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Handbook for Electoral Registration Officers - Election Commission ...

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ToANNEXURE 5.1aCHAPTER V, PARA 5FORM 6[See rules 13(1) and 26]Application <strong>for</strong> inclusion of name in electoral rollThe <strong>Electoral</strong> <strong>Registration</strong> Officer……………………Assembly/ Parliamentary £ Constituency.Sir,I request that my name be included in the electoral roll <strong>for</strong> the aboveConstituency. Particulars in support of my claim <strong>for</strong> inclusion in the electoralroll are given below:SPACE FOR PASTING ONERECENT PASSPORT SIZEPHOTOGRAPH(3.5 CM X 3.5 CM)SHOWING FRONTAL VIEW OFFULL FACE WITHIN THIS BOXI. Applicant’sdetailsNameSurname (if any)Age as on 1 st January ………….# Years: Months: Sex (male/female/others):Date of birth, if known: Day: Month: Year:Place ofbirth:Village/ Town:District:State:* Father’s/ NameSurname (if any)Mother’s/ NameHusband’sII. Particulars of place of present ordinary Residence (Full address)House/ Door number:Street/ Area/Locality/Mohalla/Road:Town/ Village:Post Office:Pin Code:Tehsil/ Taluka/Mandal/ Thana:District:III. Details of member(s) of applicant’s family already included in the current electoral roll of theConstituency:Name1.2.Relationshipwith applicantPart number of theroll of theConstituencySerial numberin that PartElector’s PhotoIdentity CardNumber£In case of Union territories having no Legislative Assembly and the State of Jammu &Kashmir.# Please give the year i.e. 2007, 2008, etc.* Strike out the inappropriate alternative165

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