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E-Registration (Form-6)

[See Rules 13(1) and 26]

Application for Inclusion of Name in Electoral Roll for First time Voter OR on Shifting from One Constituency to Another Constituency

To,
    The Electoral Registration Officer

         I request that my name be included in the electoral roll for the above Constituency. Particulars in support of my claim for inclusion in the electoral roll are given below:

                                    (OR)

Upload Supporting Document

Your Photograph*                                                                         Age Proof                                                                         Address Proof*

Note:
1. Recent Passport Size Photograph(3.5CM X 3.5CM) and Photo should be in jpg Format and Maximum Size of Image should be 100KB only.
2. Age Proof Document should be in jpg Format and Maximum Size of Image should be 100KB only.
3. Address Proof Document should be in jpg Format and Maximum Size of Image should be 100KB only.

Mandatory Particulars

(Or) 

(h) Current Address where Applicant is Ordinarily Resident

తహసీల్ / మండలం*

(i) Permanent Address of Applicant


Optional Particulars



 

Declaration

    I hereby declare that to the best of my knowledge and belief-

     (i)    I am a citizen of India and place of my birth is

         
                   
         
     (ii)   I am ordinarily resident at the address given at (h) above since (date,month,year)
     (iii)  I have not applied for the inclusion of my name in the electroal roll for any other consitituency.
        (iv)  My name has not already been included in the electoral roll for this or any other assembly constituency.
(OR)
    My name may have been included in the electoral roll for Constituency in State in which
      I was ordinarily resident earlier at the address mentioned below and if so, I request that the same may be deleted from that electoral roll.

       I am aware that making a statement or declaration which is false and which I know or believe to be false or do not believe to be true, is punishable under Section 31 of the Representation of the People Act, 1950 (43 of 1950).

 


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