If, at any time, during a period of six months from the date on which any amendment to a form for making any claim, objection or other application to the registration officer under these rules takes effect, a person makes, such claim, objection or, as the case may be, other application in the Form as it stood before such amendment, the registration officer shall deal with such claim, objection or other application and he may, for this purpose, require such person, by notice in writing, to furnish such additional information (being the information which would have been furnished if the amended Forms had been used) within such reasonable time as may be specified in the notice.]
Form 1
(See Rule 7)
Statement as to place of Ordinary Residence by a Person holding a Declared Office
Full name
67[Father's/Mother's/Husband's name] .. ..
Age years
Office
held
I hereby declare that I am a citizen of India and that but for my holding the above mentioned office, I would have been ordinarily resident at (full postal address)
I further declare that my wife (name) aged years, ordinarily
resides with me 68[and is a citizen of India].
This cancels any previous statement as to place of ordinary residence made by me.
Place
Date Signature
69[Form 2
(See Rule 7)
Statement as to place of Ordinary Residence by a member of the Armed Forces
I hereby declare that I am a citizen of India and that but for my service in the Armed Forces I would have been ordinarily resident at
House No.
Street/Mohalla
Locality
Town/Village
Post Office
Police Station
Tehsil/Taluka
District
State
My full name . Rank
Service No.
Service/Corps/Regiment
Name and address of record office
Age last birthday years Years.
*I further declare that my wife age . Years, ordinarily resides with me and is a citizen of India.
This cancels any previous statement as to ordinary place of residence made by me.
Date 199 . .
(Signature)
_____________________________________________________________________________________
Record Office Verified and found correct
Folio No (Signature) .
Place (Designation) .
Date . Officer-in-charge, Records.
_____________________________________________________________________________________
(For use in the Election Office)
Statement received on the 199.
Registered in the electoral roll for the Assembly Constituency (No .). Service voters' part, at S. No.
Date 199 . 70[Electoral Registration Officer].]
_____________________________________________________________________________________
*Delete if not applicable.
71[Form 2-A
(See Rule 7)
Statement as to place of Ordinary Residence by a member of an Armed police force of a state, who is serving outside that State
I hereby declare that I am a citizen of India and that but for my service outside the State in the armed police force mentioned below, I would have been ordinarily resident at
House No. .
Street/Mohalla
Locality
Town/Village
Post Office
Police Station
Tehsil/Taluka
District
State
My full name Rank .
Buckle No. . .
Name of Armed police force
Name and address of the office of the Commandant
Age last birthday years Years.
*I further declare that my wife age years, ordinarily resides with me and is a citizen of India.
This cancels any previous statement as to ordinary place of residence made by me.
Date .199 . .
(Signature)
_____________________________________________________________________________________
*Delete if not applicable.
Commandant's Office Verified and found correct.
Folio No . (Signature) .
Place (Designation) .
Date . Commandant.
_____________________________________________________________________________________
(For use in the Election Office)
Statement received on the .199.
Registered in the electoral roll for the Assembly Constituency (No ). Service voters' part, at S. No.
Date 20 . 72[Electoral Registration Officer].]
Form 3
(See Rule 7)
Statement as to place of Ordinary Residence by a Person employed under the Government of India in a post outside India
Full Name
73[Father's/Mother's/Husband's name] .
Age .years.
Description of post
held outside India
.
I hereby declare that I am a citizen of India and that but for my being employed under the Government of India in the above-mentioned post, I would have been ordinarily resident at (full postal address) .
I further declare that my wife (name) aged years, ordinarily resides with the 74[and is a citizen of India].
This cancels any previous statement as to place of ordinary residence made by me.
Place Signature
Date
Verified
Signature
Designation of the Head of Office
Place
Date
_____________________________________________________________________________________
(For use in the Election Office)
Statement received on the 199.
Registered in the electoral roll for the Assembly Constituency (No .). Service voters' part, at S. No
Date 75[Electoral Registration Officer].
_____________________________________________________________________________________
Form 4
(See Rule 8)
Letter of request
Place
Date
To
The occupant of
Sir/Madam,
The preparation of the electoral roll for the Assembly Constituency in which you are residing has been taken in hand. It will greatly facilitate my work if you will kindly complete the statement below after reading the attached instruction and hand it over to my assistant who will call for it.
Electoral Registration Officer of the
Assembly Constituency
Statement
Names and particular, of adult citizens ordinarily residing in the above premises
| Name of citizen |
Particulars as to |
76[Father or Mother or Husband] |
77Age on 1st January/April 19 ] |
| 1. |
|
|
|
| 2. |
|
|
|
| 3. |
|
|
|
| 4. |
|
|
|
| 5. |
|
|
|
| 6. |
|
|
|
| 7. |
|
|
|
| etc. |
|
|
|
| |
|
|
Signature |
| |
|
|
Date |
Instructions
1. Enter the names of all persons who have completed [18 years of age on or before the 1st of January/April] of this year and who are ordinarily residing in the premises.
2. Only the names of those who are citizens of India should be entered.
3. Enter against Serial No. 1 in the first column, the name of the head or other senior member of the family, provided he or she has the qualifications mentioned in Paragraphs 1 and 2 above.
4. Ordinarily residing does not mean that the person should be actually in the house when you are filling in the form. The persons who normally live in the house should be included even though they may be temporarily absent, e.g., on a journey or on business or in hospital. On the other hand, a guest or visitor, who normally lives elsewhere but happens to be in the house at the time should not be included.
5. All ordinary residents of the house should be included, whether they are members of the family or not. But do not enter the name of any person who is a member of the Armed Forces of India or is employed under the Government of India in a post outside India or the name of such person's wife if she ordinarily resides with him.
6. In the case of every male citizen, enter in the second column the name of his father preceded by the words son of
7. In the case of every female citizen, enter in the second column
(i) the name of the husband preceded by the words wife of , if she be married;
(ii) the name of the late husband preceded by the words widow of , if she be a widow; and
(iii) the name of the [Father of Mother] preceded by the words daughter of , if she be unmarried.
8. In the third column, enter the age of the citizen as accurately as possible, giving only the number of complete years and ignoring the months.
[Note: For preparation/revision of rolls in 1989, omit January and retain April . For preparation/revision of rolls in any other year, omit April and retain January ].
78Form 5
(See Rule 10)
Notice of publication of electoral roll in draft
To
The Electors of the constituency.
Notice is hereby given that the electoral roll has been prepared in accordance with the Registration of Electors Rules, 1960, and a copy thereof is available for inspection at my office, and at during office hours.
The qualifying date for the preparation of the electoral roll is
If, with reference to the abovesaid qualifying date, there be any claim for the inclusion of a name in the roll or any objection at the inclusion of name or any objection to particulars in any entry, it should be lodged on or before the 19 , in Form 6, 7 or 8 as may be appropriate.
Every such claim or objection should either be presented in my office or to or sent by post to the address given below so as to reach me not later than the aforesaid date.
Electoral Registration Officer,
(Address) ]
Date
| .png) |
79[ELECTION 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 |
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. |
|
| Street/Area/Locality |
|
| Town/Village |
|
| Post Office |
|
Pin Code |
|
| 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) E-mail 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 |
|
| Post Office |
|
Pin Code |
| 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 |
| |
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 . |
Postage Stamp to be affixed by the Electoral Registration Authority at the time of dispatch |
| Current address where applicant is ordinarily resident |
House No. |
| Street/Area/Locality |
|
|
| Town/Village |
|
|
| Post Office |
|
Pin Code |
| 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 |
| .png) |
ELECTION COMMISSION OF INDIA Form 6-A Acknowledgement No.____________ (To be filled by office) (See Rule 8-B of Registration of Electors Rules, 1960) |
| Application for Inclusion of Name in Electoral Roll by an Overseas Elector |
| To, The Electoral Registration Officer, Assembly/Parliamentary Consitituency |
PASTE 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 may be included in the electoral roll for the Constituency in which my place of residence is located as mentioned in (j) below: |
| (a) Name |
|
| (b) Last Name* |
|
| (c) Name of relative* |
Father Mother Husband Wife Other |
| |
| (d) Last Name of relative* |
|
| (e) Date of Birth (DD/MM/YYYY) |
// |
| (f) Place of Birth |
Village/Town |
|
| District |
|
| State |
|
| (g) Gender (Put a cross mark in proper box) |
Male Female Third Gender |
| (h) E-mail Id# |
|
| (i) Mobile No. # |
|
| (j) Address in India as mentioned in original passport |
House No. |
|
| Street/Area/Locality |
|
| Town/Village |
|
| District |
|
Pin Code |
|
| (k) Details of current Passport |
Place of issue |
|
| Passport No. |
|
Date of expiry (dd/mm/yyyy) |
|
| Date of issue (dd/mm/yyyy) |
|
| (l) Details of Visa of the Country of current residence |
Visa Number |
|
| Date of issue |
|
Date of expiry |
|
| Type of Visa |
|
Name of issuing authority |
|
| *To be filled in capital letters only #Optional |
| |
| Note Copies of the relevant pages of the passport containing the particulars mentioned at items (a) to (l) and current valid visa endorsement mentioned above to be enclosed duly self attested if sent by post and produced with the original passport if presented in person before the registration officer |
| 2. (a) Reason of being absent from the place of ordinary residence in India. |
Employment |
Education |
Other(give Description) |
|
| |
| (b) Date from which absenting from ordinary residence in India (dd/mm/yyyy) |
|
| 3. Full current Address in the country outside India where residing- |
House No. |
|
| Street/Area/Locality |
|
| Town/Village |
|
| State |
|
Country |
|
| Zip Code |
|
|
| DECLARATION - I hereby declare that to the best of knowledge and belief a. All information given in this application is true. b. I am a citizen of India by birth/domicile/naturalisation. c. I have not acquired citizenship of any other country. d. But for being absent from the place of my ordinary residence in India owing to the reason given in 2(a) above, I would have been ordinarily resident at the address given in my Indian Passport, which has been reproduced at 1(j) above. e. I undertake to immediately inform the Electoral Registration Officer through the Indian Mission in the Country of my current residence if I renounce my Indian Citizenship or if I acquire the citizenship of any other country. f. I undertake to immediately inform the Electoral Registration Officer through the Indian Mission in the country of my current residence of any change in my residential address in the country of my residence for the records of the Electoral Registration Officer. I understand that any notice sent to me at the address, which is my residential address in the country of my current residence according to the records of the Electoral Registration Officer, shall be considered as due service of notice to me under the Representation of the People Act, 1950 and the rules made there under, and that it is my responsibility to keep the Electoral Registration Officer informed of my latest residential address in the country of my current residence. g. If I return to India and become ordinarily resident in India, I shall immediately inform the Electoral Registration Officer of the concerned Assembly/Parliamentary Constituency. h. I have not applied for inclusion of my name in the electoral roll of any other constituency. i. My name has not already been included in this or any other constituency Or My name may have been included in the electoral roll of . 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, or transposed, as may be appropriate. Full address (earlier place of ordinary residence) Elector Photo Identity Card (if issued) Number . . date of issue . j. I have not been issued an EPIC in India/have been issued an EPIC which is enclosed with this application for cancellation. [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 the People Act, 1950 (43 of 1950).] Place Date . Signature |
| Details of action taken (To be filled by Electoral Registration Officer of the constituency) |
| Application received on (DD/MM/YYYY) The application in Form 6-A of Shri/Shrimati/Kumari . has been (a) Accepted and the name has been registered in the electoral roll of . . (constituency) at Sl. No. Part No. (b) Rejected for the reason: Date:_________________ Name/Signature of ERO/AERO |
| Acknowledgement/Receipt Acknowledgement Number _ _ _ _ _ _ _ _ _ _ _Date _ _ _ _ _ _ _ _ _ Received the application in name of self form Shri/Smt./Ms. ________________________ [Applicant can refer the Acknowledgement No. to check the status of application]. Name/Signature of ERO/AERO/BLO |
| .png) |
ELECTION COMMISSION OF INDIA Form 7 Acknowledgement No.____________ (To be filled by office) (See Rules 13(2) and 26) of Registration of Electors Rule, 1960 |
| 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 Consitituency |
| 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: |
| Details of action taken (To be filled by Electoral Registration Officer of the constituency) |
| 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 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 available in the record) |
| The application in Form 7 of Shri/Shrimati/Kumari |
Postage Stamp to be affixed by the Electoral Registration Authority at the time of dispatch |
| Current address where applicant is ordinarily resident |
House No. |
|
| Street/Area/Locality |
|
| Town/Village |
|
| Post Office |
|
Pin Code |
| District |
|
State/UT |
|
| Has been (a) accepted and the name of Shri/Shrimati/Kumari has been deleted from 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 7 of Shri/Smt./Ms. ________________________________________ [Applicant can refer the Acknowledgement No. to check the status of application]. Name/Signature of ERO/AERO/BLO |
| ELECTION COMMISSION OF INDIA Form 8 Acknowledgement No.____________ (To be filled by office) (See Rule 13(1) and 26) of Registration of Electors Rules, 1960 |
| 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) E-mail 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 . |
| Remarks of Field Level Verifying Officers |
| Details of action taken (To be filled by Electoral Registration Officer of the constituency) |
| 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: |
| 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 available in the records/given by applicant) |
| The application in Form 7 of Shri/Shrimati/Kumari |
Postage Stamp to be affixed by the Electoral Registration Authority at the time of dispatch |
| Current address where applicant is ordinarily resident |
House No. |
|
| Street/Area/Locality |
|
| Town/Village |
|
| Post Office |
|
Pin Code |
| District |
|
State/UT |
|
| Has been (a) accepted and the entry at Sl. No. Part No of AC No. . has been modified accordingly (b) rejected for the reason . Date: Electoral Registration Officer 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]. Name/Signature of ERO/AERO/BLO |
| .png) |
ELECTION COMMISSION OF INDIA Form 8-A Acknowledgement No.____________ (To be filled by office) (See Rules 13(4) and 26) of Registration of Electors Rule, 1960 |
| 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 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 entry in the electoral roll for the abovementioned 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. |
|
| (e) EPIC No. (If issued) |
|
| (f) E-mail id (optional) |
|
| (g) Mobile No. (optional) |
|
| (h) Current address of my ordinary residence where I have shifted |
House No. |
|
| Street/Area/Locality |
|
| Town/Village |
|
| Post Office |
|
Pin Code |
|
| 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 . |
| Remarks of Field Level Verifying Officer: |
| Details of action taken (To be filled by Electoral Registration Officer of the constituency) |
| The application of Shri/Smt./Km. for transposition of entry relating to himself/ Herself/Shri/Smt./Km. in the electoral roll in Form 8-A has been accepted/rejected. Detailed reasons for acceptance or rejection [under or in pursuance of Rule 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 8-A of Shri/Shrimati/Kumari |
Postage Stamp to be affixed by the Electoral Registration Authority at the time of dispatch |
| Current address where applicant is ordinarily resident |
House No. |
|
| Street/Area/Locality |
| Town/Village |
| Post Office |
|
Pin Code |
| 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. . . (b) rejected for the reason . Date: Electoral Registration Officer Address . |
| Acknowledgement/Receipt Acknowledgement Number _ _ _ _ _ _ _ _ _ _ _ _ _Date _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Received the application in Form 8-A of Shri/Smt./Ms. ___________________________________ [Applicant can refer the Acknowledgement No. to check the status of application]. Name/Signature of ERO/AERO/BLO] |
Form 8-B
(See Rule 26)
Application for deletion of entry in electoral roll
To
The Electoral Registration Officer,
Assembly/Parliamentary Constituency.
Sir,
I submit that the entry relating to the person named below in the electoral roll for the above Constituency is required to be deleted for the reasons stated hereunder:
I. Details of person whose entry is to be deleted
1. Title$
2. First and middle name
3. Last name
4. Part number of electoral roll in which his/her name is included :
5. His/her serial number in that part :
6. Electors' Photo Identity Card number
II. (a) Details of relation of person whose entry is to be deleted (Father/Mother/Husband)
7. Title$
8. First and middle name
9. Last name
(b) Relationship with the person whose entry is to be deleted. Father/Mother/Husband:
III. Reasons for objection
(a)* Death on
10. Day :
11. Month :
12. Year :
(b)* No longer ordinarily resident since
13. Day :
14. Month :
15. Year :
(c)* * Not entitled to be registered for the reason:
IV. (a) Objector's details:
16. Title$
17. First and middle name
18. Last name
19. Sex (male/female) :
20. Part number of electoral roll in which objector's name is included :
21. His/her serial number in that part :
(b) Details of relation of objector (Father/Mother/Husband)
22. Title$
23. First and middle name
24. Last name
(c) Relationship with objector (Father/Mother/Husband):
V. Particulars of place of ordinary residence of objector (Full address):
25. House/Door number :
26. Street/Mohalla/Road/Gali :
27. Area/Locality :
28. Town/Village :
29. Post Office :
30. Pin Code :
31. Police Station :
32. Tehsil/Taluka@ :
33. Block/Mandal (for Village)@ :
34. District :
________________________________________________________________________________________________________________________
$ Sh./Smt/Km./Dr. etc.
@ May not be applicable in Metropolitan Areas
In case of Union territories having no Legislative Assembly and the State of Jammu and Kashmir
@ Strike out the inappropriate alternative
VI. Details of objector's Photo Identity Card, if issued, in this or in any other Constituency
35. Electors' Photo Identity Card number :
36. Date of issue :
37. Constituency (Assembly/ Parliamentary Constituency) number :
Name :
VII. Declaration
I hereby declare that the facts and particulars mentioned above are true to the best of my knowledge and belief.
Place :
Date :
I am submitting the application to the Electoral Registration Officer through
Sh./Smt./Km. (full name and address)
.
Signature or thumb impression of objector
Or (ii) in person*,/or (iii) by Post*
Signature or thumb impression of objector
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 the People Act, 1950.
_____________________________________________________________________________________
* Strike out the inappropriate alternative.
In case of Union territories having no Legislative Assembly and the State of Jammu and Kashmir.
Signature or thumb impression of the
person submitting the application
For use of registration officer or other officer designated by him
Details of acknowledgement
(To be filled by Officer receiving the application)
Details of acknowledgement receipt issued to the applicant.
Receipt number : . Signature of officer
Date of receipt : receiving the application .
Remarks, if any, of the Officer receiving the application :
Application received by:
Name of Officer :
Designation * :
Place : . Signature of officer
Date : receiving the application .
_____________________________________________________________________________________
* Electoral Registration Officer/Assistant Electoral Registration Officer
Details of action taken
(To be filled by electoral registration officer of the constituency)
Revision identity
Constituency number and name
The application of *Shri/*Smt./*Km. for transposition of entry relating to *Shri/*Smt./*Km. in the electoral roll in Form 8B has been accepted*/rejected*
*Accepted:
Under Rule 26(4) and relevant entry is deleted in the electoral roll of the Constituency
Serial number of entry deleted
In part number
*Rejected:
Rejected, under Rule 26(4)
Detailed reasons for acceptance or rejection [under Rule 26(4)] :
Place : . .
Date : (Seal of Electoral Registration Officer)
Signature of Electoral Registration Officer
_____________________________________________________________________________________
* Strike out the inappropriate alternative.
Form 9
(See Rules 15 and 16)
Designated location identity
(where applications have been received)
List of applications for inclusion of names received in Form 6
Revision identity
Constituency (Assembly/Parliamentary Constituency):
1. List number@
2. Period of receipt of applications (covered in this list)
From date
To date
3. Place of hearing*
| Serial number of application |
Date of receipt |
Name of claimant |
Name of Father/Mother/Husband and (Relationship)# |
Place of residence |
Date of hearing* |
Time of hearing* |
| 1 |
2 |
3 |
4 |
5 |
6(a) |
6(b) |
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Date of exhibition at designated location under Rule 15(b)
Date of exhibition at Electoral Registration Officer's Office under Rule 16(b)
_____________________________________________________________________________________
In case of Union territories having no Legislative Assembly and the State of Jammu and Kashmir
@ For this revision for this designated location
* Place, time and date of hearing as fixed by electoral registration officer
Running serial number is to be maintained for each revision for each designated location
# Give relationship as F=Father, M=Mother and H=Husband within brackets i.e. (F), (M), (H)
Form 10
(See Rules 15 and 16)
Designated location identity
(where applications have been received)
List of applications for objection to inclusion of names received in Form 7
Constituency (Assembly/Parliamentary Constituency):
1. List number@ :
2. Period of receipt of applications (covered in this list)
From date
To date
3. Place of hearing* :
| Serial number of application |
Date of receipt |
Name (in full) of objector |
Particulars of name objected to |
Reasons in brief for objection |
Date of hearing* |
Time of hearing* |
| |
|
|
Part number |
Serial number |
Name in full |
|
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| 1 |
2 |
3 |
4 |
5 |
6 |
7 |
8(a) |
8(b) |
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Date of exhibition at designated location under Rule 15(b)
Date of exhibition at Electoral Registration Officer's Office under Rule 16(b)
_____________________________________________________________________________________
In case of Union territories having no Legislative Assembly and the State of Jammu and Kashmir
@ For this revision for this designated location.
* Place, time and date of hearing as fixed by electoral registration officer.
Running serial number is to be maintained for each revision for each designated location
Form 11
(See Rules 15 and 16)
Designated location identity
(where applications have been received)
List of applications for objection to particulars in entries in electoral roll received in Form 8
Revision identity
Constituency (Assembly/Parliamentary Constituency):
1. List number@ :
2. Period of receipt of applications (covered in this list)
From date .
To date
3. Place of hearing* :
| Serial number of application |
Date of receipt |
Name (in full) of elector objecting |
Particulars of entry objected to |
Nature of objection |
Date of hearing* |
Time of hearing* |
| |
|
|
Part number |
Serial number |
|
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|
| 1 |
2 |
3 |
4 |
5 |
6 |
7(a) |
7(b) |
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Date of exhibition at designated location under Rule 15(b)
Date of exhibition at Electoral Registration Officer's Office under Rule 16(b)
_____________________________________________________________________________________
In case of Union territories having no Legislative Assembly and the State of Jammu and Kashmir
@ For this revision for this designated location.
* Place, time and date of hearing as fixed by electoral registration officer.
Running serial number is to be maintained for each revision for each designated location]
80[Form 11-A
[See rules 15 and 16]
List of applications for transposition of entries in electoral roll received in Form 8A
| Designated location identity (where applications have been received) |
Constituency (Assembly/Parliamentary Constituency |
Revision identity |
| 1. List number @ |
2. Period of receipt of applications (covered in this list) |
From date |
To date |
| ./ / . |
./ / . |
| |
|
| 3. Place of hearing* |
| Serial number of application |
Date of receipt |
Details of applicant |
Details of person whose entry is to be transposed |
|
| (As given in Part V of Form 8A) |
Name of person whose entry is to be transposed |
Part/Serial no. of roll in which name is included |
EPIC No. |
Present place of ordinary residence |
Date/Time of hearing* |
| 1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
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| In case of Union territories having no Legislative Assembly and the State of Jammu and Kashmir @ For this revision for this designated location * Place, time and date of hearing as fixed by electoral registration officer Running serial number is to be maintained for each revision for each designated location |
Date of exhibition at designated location under Rule 15(1)(b) |
Date of exhibition at Electoral Registration Officer's Office under Rule 16(b)] |
| |
|
Form 13
[See Rules 19(1)(b)(ii)]
Notice to the objector
Duplicate
(Office Copy)
To
(Full name .
and address
of objector)
Reference: Objection No. .
Take notice that your objection to the inclusion of the name of
will be heard at (place) at O'clock on the day of .19 . Your are directed to be present at the hearing with such evidence as you/may like to adduce:
Place
Date
Form 13
[See Rules 19(1)(b)(ii)]
Notice to the objector
Original
(To be served on the objector)
To
(Full name .
and address
of objector)
Reference: Objection No. .
Take notice that your objection to the inclusion of the name of
will be heard at . (place) at O'clock on the day of .19 . You are directed to be present at the hearing with such evidence as you may like to adduce:
Place .
Date
Electoral Registration Officer.
_____________________________________________________________________________________
Certificate of Service of notice
Received notice of the date of hearing
Date .
Objector
Certified that the notice on the objector has been duly served by me this .day of on (name) personally/by affixation on residence.
Place
Date
Serving Officer.
_____________________________________________________________________________________
N.B. If this notice is served by post, attach the receipt here.
Form 14
[See Rules 19(1)(b)(ii)]
81[Notice to the person in respect of whomobjection has been made]
Duplicate
(Office Copy)
To
(Full name
and address of person . objected of)
Reference: Objection No.
Take notice that objection to the inclusion of your name at Serial No. . in Part of the electoral roll for constituency filed by
(Full name
and address of .
objected) will be heard at . (place) at . O'clock on the day of .19 . You are directed to be present at the hearing with such evidence as you/may like to adduce. The grounds of objection (in brief)
(a)
(b)
(c)
Place
Date .
Electoral Registration Officer.
Form 14
[See Rules 19(1)(b)(ii)]
[Notice to the person in respect of whomobjection has been made]
Original
(To be served on the person objected to)
To
(Full name
and address of person
objected of)
Reference: Objection No.
Take notice that the objection to the inclusion of your name at Serial No. in Part of the electoral roll for constituency filed by
(Full name
and address of
objected)
will be heard at . (place) at . O'clock on the day of .19 . You are directed to be present at the hearing with such evidence as you/may like to adduce. The grounds of objection (in brief) are:
(a)
(b)
(c)
Place
Date .
Electoral Registration Officer.
_____________________________________________________________________________________
Certificate of Service of notice
Received notice of the date of hearing
Date .
Person objected to
Certified that the notice on the person, the entry relating to whose name has been objector to, has been duly served by me this . day of on (name) .personally/by affixation on residence.
Place .
Date
Serving Officer.
_____________________________________________________________________________________
N.B. If this notice is served by post, attach the receipt here.
Form 15
[See Rules 19(1)(b)(iii)]
Notice of hearing of an objection to particulars in an entry
Duplicate
(Office Copy)
To
(Full name
and address of
objector)
Reference: Objection No.
Take notice that your objection to certain particulars in the entry relating to you will be heard at .(place) at O'clock on the day of 19 . You are directed to be present at the hearing with such evidence as you may like to adduce.
Place
Date .
Electoral Registration Officer.
Form 15
[See Rules 19(1)(b)(iii)]
Notice of hearing of an objection to particulars in an entry
Original
(To be served on the objector)
To
(Full name
and address of
objector)
Reference: Objection No.
Take notice that your objection to certain particulars in the entry relating to you will be heard at .(place) at O'clock on the day of 19 . You are directed to be present at the hearing with such evidence as you may like to adduce.
Place
Date .
Electoral Registration Officer.
_____________________________________________________________________________________
Certificate of Service of notice
Received notice of the date of hearing
Date .
Objector
Certified that the notice on the objector has been duly served by me this .day of on (name) .personally/by affixation on residence.
Place .
Date
Serving Officer.
_____________________________________________________________________________________
N.B. If this notice is served by post, attach the receipt here.
82[Form 16
[See Rule 22(1)]
Notice of final publication of electoral roll
It is hereby notified for public information that the list of amendments to the draft electoral roll for the constituency has been prepared with reference to as the qualifying date and in accordance with the Registration of Electors Rules, 1960. A copy of the said roll together with the said list of amendments has been published and will be available for inspection at my office.
Place
Date
(Address) .
]
.
Electoral Registration Officer
Form 17
[See Rule 30]
Application for inclusion of name in the electoral roll for a local authorities' constituency
To
The Electoral Registration Officer,
(Local Authorities) Constituency.
Sir,
I am a member of which is a constituent local authority exercising jurisdiction within the limits of the .local authorities' constituency. I am therefore entitled to be registered as an elector in the said constituency, and request that my name be included in the electoral roll thereof.
My address is:
.
Yours faithfully
| 83[FORM 18 (See Rule 31) Claim for inclusion of name in the electoral roll for a graduates' constituency |
| |
PHOTO of the applicant |
| To |
| The Electoral Registration Officer, (Graduate) Constituency. |
| Sir, |
| I request that my name be registered in the electoral roll for the (graduate's) Constituency. The particulars are: |
| Name (in full) Sex Father's/Mother's/Husband's name (in full) . Qualification Occupation House address (Place of ordinary residence) . House No. Street/Mohalla Town/Village Post Office Police Station/Tehsil/Taluka/Mouza District Age . Whether registered as an elector for any assembly constituency If yes, then mention the following--- |
| (a) Number and name of the assembly constituency . (b) Part/polling station No. (if known) (c) Date of birth . (d) Electors' Photo Identity Card number (if any) |
| Contact number- (i) Mobile . (ii) Landline E-mail id (if any) 2. *I am a graduate of the .University having passed the degree/diploma examination in the year OR *I am in possession of a diploma/certificate in which is a qualification equivalent to that of a graduate of a University in India having passed the examination for the diploma/certificate in the year 3. In support of my claim as being a graduate/in possession of the above diploma/certificate. I submit herewith . 4. ** My name has not been included in the electoral roll for this or any other graduates' constituency. OR **My name has been included in the electoral roll for the .graduates' constituency under the address given below and I request that it be deleted from that roll: . 5. I declare that I am a citizen of India and that all the particulars given above are true to the best of my knowledge. |
| Place Date |
Signature of claimant. |
| NOTE : Any person who makes a statement or declaration which is false and which the either knows or believes to be false or does not believe to be true is punishable under Section 31 of the Representation of the People Act, 1950. *Strike out the paragraph not applicable. **Strike off the inappropriate alternative. (Perforation) Intimation of action taken The application in Form 18 of Shri/Shrimati/Kumari address .has been (a) accepted and the name of Shri/Shrimati/Kumari has been registered at Serial No in Part No . (b) rejected for the reason |
| Date |
Electoral Registration Officer. (Address) . |
| (Perforation) |
| Receipt for application |
| Received the application in Form 18 from Shri/Shrimati/Kumari* address* . |
| Date |
Electoral Registration Officer. (Address) . |
| *To be filled in by the applicant. |
FORM 19
[See Rule 31]
Claim for inclusion of name in the electoral roll for a teachers' constituency
| |
|
| To |
|
| The Electoral Registration Officer, |
|
| (Teachers') Constituency. |
Photo of the applicant |
| Sir, I request that my name be registered in the electoral roll for the . (teachers') Constituency. |
|
The particulars are:
Name (in full) .Sex .
Father's/Mother's/Husband's name (in full)
House address (Place of ordinary residence):
House No.
Street/Mohalla
Town/Village . .
Post Office .
Police Station/Tehsil/Taluka/Mouza
District .
Age .
Whether registered as an elector for any assembly constituency
If yes, then mention the following---
(a) Number and name of the assembly constituency
(b) Part/polling station No. (if known) .
(c) Date of birth .
(d) Electors Photo Identity Card number(if any) .
Contact number- (i) Mobile .
(ii) Landline
E-mail id (if any)
2. During the last six years I have been engaged in teaching for a total period of more than three years as follows
| Name of Educational Institution |
From (Date) |
To (Date) |
Period |
| 1. |
|
|
|
| 2. |
|
|
|
| 3. |
|
|
|
| 4. |
|
|
|
In support of the above I submit herewith . .
.
.
.
3. *My name has not been included in the electoral roll for this or any other teachers' constituency.
OR
*My name has been included in the electoral roll for the teachers' constituency under the address given below and I request that it be deleted from that roll:
4. I declare that I am a citizen of India and that all the particulars given above are true to the best of my knowledge and belief.
Place
Date
Signature of claimant.
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 the People Act, 1950.
*Strike out the paragraph not applicable.
. (Perforation)
Intimation of action taken
The application in Form 19 of Shri/Shrimati/Kumari
address . .has been
(a) accepted and the name of Shri/Shrimati/Kumari . has been registered at Serial No . in Part No. .
(b) rejected for the reason .
Date .
Electoral Registration Officer
(Address)
]
(Perforation)
Receipt for application
Received the application in Form 19 from Shri/Shrimati/Kumari* . address*
Date .
Electoral Registration Officer
(Address)
.
*To be filled in by the applicant.]
_____________________________________________________________________________________