FORM-6 (See Fules 13() and (26 ofthe Registration of ectors Rules, 1960) G ELECTION COMMISSION OF INDIA wy at Application Form for New Voters Ackwowiedgement No szors2oen2i0az41200016 be filed by ofice) ta The Electoral Registration Oficer, Nak Nameot ssi censttueny we Teg) NE Upc (Or No. Name Partamentary Consttuancy@ No, 1 Name: (Only for Union Territories not having Leatstative Assembly) — | ism plein ernest estar fr bev cont (ie) ne nf Langage ot Ste FistNane lonely Mile Name FRR sume) (oye) Namen ngs neLoox LETTERS Fist Nae flonedy ii Name BAL soar ta) ARMED ‘scam name nt fein go lle eneltetey sore “2)a) Named Sunare (ncfllangage ct Site) fay on oe ree reer or woe or uene on vite ow v Legal Saranin aetna Tider (aye nare and suman inEngishin LOCKLETERS feelin cbve SHAPRAL ARMED ap ae (@) Mable no of St (taal). felofols)el7)e2 else] L ° Le? | Le ‘Of relative mentioned at tem No. 2 L “| | (eal ot se aveabe) roarmedaitst22@gnelcom o (of reatve menvoned at temo, 2 — 55 --------5------ (6 aca Details ten hee Ie Te Ih Te : a a | | | | (@ender wae Feats THIRD GENDER YI LI L_J (n{aypateof ert (édrmenyys) 7] : I. 1 5 o | fa ee | (b) Se attested copy of documert supporting age prot attached (anyone the following) (@ Docume fr Proof of Date of aren’: (anyon ofthese) 1] _] ith certificate issued by Competent Local Body/Muricipel Authoriy Registrar of iths& Deaths af | Aschaer Card af] PAN Card {| Orving License ly) LI i= 5{ | Certificates of class x or class xi issued by CBSE/ICSE/ State EducationBoards, ft contain Date of Birth 6. indian Passport (Any otter Docurent for Proto Date of Birth (fe documertis avaiable (Speci).ie) Posen vay foncence PuNBaoa=s) Howsereuléing/Aparment No. 11 ‘SueevArea/Locelty, jin sohabKbaadl ke pichoe rarest adh rf TehsTauge/Mandal giwa TownWilage rohan eslony,see2 saweena tart ler 8612.41 Post fie ian magh fe at sete Rajsthon Distiet Udaipur PinCode 313002 () Seeatestd copy ct adeeseproot tar inta rare of aplant ran one of parani/epouse/aat (@ Docume for proof of residence i akeady evoled selector at the same adress (tech anyone of them) 1 otereecreny/Gaa conection ail forthat adresses yar) aL] Mtawcot al Curent passbook of Natonlzot/ Scheduled EankPost office 4 Indian Passport s{ | Reon psraers Lindow ae nese a Rogatered Ret Lee Deedincace often) 7) Reese sete of own aus) (ny oterDocurent ar rota rstéence-( no document avalible) spent) (@)eategory of iat ny (Optional Locomotive vout —{ Dest wv | oe ayer (ne een cara of debt [ pesteseomtramramenamtay vel] ve fy (lore cy animate teat uc nt tll tue ate wh om cede nd seedy meer ep wh pear tater EP DECLARATION: | WEREBY DECLARE that tthe best my knowledge an bbet- ) ama etize of nda and place of my bith > TowVilage sawn Disc uasipur ‘Site Raasthan (i) am ordinary resident a the atess mentioned a S.No, So) in Form since: 2024-02 (Lam applying for incuson in Beta Rol forthe ist ine and my name sot includ in any Assembly Constituency Parliamentary Constituency. (Gu) dot possess any ofthe documents of age prot. Theefre, Ihave enclosed: (Name of the document in supporto ge poof (Stik oft not applicable. (0) lam aware that making the above statement or declaration in elation to this application whichis false and whch know or believe fo be false or dot believe io be ues purishable under Secon 21 of Representation of the People Ac, 1950 (19 of 1950) wth imprisonment fra erm wich may extend oan yar with neo with oth DaTE:21-09-2026 PLACE SAWEENA Acessitlty instructions Inthe light of provisions of Rights of Persons with Disses Act 2016 and Rights of Parson wth Disbiltes Rules, 2017, incase of persons with intl sai, ats, cerebral palsy and multiple disables et, signature ret hand thumb impression of parson with isaiity,osgnatur or eft hand thumb impression of hse gal guaran wil be required tale [incase ofa maried female applicant name of usband may preferably be mentioned Submision of sel-attested copy of document wl ensure speedy delivery of eee, 7 incase none ofthe documents is avaiable fed vreation is must. As for example category ike homeless indian cizen who ae otervise elle to became elector but donot possess ay documentary proof of ernar residence, letra Reglovation Office shall designate an ofie fer f veriestion Actnauledgemect/Recint Acknowadgemant Number 209 S206N2108281200098 ware 2-00-2004 eczve the aplication in Form 6 of ShiVSrt Ms. bal ahmed FATE TS pplantcan eer the Ackoowledgerent Noto check the status of application) 1 This is 2 computer generated document and does not require signature ++