Form-6 - Application For Inclusion Of Name In Electoral Roll For First Time Voter Or On Shifting From One Constituency To Another Constituency
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1
2ELECTION COMMISSION OF INDIA
FORM-6
Acknowledgement No.____________
(To be filled by office)
(See Rules 13(1) and 26) of Registration of Electors Rule-1960
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, ………………..………………………………………...Assembly / Parliamentary Consitituency
I request that my name be included in the electoral roll for the above Constituency.
(Tick appropriate box)
SPACE FOR PASTING ONE
As a first time voter
or due to shifting from another constituency
RECENT PASSPORT SIZE
PHOTOGRAPH (3.5 CM X
Particulars in support of my claim for inclusion in the electoral roll are given below:-
3.5 CM) SHOWING
Mandatory Particulars
FRONTAL VIEW OF FULL
(a) Name
FACE WITHIN THIS BOX
(b) Surname(if any)
(c) Name and surname of Relative of
Applicant
[see item (d)]
(d) Type of Relation
Father
Mother
Husband
Wife
Other
(Tick appropriate box)
st
(e) Age [as on 1
January of current calendar year………………..]
Years
Months
(f) Date of Birth (in DD/MM/YYYY format)(if known)
(g) Gender of Applicant
Male
Female
Third Gender
(Tick appropriate box)
(h)Current address where applicant is ordinarily resident
House No.
Street/Area/Locality
Town/Village
Post Office
Pin Code
District
State/UT
(i)
House No.
Permanent address of applicant
Street/Area/Locality
Town/Village
Post Office
Pin Code
District
State/UT
(j)EPIC No. (if issued)
Optional Particulars
(k)
Visual impairment
Speech & hearing disability
Locomotor disability
Other
Disability (if any)
(Tick appropriate box)
(l)
Email id (optional)
(m)
Mobile No. (optional)
- I hereby declare that to the best of knowledge and belief –
DECLARATION
(i) I am a citizen of India and place of my birth is Village/Town…………………………..…….District………………………..……State…………………………………
(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 electoral roll for any other constituency.
*(iv)My name has not already been included in the electoral roll for this or any other assembly/ parliamentary 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.
* strike off the option not appropriate
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