg in BLOC LETTER) fhe elie mentored above LATA DEVARUPPULA os tse5 0 aa (9) Mobie oof Se fava) CIEE] TT ic Me frat menedat tem No 2 SSM MeN ae eee LL ee (6 Ems ofS avaible) o frat mntonedattem Ne, 2 (6 Aaa Otis 7D: (6) ender wale 7) MME ‘THRO GENER im ((e)ome ofa adore) (b) sefatested copy of documetsupoting ge pot tached (Docu for Prot of Date of Birth (Ay one of hese) UE EN) 9) anyone ote folowing) 11] incest suey competent Lora Bayi uthontyReita of its & Deas af] PaNcard a] 2) saa Cad Lan 5.) Catia fase Xr Cas Xlissued by CBSE CSE Stat Educa icon Date of Bt ef) edn Passport LI i] (Ary her Dosurent forProofofDsteof Brth(fredocumertisavalbl) Speci)(We reser Orday Residence Fades) House/uldingApwrtmentNo, 2-76 276 Steevea/Localy, NARAYANAGIRL aPCrOKEDRB Tesauga Mandl DHARMASAGAR S206 Tonite NARAYANAGIRI POMC Post ice NARAYANAGIR PO aPenca 8 oF Ske)UT Telangana District Hanumakond Pincade 506142 (b) Seats copy of ais prot eter nthe nae of eppicat or en nef pares! spouses chi i aes eld as ctr at tesa adress (tach anyone of hen) (Docurent or poo of residence 1 ate letty/cas conection ler tatadess(teast 1 yee) a | pacaercat [| Curent passbook of Ntnaze/ScheedSak/PostOfce 4] tndanassprt Sani pes a nnn ekki a 6) pete esse eet) 71] _ Reiter see Deeincas of om house) ian one bocuent or Poof resdece (fn documents ealabe) Speci) (@jategry of sbi. any (Opto) Locomatie vin! [ Dest ayo sept) Peretage of dsabiiy "cerca atiached (Tk the ppopriat box) Yes | No ] (10)TR deta of my ay mere eat nuded nthe electoral at cuentas wth who cure reser asunder Nar o fay member LATA DEVARUPPULA Felatonship wih apliant Mother ser PICro, FMOISTISE DECLARATION: ‘HEREBY DECLARE that othe best of my knowledge anblel- (Dam citizen of nde and place of my births Ton Vilage NARAYANAGIRI Distt: Hanumakonda State(UT Telangana (amon resident tthe sess mentioned at Non Frm Since: 200-01 (i amapp}ig fonction nlc Rell othe rs time ae my rame tine nny Assembly Constuency/Parlaentry Consttuency. (ho) do possess ay of the documents of age poo. Therefore Ihave enclose: (Name he document in supporto age rool (Ske of tapi) (0) 1am aware tat making theabore statement or detain nln tots applestin whichis fle and wl now or bel to be aso o not eve tobe tu, purihsbe under ‘Section 3 of Represertatin of the People At, 19504 of 1980) th imprisnmert for aterm which may extend to one year wth fine cr ith both DATE 01-11-2008 PLACE:NARAYANAGIRI AccesibityInstuctons In theight of provisions of Rghs of Persons with isablties Act 2016 and Rights of Person wih Dsbltis Rules, 2017, incase of persons wthintlectal sail, ‘ats, cerebral pals and mute csbitis et, signature orf hand thm meesinof person with csbily, or sigratureo left and thumb impression of ise leg quran willbe required. ate: | nase ofa mare female applicant ame of Husband may preferably be mentioned 7 | Susin of el atested copy of ocarent wil encire speedy delver of series. 4 |Incasenone ofthe documents save el verfeatons must As for example, category Ike homeless nan zens who are terse elgleo become electors but dont possess ey documentary prot of ordinary sien, letra Registration fcr shal designate an fer fr eld veiestion. Aciomsipemet Rect Ackrowlegeent Number $2909806N0111251200010, pare ortt2008 ecive he appcatn in Fam 6 of SriSi/Ms SHIVA RAM DEVERUPPLLA 93 ovo ESE appent can fre Actnonledgeent Noto check the sats of epaton] “This Is @ computer geerted document and does not require signature **