Application For Correction To Particulars Entered In Electoral Roll
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6FORM 8
[See rule 13(1) and 26]
Application for correction to particulars entered in electoral roll
To
The Electoral Registration Officer,
SPACE FOR PASTING ONE
RECENT PASSPORT SIZE
£
/
PHOTOGRAPH
……………………………Assembly
Parliamentary Constituency.
(3.5 CM X 3.5 CM) SHOWING
FRONTAL VIEW OF FULL
FACE WITHIN THIS BOX
Sir,
I request that entry relating to myself appearing in the electoral roll the above Constituency is not
correct and it should be corrected. Correct particulars in support of my request are given below:
I. Applicant’s
Name
Surname (if any)
details
Part number of electoral roll:
Serial number in that part:
st
Age as on 1
January ………….#
Years:
Months:
Sex (male/female/others):
Date of birth, if known:
Day:
Month:
Year:
* Father’s/
Name
Surname (if any)
Mother’s/
Name
Husband’s
II. 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 Elector’s Photo Identity Card (if issued, in this or some other constituency)
Elector’s Photo Identity Card number:
Name of the Constituency:
IV. Details of entries to be corrected:
*My name / *Age/ *Father’s/Mother’s/Husband’s name/ *Sex/ *Address/ *Elector’s Photo Identity
Card Number may be corrected in terms of information provided in this Form above.
Place:
Date:
Signature or thumb impression of the applicant
Please give your mobile number ……………………………………………………………
E-mail I.D ……………………………………………………………………………………
Note- Any person who makes a statement or declaration which is false and which he either
knows or believes to be false or does not believe to be true, is punishable under section 31 of the
Representation of People Act, 1950 (43 of 1950).
£
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 alternative.
\PBXEONceopb_DocumentsDocument 2015Form_2015Forms Without Aadharcard option_01.10.2015Form-8 English.doc
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