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 s2orsa04n 3741200038, (obefiedyofce) ta The Electoral Registration Oficer, Nak Nameot ssi censttueny we Ta) Ne Uap (Or No. Name Partamentary Consttuancy@ No, 1 Name: (Only for Union Territories not having Leatstative Assembly) — | ism plein ernest estar fr bev cont (06) None (notslLanguageot Se FistNaneflonedy idle Name St ‘Surname (if any) BGR (oye) Namen ngs na.oon LETTERS Fist Nae lone Mit Name PUA snare ta) Lowa ‘scam name nt fiein go le eneletety 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 (a(t Name and suman ings LOCKLETERS cf elie mets above PRAKASH CHANDRA LOHAR one (@) Mable no of St (taal). llelolTetleToTe In Te] Le Le]? | Le ‘Of relative mentioned at tem No. 2 L “| | (Era oF Se Foes roarmedaitst22@gnelcom o (of reatve menvoned at temo, 2 — a5 --------5------ (6 aca Details tenn he Io ele In a | | | (cede wae Feats THIRD GENDER | iJ L_J (n{aypateof ert (édrmenyys) 2y7]/ ofr) / 2 fo fo [2 I Lou L I (b) Se attested copy of documert supporting age prot attached (anyone the following) (@ Docume fr Proof of Date of aren’: (anyon ofthese) 1] set coset sed by Copetnt Local Body Muri uborty Regist of Beth Deaths of] Aemaer cons a) Panu 4D | oting cence ea u Ld 3{] _centcats of class xox lass suey COSENCSEY Sate EucatorBoad it cota Date of ith ef] ten esspt (Any Otter Document for Prot of Date of Birth (ne documetis avaiable (Speci)ie) Posen vay foncence PuNBaoa=s) HowserBuling/Aparment No. pathrvnath mandi pase Tmt oe, ‘SueeUATe/Localty. roca ik bamaghl waa ghar arf Afar TehsTauge/Mandal giwa TownWilage dewalt Post fie ian magh fe at sete Rajsthon Distiet Udaipur PinCode 313001 () 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 une any tter (one desertion} orga | Aectetunswsratavsssptay wel | ve [ (47 deta of my aly member ateaty inde nthe electra ol atcurent adress wth whom curently recile r asunder Name offal member PRAKASH CHANDRA LOWAR Relationship wth aplcer: Husband Hier PI 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:18-09-2026 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 sctnauledgemeciieciat Acknowsdgement Number 20 Stoenv80s241200199 are 1-02-2008 Feczved the aplication in Frm 6of h/Smt Ms. uj har TST pplantcan eer the Ackoowledgerent Noto check the status of application) 1 This is 2 computer generated document and does not require signature ++