4.
Request for marking as Person with Disability
1. Application for Shifting of Residence
I have shifted my residence and I request that my name may be deleted from the previous address and shifted to the current address mentioned
below. I request that a replacement EPIC may be issued to me due to change in my address. I hereby return my old EPIC.
Present Ordinary Residence(Full Address)
House/Building/Apartment No.
Form 8
Town/Village
(See rules 13(3) and (26))
PIN Code
ELECTION COMMISSION OF INDIA
District
Voter Application Form for Shifting of Residence/ Correction of Entries in Existing Electoral Roll/ Replacement of EPIC/ Marking of PWD
Street/Area/Locality/ Mohalla/Road
Post Office
Guidelines English
Tehsil/Taluqa/Mandal
State/UT
A. Select State, District & Assembly/Parliamentary Constituency
Self-attested copy of address proof either in the name of applicant or anyone of the parents/spouse/adult child, if already enrolled with as
elector at the same address
To, (Attach any one of the documents mentioned below ^):-
The Electoral Registration
1. Officer
Water/Electricity/Gas Bill for that address (atleast 1 year)
2.
State *
Aadhaar Card
Punjab 3.
Current passbook of Nationalized/Scheduled Bank/Post Office
4.
District Indian Passport
5.
SahibzadaRevenue
Ajit Singh Nagar
Department's Land Owning records including Kisan Bahi
6.
Registered Rent Lease Deed (In case of tenant)
No. & Name
7. of Assembly Constituency*
Registered Sale Deed(In case of own house)
112 Any Other:- (Pl. Specify)____________________________________ Dera Bassi
Or
No.2.& Application
Name of Parliamentary
for CorrectionConstituency@*
of Entries in Existing Electoral Roll
(@Only forPlease
Union Territories
correct mynot having details
following Legislative Assembly)
in Electoral Roll/EPIC:
(Maximum of 4 entries/particulars can be corrected)
(Put a tick  in appropriate box below.)
Copy of self-attested Documentary Proof in support of claim to be attached.
1.
Next
Name
2.
Gender
3.
B. Details DoB/Age
4.
Name of the Relation
applicantType
*
5.
Relation Name
RITU VERMA
6.
Address
EPIC NO *
7.
DFZ4841474
Mobile Number
8.
Photo
Aadhaar Details :-(Please tick the Appropriate box)
The correct particulars in the entry to be corrected are as under:-
Aadhaar Number
a.
I am not able to furnish my Aadhaar Number because I don't have Aadhaar Number.
9878668677
b.
Mobile Number
Self
N fD ti t f b l i tt h d
4.
Request Any
Father/ Mother/ for marking as Person
other relative with Disability
(If available)
Email Id
1. Application for Shifting of Residence
Self
I have shifted my residence and I request that my name may be deleted from the previous address and shifted to the current address mentioned
below. I request that a replacement EPIC may be issued to me due to change in my address. I hereby return my old EPIC.
Father/ Mother/ Any other relative (If available)
Present Ordinary Residence(Full Address)
House/Building/Apartment No.
Town/Village
Previous Next
PIN Code
District
Street/Area/Locality/ Mohalla/Road
Post Office
C. I Submit application for (Tick any one of the following)
Tehsil/Taluqa/Mandal
State/UT
Shifting of Residence
Self-attested
Correction of Entries copy of address proof either in the name of applicant or anyone of the parents/spouse/adult child, if already enrolled with as
in Existing
Electoralelector
Roll at the same address
(Attach any one of the documents mentioned below ^):-
Issue of Replacement
1. EPIC without
correction Water/Electricity/Gas Bill for that address (atleast 1 year)
2.
Request for marking
Aadhaar as Person with Disability
Card
3.
Current passbook of Nationalized/Scheduled Bank/Post Office
4.
Indian Passport
Application for Correction of Entries in Existing Electoral Roll
5.
Revenue Department's Land Owning records including Kisan Bahi
Please correct6.my following details in Electoral Roll/EPIC:
Registered Rent Lease Deed (In case of tenant)
(Maximum of 4 entries/particulars can be corrected)
7.
Registered
Copy of self-attested Sale Deed(In
Documentary case
Proof in of own house)
support of claim to be attached.
Any Other:- (Pl. Specify)____________________________________
Name
Gender
2. Application for Correction of Entries in Existing Electoral Roll
DoB/Age
Please correct my following details in Electoral Roll/EPIC:
Relation (Maximum
type of 4 entries/particulars can be corrected)
(Put a tick  in appropriate box below.)
English
भारत निर्वाचन आयोग Documentary Proof in support of claim to be attached.
Relative'sCopy
Nameof self-attested
ELECTION
1. COMMISSION OF INDIA
Name
Address
2.
Gender
undefined
Mobile Number
3.
DoB/Age
Photo 4.
Relation Type
5.
The correct particulars in the entry to be corrected are as under:-
Relation Name
6.
Mobile No. *Address
7.
+91 9878668677
Mobile Number
8.
Photo
Previous Next
The correct particulars in the entry to be corrected are as under:-
a.
9878668677
D. Declaration
b.
N fD ti t f b l i tt h d
4.
I HEREBY DECLARE
Requestthat
for to the best
marking asof my knowledge
Person and belief that I am a citizen of India and I am aware that making a statement or declaration which is
with Disability
false and which I know or believe to be false or do not believe to be true, is punishable under Section 31 of Representation of the People Act, 1950 (43 of
1950) with the imprisonment for a term which may extend to one year or with fine or with both.
1. Application for Shifting of Residence
Date * I have shifted my residence and I request that my name may be deleted from the previous address and shifted to the current address mentioned
below. I request that a replacement EPIC may be issued to me due to change in my address. I hereby return my old EPIC.
23 07 2025
Present Ordinary Residence(Full Address)
House/Building/Apartment No.
Place *
Town/Village
PIN Code
ZIRAKPUR
District
Street/Area/Locality/ Mohalla/Road
Post Office
Tehsil/Taluqa/Mandal Previous Next
State/UT
Self-attested copy of address proof either in the name of applicant or anyone of the parents/spouse/adult child, if already enrolled with as
Accessibility Instructions:-In
elector at the same addressthe light of provisions of Rights of Persons with Disabilities Act 2016 and Rights of Persons with
Disabilities Rules,
(Attach 2017,
any one of theindocuments
case of persons
mentionedwith
belowintellectual
^):- disability, autism, cerebral palsy and multiple disabilities etc., signature
or left hand 1.thumb impression of person with disability, or of signature or left hand thumb impression of his/her legal guardian will
be required.Water/Electricity/Gas Bill for that address (atleast 1 year)
^Submission2. of self-attested copy of mentioned documents will ensure speedy delivery of services.
Aadhaar Card
3.
Current passbook of Nationalized/Scheduled Bank/Post Office
E. Submission
4.
Indian Passport
5.
Revenue Department's Land Owning records including Kisan Bahi
6.
Registered Rent Lease Deed (In case of tenant)
7.
Registered Sale Deed(In case of own house)
Any Other:- (Pl. Specify)____________________________________
Captcha *
Enter Captcha Send OTP
OTP
2. Application for Correction of Entries in Existing will be sent
Electoral Roll to 9878668677
Please correct my following details in Electoral Roll/EPIC:
(Maximum of 4 entries/particulars can be corrected)
(Put
Preview and a tick
Submit  in
Save appropriate
Cancelbox below.)
Copy of self-attested Documentary Proof in support of claim to be attached.
1.
Name
2.
Gender
3.
DoB/Age
4.
Relation Type
5.
Relation Name
6.
Address
7.
Mobile Number
8.
Photo
The correct particulars in the entry to be corrected are as under:-
a.
9878668677
b.
N fD ti t f b l i tt h d
