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Handbook for Electoral Registration Officers - Election Commission ...

Handbook for Electoral Registration Officers - Election Commission ...

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ANNEXURE 4.8CHAPTER IV, PARA 64FORMAT FOR FURNISHING LIST OF SHIFTED ELECTORSNo. & Name of assembly constituency:<strong>Electoral</strong> Roll Part No.Sl.No. of entryin the electoralrollName of theelectorEPIC No., ifissuedPlace of shifting(with address ifknown)Source ofin<strong>for</strong>mationI hereby declare that the in<strong>for</strong>mation furnished by me is on the basis of proper verification of thepart of the electoral roll given to me and I am aware of the penal provisions of Section 31 of theRepresentation of the People Act, 1950 <strong>for</strong> making false declaration.Date:(full signature of BLA)Name in full:Name of the Party:164

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