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ELECTION COMMISSION OF INDIA

FORM-6 Acknowledgement No.____________ (See Rules 13(1) and 26) of Registration of Electors Rule-1960 (To be filled by office)

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

SPACE FOR PASTING ONE

RECENT PASSPORT SIZE

PHOTOGRAPH (3.5 CM X

3.5 CM) SHOWING

FRONTAL VIEW OF FULL

FACE WITHIN THIS BOX

I request that my name be included in the electoral roll for the above Constituency. (Tick appropriate box)

As a first time voter or due to shifting from another constituency

Particulars in support of my claim for inclusion in the electoral roll are given below:-

Mandatory Particulars

(a) Name

(b) Surname(if any)

(c) Name and surname of Relative of

Applicant [see item (d)]

(d) Type of Relation (Tick appropriate box)

Father Mother Husband Wife Other

(e) Age [as on 1st January of current calendar year………………..]

Years Months

(f) Date of Birth (in DD/MM/YYYY format)(if known)

(g) Gender of Applicant (Tick appropriate box) Male Female Third Gender

(h)Current address where applicant is ordinarily resident House No.

Street/Area/Locality

Town/Village

Post Office Pin Code

District State/UT

(i) Permanent address of applicant House No.


Town/Village


District State/UT

(j)EPIC No. (if issued)

Optional Particulars

(k) Disability (if any) (Tick appropriate box)

Visual impairment Speech & hearing disability Locomotor disability Other

(l) Email id (optional)

(m) Mobile No. (optional)

DECLARATION - I hereby declare that to the best of knowledge and belief –

(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

Address of earlier place of ordinary residence (if applying due to shifting from another constituency)

House No. Street/Area/Locality

Town/Village


District State/UT

I am aware that making a statement or declaration which is false and which I know or believe to be false or do not believe to be true, is

punishable under Section 31 of the Representation of the People Act, 1950 (43 of 1950).

Place……………..........................

Date……………………………………….. Signature of Applicant……….……………………………………….. Remarks of Field Level Verifying Officer:

Details of action taken

(To be filled by Electoral Registration Officer of the constituency)

The application of Shri / Shrimati/ Kumari ……………………………………………………………………………………..for inclusion of name in the

electoral roll in Form 6 has been accepted/ rejected. Detailed reasons for acceptance [under or in pursuance of rule

18/20/26(4)] or rejection [under or in pursuance of rule 17/20/26(4)] are given below:

Place:

Date: Signature of ERO Seal of the ERO

Intimation of decision taken (to be filled by Electoral Registration Officer of the constituency and to be posted to the

applicant on the address as given by the applicant)

The application in Form 6 of Shri/Shrimati/Kumari…………………………………………………………………………………………………………….. Current address where applicant is ordinarily resident House No.


Town/Village


District State/UT

Has been (a) accepted and the name of Shri/Shrimati/Kumari…………………………………………………………………………………………………

Has been registered at Serial No………………….in Part No…………………….. of AC No…………………………………………………………………….

(b) rejected for the reason……………………………………………………………………………………………………………………………………………………….

Date: Electoral Registration Officer

Address….……………………………………………. Acknowledgement/Receipt

Acknowledgement Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ Date __ _ _ _ _ _ _ _ _ _ _ _ _

Received the application in form 6 of Shri / Smt. / Ms. ___________________ ______________________________________

[ Applicant can refer the Acknowledgement No. to check the status of application].

Name/Signature of ERO/AERO/BLO

Postage Stamp to

be affixed by the

Electoral

Registration

Authority at the

time of dispatch

)

4.

5.

6.

To be appended to Form-6

l.

GUIDELINES FOR FITIXNG UP THE APPLICATIONFORM-6

The application should be addressed to the Electoral Registration Officer of the constituency in which he seeks

regisfration. The name of the constituency should be mentioned in the blank space given for the purpose.

The applicant applying as a first time voter or due to shifting from another constituency, should tick the

appropriate box, given for the purpose and fi.ll the complete details in the DECLARATION portion,

otherwise, the application is liable to be rejected at the initial stage itself.

3. Fields for providing particulars in items (a) to (i) are mandatory and therefore complete information should

mandatorily be given against the appropriate item.

Item (a) and (b) : The exact name and spelling as it should appear in the electoral roll and Electors Photo

Identity Card (EPIC) should be furnished. The full name should be written in the first box and surname should

be written in the second box. In case the applicant does not have a surntlme, then box for surname should be

left blank. Caste should not be mentioned except where the caste name is used as part of the elector's name or

a surname. Appellations like Shri, Smt. Kumari, Khan, Begum, Pandit etc. should not be mentioned. The

Applicant may mention his name in English and official language of the State both, if possible.

Item (c) and (d) (Relation's Name): In case of an unmarried female applicant, name of Father / Mother is to

be mentioned. In case of a married female applicant, name of Husband should preferably be mentioned. Strike

out the inapplicable options in the column.

Item (e) and (l) (Age and Date of Birth): The age of the applicant should be 18 years or more on lst day ofJanuary of the year with reference to which the electoral roll is being revised. Fill up the Date of Birth infigures in the space provided in DDA4M/YYYY. If the age of the applicant is between 18 and 2l years, a

documentary proof of Date of Birth should be attached. A copy of any one of the following documents can be

attached as a proof of Date of Birth:-Birth certificate issued by a Municipal Authorities or district office of the

Registrar of Births & Deaths or Baptism certificate ; or Birth certificate from the school (Gola. / Recognized)

last attended by the applicant or any other recogrized educational institution; or ifa person is class 10 or more

pass, he should give a copy of the marksheet of class 10, if it contains date of birth as a proof of date of birth;

or Marksheet of class 8 if it contains date of birth; or Mmksheet of class 5 if it contains date of birth; or Indian

Passport; or PAN card; or Driving License; or Aadhar letter/Card issued by UIDALl. In case none of the above document is available, a declaration in prescribed format given in Annexure *

II (enclosed with the guidelines) made by either of the parents of the applicant (or by guru in case of an

elector in third gender category) can be given. In those cases where parental declaration is given as proof

of age, the applicant will have to be present himself for verification before Booth Level Officer /Assistant

Electoral Registration Officer / Electoral Registration Officer. Further, if none of the above documents is

available and neither ofthe parents is alive, the applicant can attach a certificate ofhis age given by a

sarpanch of the concerned Gram Panchayat or by a member of the concerned Municipal Corporation /Municipal Committee.

2. In cases where the applicant is more than2l years and physically appears to be so to Booth Level Officer

/Assistant Electoral Registration Officer i Electoral Registration Officer, declaration of age by him / her

will be taken as proof of age and no documentary proof will be insisted on. The age should be indicated

in years and completed months as on the qualifring date i.e. I st January, of the year with reference to

which electoral roll is being revised /or has been revised.

3. If the Applicant is applying for fresh registration for the /irst time qnd he is above 2 1 years of age on the

qualifirng dqte of the year and his name is not included in the electoral roll anywhere in India, then a

declaration has to be given in the format as per annexure III otherwise his application is liable to be

rejected.

Item (g) (Gender): Gender in the appropriate box provided for'Male' / 'Female'/'Third Gender' should

clearly be tick marked.

Item (h) (Place of Cunent Ordinary Residence): The Applicant should fill up the full and complete postal

address including PIN code where he is ordinarily residing qt present and wants to get registered, only in the

appropriate space prwidedfor the particular entry.

0 House No.: If the residence of the applicant does not have house number, in the space meunt for'House Number' it should be clearly mentioned thal'No House Number has been assigned'.

(ID A copy of any of the following documents should be attached as a proof of ordinary residence: -

8.

9.

Bank / Kisan / Post Office current Pass Book; or Ration Card; or Passport; or Driving License; or

Income Tax Assessment Order; or Latgst rent agreement; or Latest Water / Telephone I Electrtcity IGas Connection Bill for that address, either in the name of the applicant or that of his / her immediate

relation like parents etc.; or Any post l;.fetter / mail delivered through Indian Postal Deparrnent in the

applicant's name at the address ofordinary residence.

QII) Homeless Indian Citizens/Sex Worken Indian Citizens: - Homeless Indian Citizens living insheds/pavement dwellers and Sex Workers Indian Citizens, who do not possess any documentary

proofofordinary residence are eligiblefor enrolment in electorql roll, provided thqt are ordinarily

residing at the given address.

QV) Students: Students, if otherwise eligible, living in a hostel or mess or lodge more or less

continuously, going back to their normal home or place ofresidence onlyfor short periods, can be

held to be ordinarily resident in the place where the hostel or mess or lodge is situated. Such

students who want to enroll themselves at the hostel / mess will hqve to attach a bonaJide declmation

duly certified by the Headmaster / Principal / Director / Registrar / Dean of the educational

institutionwith Form 6 (as per the specimen os Annexure IV).

Photograph: A recent passport size Colour Photograph of specification (200 DPI resolution with 3.5c.m x3.5

c.m ) should be pasted in the space provided for this purpose in the Form. The Photograph will be used to print

applicant's image in the electoral roll and issue of EPIC.The photograph shall show a close-up of the

applicant's head and the top of the shoulders. The face shall take 75Yo of the vertical dimension of the picture.

The photograph shall be in sharp focus, of high quality with no creases and ink marks with appropriate

brightness and contrast and showing natural skin tones ofthe elector's face and features clearly recognisable. Itshall show the elector looking directly at the camera with a neutral expression and the mouth closed. Thephotograph shall be showing the elector with the eyes open and clearly visible with no hatlcaplhatlheadgearl

veiUcover/shadoilreflection etc. obscuring the eyes. If the elector wears glasses, the photograph must show

the eyes clearly with no lights reflected in the glasses. The glasses should not have tinted lenses and it shall be

ensured that the frames of the glasses do not cover any part of the eyes of the elector. The photograph must

have a plain, light coloured background and there must be no other people or object visible with the elector.

EPIC:

1. V[henever name of any Indian Citizen is included in the electoral rolls for the first time, new

EPIC will automatically be issued without any separate application and delivered to himfree ofcost, through speed post under proper acbtowledgement.

2. Replacement EPIC on shifting: If the Applicant has shifted his qddress and applying in Form6 or Form

8A on such shifting, EPIC No., if already issued to him in the earlier constituency/ address, it should be

mentioned at appropriate place.If he wants replacement EPIC with new address, he should apply for the

same in Form EPIC-O01 ((as per the format as Annexure V), with requisite fee for replacement EPIC,

and old EPIC, after enrolment at the new place on the basis of Form 6 or Form 8A.

Optional Particulars

Fields for providing details in item (k) to (m) are optional; however, it is in interest of the applicant to supply

information in these items to enable election authorities to extend citizen services like intimation about status

of process of application form, issue of EPIC sending information/notices to electors and providing necessary

assistance at polling station during elections.

Declaration

(1) All entries in "DECLARATION" portion must compulsorily be completed in all respects. Please indicate

date from which the Applicant is presently residing at the given address. If he is not able to recall the exact

date, the month and year from which he is residing at that place should be mentioned.Ifhis name is already

included in the electoral roll of any other constituency, name of earlier constituency should be mentioned.

Also, full particulars of his previous address should be provided, otherwise his application is liable to be

rejected at the initial stage itself.The options which are not relevant should clearly be struck off. Please

note that giving any false statement made in the DECLARATION portion is punishable ffince under

Section 3 I of the Representation of P eople Act, I 9 5A.

(2) Service personnel, applying for enrolment as general elector in the electoral roll at his place ofposting at a

peace station, has to submit a declaration (Annexure-I) along with Form-6.

10.

11.

12.

,.rr1.****d<,1*r(**r<*r<**r.**********i!i(*.***r<****,k{<**ir*r.**r.****,k**{<,r******

.'.,it,.,.y

ANNEXURE - I (For Form.6)

DECLARATION BY SERVICE PERSONNEL(TO BE ATTACHED WITH THE FORM-6)

For getting myself registered as general elector in the part of the electoral roll of my

place of posting, l, ............... ...........,...(NAME lN BLocK LETTERS) am

enclosing a certificate issued by Record Office/Commandant to the effect that I have been

posted at the peace station, namely, at ............... ..................(place) since

.(Date).

l, hereby, declare that I have neither got myself already registered as service elector in

the last part of electoral roll for any constituency nor have applied for such registration as

service elector in the last part of the electoral roll of any constituency.

l, further, declare that I am aware of the law that prohibits getting registered as an

elector at more than one place either in the same constituency or in different constituencies

and if my name so appears at different places, the same may be deleted from all such places

except from the present place for which Form 6 has been presented.

SIGNATURE OF THE SERVICE PERSONNEL

RANK..

Place

Date...

FORM OF OATH OR AFFIRMATION

(To be made by either of the parents/Guru of the first time applicantin the age group of 18-21years who has no age proof)

l, ........... whose

name is enrolled at the Serial No. ........ in the Part No. ........ of electoral roll of the

... Assembly Constituency

do swear in the name of the God / solemnly affirm that my son / daughter/chela

"; ;;;; ;^ ,"; ,;,,; *i ,,0, . ;,; ; ;;;;, ;;;;

is Years

PIace:

Date:

Signature of the parenUGuru

sworn in the name of God/solemnly affirmed by shri/shrimati

(Place) at (hour) this

at

the day of

20... before me.

Signature of Electoral Registration Officer /Assistant Electoral Registration Officer with Seal

ANNEXURE -ll (For Form-6)

'' ':l' t

ANNEXURE.III

(For Form-6)

DEGLARATION*(For an elector of 21+ age group seeking fresh registration for the first

time)

1,...... ......, Son/DaughterMife of ..... R/o

..., declare as under: -

I have applied for registration in the etectorar roll of .... constituency,as my name does not figure in electoral rollanywhere in lndia,

2. I have not been issued any EPIC at any time in the past in any constituency.

place: Signature of the ApplicantDate:

*(Making false declaration in matters related topreparation/revision of electorat roll is an offencepunishable under section 3i of the Representation of thePeople Act, 1951, and also under the provisions of thelndian Penat Code)

SPACE FOR PASTINGONE RECENT

PASSPORT SIZECOLOUR PHOTOGRAPH

(3.5 CM X 3.5 CM)SHOWING FRONTALVIEW OF FULL FACE

WITHIN THIS BOX

address of native place), hereby declare that :-.--

(a) I am a bonifide student of ...... ......( name ofthe institution) and pursuing .....(details of the course)from .(month).. ...(year)to..............(month) ......(year)

*(U) t am presently residing at -

residing in hostel/mess, mention Roomhostel/mess).

No./BlockNo./ BlockName, etc. of the

';l' "ANNEXURE IV(For Form-6)

DECLARATIONBY STUDENTS LIVING INHOSTELS/NIE S SES/ELSEWHERE

(TO BE ATTACHEDWTTTITORM 6)

I, ...... ..............(NAME IN BLOCK LETTERS),: son/daughter of

Place:

Date :

(if(i).

OR

OR

(ii) (if residingelsewheredft

".iri,-rtJtii'"vrJ! '|rrrlrv

postal address of the place of stay outside the hostel/mess).

(c) * I want.to be registered in the.electoral roll/retain my registration in the electoral roll ofmy natlve place at my above-mentioned residential addre5s wTth my parents/guardian.

*I want to be registered in the electoral roll of the constituency where I am presently residing .

[. I am 4ware that.registration in the eleqtoral roll of more than one constituencv or moreman.once.ln a constltue-ncy_lq netlermlttqd_lndgq the el_ection _law and am also atiarc of thepenal provisions of Sec. 3l i,f the R.P.Aci; I950;w[icf ieadi-ili'bl6wil'--

.','lf !ny, persln makes in clnnectiln with (o)^the preparotion, reyision or correction of an electoral roll, or (b)

llte inclusion or exclusion of any entry.in or froy'on.'electoral roll, a statement or declaration inwriting *lrici {s

fapg gnd which he either htowi or lelieves "to

be false or does not believe to be true, ni sltitt ti pini,isiii[ewith imprisonment lor a term which may exteid to one year, or with line, or with both.

It is certified that the information given in the declaration x (a) above and thephotograph have been verified from the records of the institution and aie found to be correct.

Place:

Date:

(signature of the student)

Signature and seal oftheHead Master/PrincinalR

,{}'

AIINEXURE V@or Form-6)-.,f,' .,{-'

Election Commission of India(ANNEXURE.VI

Application for lssue of Replacement Elector,s Photo ldentity Card (EptC)

FORM ID

ECI.EPIC-OOI

A Stflte/ UT :

ACr (No. & Name):

District:

B Elector's Particulars(To be filled by Elector)

To,

The Electoral Registration Officer,

Assembly/

Parliamentarys Constituency

Sir/Madam,

I request that a Duplicate Electoral Photo identity Card be issued to me as my original card is

get afresh card with my new address. I am retuning my EPIC to you along with fee for issue of duplicateEPIC My name is included in the electoral roll for the above constituency. Particulars in support of my claimfor issue of duplicate EPIC are given below:

1. Name of Elector: 2. EPIC No of

Original card ( if known) :.

3. Fathefs,/ Mother's/

Husband's* Name :

4. Sex (M/F): 5. Date of Birth (DOB) lf not

known then Age in Years)as on

1stJan,200_......

6. Address

(i) House / Door number:

(ii) Streeu Mohalla / Road/ Gali :

(iii)Area / Locality :

(iv) TownA/illage : (v) PIN CODE

(vi) Police Station : (vii) District:

(viil) Reasons for applying

for a Duplicate card

1. lwill collect EPIC from VRC/CSC

2. I wish to receive my EPIC by Post(self addressed and stamped envelope enclosed)

3. lwill collect EPIC from BLO.

)

Signature of the applicant

(X) Tick (r' )the appropriate box:

I hereby return my mutilated /old card.

I undertake to retum the earlier card issued to me if the same

[ecovered at a later date.

Date:

Place

tr For o/ficral Use

Authen icationfor Issue of EPIC (To be lilled by ERO's Repraentative)

Part

No. :

Serial No. of

Elector in Part:

lD number of Designated Photography

Location (DPL) or Common Seryice centers

(csE).:

#Token No. or

Receipt No.

Register No. Serial No. in Register

Verified by:

Date: _/_/200_ Signature

D Acknowledgement of R- EPIC by the Elector

Received Duplicate EPIC on (Date): Elector's Signature

or Thumb lmpression2O0-


FORM-7 Acknowledgement No.____________ (See Rules 13(2) and 26) of Registration of Electors Rule-1960 (To be filled by office)

Application for Objecting Inclusion of Name of Other Person / Seeking Deletion of

Own Name/Seeking Deletion of Any Other Person’s Name in Electoral Roll due to

Death/Shifting.

To, The Electoral Registration Officer, ………………..…………………………………………………………………...Assembly / Parliamentary Constituency

I hereby object to the proposed inclusion of the name of the under mentioned person in the electoral roll

I hereby request that entry relating to name of the person mentioned below is required to be deleted

I request that the entry relating to myself is to be deleted from Electoral Roll

Particulars in support of my objection/deletion are given below:-

Particulars of the applicant

(a) Name

(b) Surname(if any)

(c) Part No. (d) Serial No.

(e) EPIC No. (If issued)

Details of person inclusion of whose name is objected to/whose entry is to be deleted:

(a)Name

(b)Surname(if any)

(c) Part No. (d)Serial No.

(e)EPIC No.(If issued)

(f) Reason(s) for objection/deletion:

Declaration I hereby declare that the facts and particulars mentioned above are true to the best of my knowledge and belief. I

am aware that making a statement or declaration which is false and which I know or believe to be false or do not believe to

be true, is punishable under Section 31 of the Representation of the People Act, 1950 (43 of 1950).

Place……………........................

Date……………………………………. Signature of Applicant……….………………………………………..

Remarks of Field Level Verifying Officer:



The application of Shri / Shrimati/ Kumari ……………………………………………………………………………………..objecting to inclusion/

seeking deletion of name of Shri / Shrimati/ Kumari ………………………………………………………………………………... in the electoral roll in Form 7 has been acepted/rejected.

Detailed reasons for acceptance [under or in pursuance of rule 18/20/26(4)] or rejection [under or in pursuance of rule

17/20/26(4)] are given below:

Place:



applicant on the address available in the record)

The application in Form 7 of Shri/Shrimati/Kumari…………………………………………………………………………………………………………….. Current address where applicant is ordinarily resident

House No.


Town/Village


District State/UT

Has been (a) accepted and the name of Shri/Shrimati/Kumari......................................................................................has been

deleted from………………………………….. Part No.................................... of AC No…………………………….…………….



Address……………………………………………….

Acknowledgement/Receipt

Acknowledgement Number _ _ _ _ _ _ _ _ _ _ _ _ _ Date _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Received the application in form 7 of Shri / Smt. / Ms. ________________________________________________________ [

Applicant can refer the Acknowledgement No. to check the status of application].


Postage Stamp

to be affixed by

the Electoral

Registration

Authority at the

time of dispatch

.',lt ,.tTo be appended to Form-7

GTITDELINES FOR FILLING UP THE APPLICATIONFORM-7

How to Fill up Form-7

l. The application should be addressed to the Electoral Registration Officer of the constituencyin which another elector registered in that roll objects the proposed inclusion of an entry inthe draft electoral roll. The name of the constituency should be mentioned in the blank space.

2. Details of person inclusion of whose name is objeeted to / Details of person whose entryis to be deleted:

Out of the three options, the first option is relevant after draft publication of electoralroll during revision of electoral roll. In other words, to show the objected entry in the draftroll in the list of deletions at the time of final publication of the roll. The second option isrelevant during continuous updation after final publication of electoral roll. In other words,for deletion of an entry already included in the final electoral roll.(Please tick the appropriate alternative white fitling up the Form)

Besides the name of the person whose entry is objected for inclusion or sought to bedeleted, the other details of the electoral roll Part No., Serial No. of the entry in that Part ofelectoral roll and Identity Card No issued to that person (Items (a), (b), (c) and (d)) arealso required to be filled up. These details are available in the relevant part of electoral roll.The Part No. of the electoral roll is printed on the right hand top corner of the electoral roll.Every entry is given a serial number. Please check the electoral roll and write the serialnumber at which the name of the person whose enbry is objected for inclusion/sought to bedeleted is listed. In case the person has already been issued an Identity Card that No. is alsoprinted against that entry. Please write that card no. in full in the space provided.

Separate Application is required to be filed for each of the three alternatives forobjecting inclusion/seeking deletion of each entry. In other words, the only one alternative isallowed to be opted.

3. Details of objector

An "Objector" can file Application in Form 7 only in respect of persons included in the partof the electoral roll in which he/she is registered. The objector has to fill up in the space (item(a) , (b), (c) and (d) and (e)) provided his/her name including surname, part no. of electoralroll and serial number at which his/her name is registered in that part of the electoral roll.

4, Reason(s) for objection / deletion

The applicant 'objector' must specifu the reason(s) in item (0 as to why according to him/herthe person whose name is objected is not qualified for inclusion in that part of electoral rollviz. Due to death, due to shifting, not ordinarily residing at the registered address etc. Theonus of proof to substantiate the reason given for removal of the name lies with the Objector.

5. Declaration

In last part of the Application, the applicant must give a declaration that the facts andparticulars mentioned in the application are true to the best of his/her knowledge and belief.The date from which the applicant is residing at the given address should be clearlymentioned. Giving a false declaration is punishable under Section 3 1 of the Representation ofthe People Act, 1950.

*r<16***x***


FORM-8 Acknowledgement No.______________ (See Rules 13(1) and 26) of Registration of Electors Rule-1960 (To be filled by office)

Application for Correction to Particulars Entered in Electoral Roll

To, The Electoral Registration Officer,………………..……………………………………Assembly / Parliamentary Constituency SPACE FOR PASTING

ONE RECENT PASSPORT

SIZE PHOTOGRAPH (3.5

CM X 3.5 CM)

SHOWING FRONTAL

VIEW OF FULL FACE

WITHIN THIS BOX [if

correction in

photograph]

I request that entry relating to myself appearing in the electoral roll the above Constituency

is not correct and it should be corrected. (a) Name

(b) Surname(if any)

(c) Details of registration with electoral roll

Name of Assembly/ Parliamentary Constituency

Part No. of Electoral Roll Serial No. of Electoral Roll

(d) EPIC No. (if issued)

(e) Please tick the entry which is to be corrected

Name Photograph EPIC Address Date of Birth

Age Name of Relative Type of Relation Gender

The correct particulars in entry to be corrected are as below:-

(g) Email id (optional)

(h) Mobile No. (optional)

I am aware that making a statement or declaration which is false and which I know or believe to be false or do not believe to be true, is

punishable under Section 31 of the Representation of the People Act, 1950 (43 of 1950).

Place……………........................

Date……………………………………. Signature of Applicant……….………………………………………..




The application of Shri / Shrimati/ Kumari …………………………………………………………………………………………………………for correction of entry in the electoral roll in Form 8 has been accepted/rejected.

Detailed reasons for acceptance [under or in pursuance of rule 18/20/26(4)] or rejection [under or in pursuance of rule

17/20/26(4)] are given below:

Place:



applicant on the address as available in records/given by applicant)

The application in Form 8 of Shri/Shrimati/Kumari…………………………………………………………………………………………………………….. Current address where applicant is ordinarily residence

House No.


Town/Village


District State/UT

Has been (a) accepted and the entry at Sr. No……………….. .............................of Part No................................................... of AC

No…………………………………………….. has been modified accordingly



Address………………………………………………. Acknowledgement/Receipt

Acknowledgement Number _ _ _ _ _ _ _ _ _ _ _ _ __ _ Date _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Received the application in form 8 of Shri / Smt. / Ms. _______________________________________________________



Postage Stamp

to be affixed by

the Electoral

Registration

Authority at the

time of dispatch

',ir,'

.,)

GUIDELINES FOR FILLING UP TIIE APPLICATIONFORM-8

How to Fitl up Form-8

1. The application should be addressed to the Electoral Registration Officer of the constituency inwhich the name of the applicant is already included. The name of the constituency should bementioned in the blank space.

2. In Part I (Item (a) and (b) )of the Application, the applicant should write his name, as it shouldappear in the electoral roll. In case the initials to applicant's name printed in the electoral roll are

in abbreviated form and he wants them to be printed in expanded form he can write his full namein expanded form. The full name except the surname should be written in the first box andsurname should be written in the second box. In case the applicant does not have a surname, thegiven name only should be written. Caste should not be mentioned except where the caste nameis used as part of the elector's name or a surname. Honorific appellations like Shri, Smt. Kumari,Khan, Begum, Pandit etc. should not be mentioned.

3. Item (c): Please fill up the Part Number and serial number in that part of electoral roll where thename of the Applicant is listed. This is mandatory.

4, For correction in date of birth, documentary proof should be attached as under:

i) Birth certificate issued by a Municipal Authorities or district office of the Registrar of Bi(hs& Deaths or Baptism certificate; orii) Birth certificate from the school (Govt. / Recognised) last attended by the applicant or anyother recognised educational institution; oriii) If a person is class 10 or more pass, he should give a copy of the marksheet of class 10, ifit contains date of birth as a proof of date of birth; oriv) Marksheet of class 8 if it contains date of birth; orv) Marksheet of class 5 if it contains date of birth; orvi) A declaration in prescribed format given in Annexure-l (made available on demand byregiskation authorities) made by either of his parents if the person is not educated till class l0 (Inthose cases where parental declaration is given as proof of age, the applicant will have to bepresent himself for verification before BLO/AERO/ERO); orvii) A certificate of his age given by a sarpanch of the concerned Gram Panchayat or by amember of the concemed Municipal Corporation / Municipal Committee, in case the person isnot educated till class 1 0 and both the parents are not alive.viii) Indian Passport.

ix) PAN Card.

x) Driving License.

xi) Aadhar letter issued by UIDAI.Note: Documentary proof of age will be required only in those caseso where ageapplicant is between 18 and 21 years. In all other cases declaration of his ageapplicant will be taken as proof of age.

Details of Electors' Photo Identity Card (Item d).

1. If the Applicant has already been issued a Photo Identity Card by the Election Commission,the card number (printed on the front side) and date of issue (printed on the back side) of thecard in the space provided in Item (d) of the Application Form, should be mentioned. Pleaseattach a self-attested photocopy ofboth sides ofthe card.

2. If the Applicant wants a fresh EPIC due to correction in entries through Form 8, an

application has to be made for issue of such replacement EPIC in EPIC-001 (as per the

To be appended to Form-8

of theby the

a..,.r-

format given as Annexure-Il) with old EPIC and the requisite fee after correction by ERO onbasis of Form-8.

,.,,,). ,.,

Details of entries to be corrected. ;s-

1. In item (e) of the Application, the applicant should clearly tick the entry(ies) to be corrected.Therefore, this is a very important part of the Application

2. In most part of the country now the electoral roll is printed with the photograph of electors. Incase the application is for correcting a wrong photograph, then the applicantmay tick on the"Photograph" in item (e) of the application and please, attach a recent passport size colourphotograph with the application. In case of correction of entries in electoral roll, pleasemention correct particulars (which should be after proposed correction) in the box providedfor this purpose, just below the item (e) of the Form.

3. Full name and address on the acknowledgement and intimation portions should also be given.4. Applicant may give mobile number and E-mail I.D in the Form, which is optional, as the

same, if given, may be used by the Electoral Registration Officer for further communicationwith the applicant whenever required.

Replacement EPIC

If the Applicant wants replacement EPIC with new address, he should apply forthe same in Form EPIC-001 (as per the Format as Annexure I ), with requisite fee forreplacement EPIC, and old EPC, after enrolment at the new place on the basis of Form8A.

**********

ANNEXURE -l (For Form 8)

FORM OF OATH OR AFFIRMATION

(To be.made by either of the parents/Guru of the first time applicantin the age group of 18-21years who has no age prooi)'

l, ........... ......:......... whose

name is enrolled atthe Serial No. ........ in the Part No. ........ of electoral roll of the

... ... . Assembly Constituency

do swear in the name of the God / solemnly affirm that my son / daughter/chela

....... is ........years

of age as on 1't January,20... and is residing with me.

Place:

Date:

Signature of the parenUGuru

Sworn in the name of God/solemnly affirmed by shri/shrimati

(Place) at (hour) this the day of

20... before me.

Signature of Electoral Registration Officer /Assistant Electoral Registration Officer with Seal

..'.,,*

ANNEXURE II @or Form 8):.i1, .y['- '

Election Commission of India(ANNEXURE.II)

Application for lssue of Replacement Elector,s photo ldentity Card (EplC)

FORM ID

ECI.EPIC.OOI

A State/ UT :

AC" (No. & Name):

District:

B Electo/s Particulars(To be filled by Etector)

To,


Assembly/

Parliamentary$ Constituency

Sir/Madam,

I request that a Duplicate Electoral Photo identity card be issued to me as my original card islosudestroyed/mutilated due to corrections in my elector's detail or due to change of address I want toget afresh card with my new address. I am retuning my EPIC to you along with fee for issue of duplicateEPIC My name is included in the electoral roll for the above constituency. Particulars in support of my claimfor issue of duplicate EPIC are given below:

1. Name of Elector: 2. EpIC No of


3. Father's/ Mother's,/

Husband's* Name :

4. Sex (M/F): 5. Date of Birth (DOB) lf not

known then Age in Years)as on

1stJan,200_......

6. Address

(i) House / Door number:

(ii) StreeU Mohalla / Road/ Gali

(iii)Area / Locality :

(iv) Town^/illage : (v) PIN CODE

(vi) Police Station : (vii) District

(viii) Reasons for applying



2. I wish to receive my EPIC by pos(self addressed and stamped envelope enclosed)

3. lwill collect EPIC from BLO.

)


(ix) Tick (r' )the appropriate box:

I hereby return my mutilated /old card.

I undertake to retum the earlier card issued to me if the same

ftecovered at a later date.

Date:

Place:

tr For olficial (/.se

Authenticationfor Issue of EPIC (To beJilled by ERO,s Representative)

Part

No. :

Serial No. of

Elector in Part:lD number of Designated Photography

Location (DPL) or Common Service centers(csE).:

#Token No- or

Receipt No.


Verified by:


D Ackrowledgement ofR- EPIC by the Elector


or Thumb lmpression200_


FORM-8A Acknowledgement No.____________ (See Rules 13(4) and 26) of Registration of Electors Rule-1960 (To be filled by office)

Application for Transposition of Entry in Electoral Roll (in case of Shifting from One

Place of Residence to Another Place of Residence within Same Constituency )

To, The Electoral Registration Officer,………………..……………………………………………….…Assembly / Parliamentary Constituency SPACE FOR PASTING

ONE RECENT PASSPORT

SIZE PHOTOGRAPH (3.5

CM X 3.5 CM) SHOWING

FRONTAL VIEW OF FULL

FACE WITHIN THIS BOX

I request that entry in the electoral roll for the above mentioned Constituency relating to Myself

should be transposed to the relevant part of the roll in this constituency because I have shifted my

place of ordinary residence within the same constituency.

Particulars of the applicant

(a) Name

(b) Surname(if any)

(c) Part No. (d) Serial No.

(d) EPIC No. (if issued)

(e) Email id (optional)

(f) Mobile No. (optional)

(g)Current address of my ordinary residence where I have shifted House No.


Town/Village


District State/UT

DECLARATION- I hereby declare that the facts and particulars mentioned above are true to the best of my knowledge

and belief.I am aware that making a statement or declaration which is false and which I know or believe to be false

or do not believe to be true, is punishable under Section 31 of the Representation of the People Act, 1950 (43 of

1950).

Place……………........................

Date……………………………………. Signature of Applicant……….…………………………………………….




The application of Shri/Smt./Km. ……………………………………………………………………. for transposition of entry relating to himself/

herself/ Shri/ Smt. / Km. …………………………………………………………….in the electoral roll in Form 8A has been accepted/rejected.

Detailed reasons for acceptance or rejection [under or in pursuance of rule 26(4)] are given below:

Place:



applicant on the address as given by the applicant)

The application in Form 8A of Shri/Shrimati/Kumari…………………………………………………………………………………………………………….. Current address where applicant is ordinarily residence

House No.


Town/Village


District State/UT

Has been (a) accepted and the name of Shri/Shrimati/Kumari............................................................................. has been

deleted from Part No …………………………………….. and registered at Sl.No………………………………………. in Part No…………………………

of AC No...........................................



Address………………………………………………. Acknowledgement/Receipt

Acknowledgement Number _ _ _ _ _ _ _ _ _ _ _ _ _ Date _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Received the application in form 8A of Shri / Smt. / Ms. _______________________________________________________



Postage Stamp

to be affixed by

the Electoral

Registration

Authority at the

time of dispatch

To be appended to Form-8A

;:l '' "GTIIDELINES FOR FILLING I]P THE APPLICATION

FORM-8A

How to Fill the Form-8A

1. The application should be addressed to the Electoral Registration Officer of the constituencyin which transpositions of the relevant entry is required. The name of the constituency should

be mentioned in the blank space.

In Item (a) and (b) )of the Application, the applicant should write his name, as existing in the

electoral roll. In case the initials to applicant's name printed in the electoral roll are inabbreviated form and he wants them to.be printed in expanded form he can write his fullname in expanded form. The full name except the surname should be written in the first boxand sumame should be written in the second box. In case the applicant does not have asurname, the given name only should be written. Caste should not be mentioned except where

the caste name is used as part of the elector's name or a surname. Honorific appellations likeShri, Smt. Kumari, Khan, Begum, Pandit etc. should not be mentioned.

Item (c) and (d): Fill the name Part No. & Serial No. of the electoral roll where alreadyregistered and Electors Photo Identity Card No.(EPIC) in full. (as printed in the electoral roll).

In item (g) of the Application please mention the complete address of the new place where theApplicant/person concerned has shifted place of ordinary residence within the constituency.Please do not write incomplete address as in that case it may not be possible to link theaddress to the relevant part of electoral roll where the entry is required to be transposed.

Full name and address may also be given on the intimation portions .The Applicant may givehis mobile number and E-mail I.D in the Form, which is optional, as the same, if given, maybe used by the Electoral Registration Officer for further communication with the applicantwhenever required.

Replacement EPIC

If the Applicant wants replacement EPIC with new address, he should apply for the same in

Form EPIC-001 (as per the Format as Annexure I ), with requisite fee for replacement EPIC, and old

EPC, after enrolment at the new place on the basis of Form 8A.

********{.*

2.

3.

4.

5.

. :''*

ANNEXURE I (For Form 8A)',!' .,

i!-- -

Election Commission of India(ANNEXURE-II

for lssue of Replacement Elector,s photo ldentity Card (EptC)Application

FORM ID

ECI,EPIC.OOI

A State/ UT :

ACD (No. & Name):

District:

B Elector's Particulars(To be filled by Elector)

To,


Assembly/

Parliamentary$ Constituency

Sir/Madam,

I request that a Duplicate Electoral photo identity card be issued to me as my original card islosudestroyed/mutilated due to corrections in my elector's detail or due to change of address I want toget afresh card with my new address. I am retuning my EPIC to you along with fee for issue of duplicateEPIC My name is included in the electoral roll for the above constituency. Particulars in support of my claimfor issue of duplicate EPIC are given below:

1. Name of Elector:2. EPIC No of


3. Fathe/s/ Mother's/

Husband's'Name :

4. Sex (M/F): 5. Date of Birth (DOB) tf not

known then Age in Years)as on1stJan,200_......

6. Addregs

(i) House / Door number

(il, Drreev Monaili

(ili)Ar"" / L"""lity

Gali

(iv) TownA/illage : (v) PIN CODE

(vi) Police Station : (vii) District:

(viii) Reasons for apptying



2. I wish to receive my Eplc by post(serf addressed and stamped enverope encrosed)3. lwill collect EPIC from BLO.

)


(ix) fick 1; )the appropriate box:

lhereby retum my mutilated /old card.

I undertake to retum the earlier card issued to me ff the same

ftecovered at a later date.

Date:

Place

tr Fot offrcidl Llse

Authen iurionfor Iss. ofEPIC (To belilled by ERO,s Representutive)

Part

No. :

Serial No. ofElector in Part:

lD number of Designated photography

Location (DPL) or Common Service centers(csE).:

#Token No. or

Receipt No.


verfied by:


D Acknowledgement of R_ [pIC by the Elector


or Thumb lmpression200_

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