registrationForm

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Note: Fields marked with asterisks ( * ) are mandatory

Type 6
[See rule 13(1) and 26]

Application for inclusion of name in the electoral roll for the first time due to the transfer of voter or any other constituency from any one constituency

In service

Electoral Registration Officer,

State ^* District

Legislative Assembly / Parlimentary
constituency^*

I request that my name be included in electoral rolls for all the aforesaid areas.

First time voter
Due to transfer from other meeting areas.

Below are specifications in support of my claim to be included in the electoral rolls.

Mandatory specifications

(A) Name^*

(B) Surname (if any)^*

(C) Name of the applicant's relative ^*

Nickname of the applicant's relative^*

(D) Type of the relationship^*

(E) Age [on January 1 of the current calender]^*

(F) Date of birth (in the form of day/ month/ year)
(if known)^*

(G) Applicant's gender^*

(H) Current address, whose applicant is nominally resident

House no. ^*

Street / area / location ^*

City / Village: ^*

Post Office: ^*

Pin Code ^*

State / Union Territory ^*

District ^*

Family / Neighbour Epic No.

Optional specialties

(T) Disability (if any)

Visual impairment Speech and hearing impairment Motion disabling other

(Th) Email ID (optional)

(D) mobile number (optional) +91

Upload supporting documents (Supported formats .jpg, .png, .bmp, .jpeg) (max. 2MB) List of supported documents

Your photo^*

Age proof^*
Document type^*
Adress proof^*
Document type^*

Declaration

I declare I declare that according to my best knowledge and belief
I am a citizen of India and of my birth;
City / Village:

Select state ^* District ^*

Date ^*
(ii) I am a nominally resident in the address given in the above (date, month, year) above;

I have not applied to include my name in the electoral roll for any other constituency;

(iv) My name has not been already included in the electoral roll for this or any other assembly / parliamentary constituency

My name would have been included in electoral rolls of the State's constituency, in which I was already residing in the address mentioned below, and if so, then I request that it be removed from that electoral roll. Go.

Location ^* date

I am afraid that the statement or declaration, which is false, to whom I know it or believe that it is false or I do not believe in being true, the People's Representation Act, 1950 (43 of 1950 ) Is punishable under section 31

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राष्ट्रीय मतदान सेवा डेमो पोर्टल

NATIONAL VOTERS' SERVICES DEMO PORTAL

Note: Fields marked with asterisks ( * ) are mandatory