1/23/12 FORM-6

1/2 ceoaperms.ap.gov.in/ERMS/Postal/userdetails.asp
Application for inclusion of name in electoral roll ApplicationID:03000297
To,
The Electoral Registration Officer
*Assembl Constituenc: Manakondur (SC)
Sir,
I request that m name be included in the electoral roll for the above
Constituenc. Particulars in support of m claim for inclusion in the
electoral roll are given below:
I. Applicant's Details:
Name: RAVINDER .a: D
Surname(if an): KOMIRE .a: s`Do
Date of birth if ou know: Da:24 Month:06 Year:1981 Gender: M
Age as on 1st Januar 2011: Year:30 Months:6
Place of birth Place of birth
Village/ Town: RAGAVAPUR
District: KARIMNAGAR State: ANDHRA PRADESH
Relation Details
Relation Tpe
Father's/Mother's/Husband's:
F
Name: LINGAIAH .a: 0_
Surname(if an): KOMIRE .a: s`Do
II. Particulars of place of present ordinar Residence(Full address)
House/Door number: 9-39
Street /Area /Localit
/Mohalla /Road:
RAGAVAPUR
Dc /o/
's0:
ocy
Town/ Village: ANNARAM /n : -_
Tehsil/ Taluka/Mandal/
Thana:
MANAKONDUR c /: s:
District: KARIMNAGAR Post Office: ANNARAM
1/23/12 FORM-6
2/2 ceoaperms.ap.gov.in/ERMS/Postal/userdetails.asp
District: KARIMNAGAR Post Office: ANNARAM
Pin code: 505469
III. Details of member(s) of applicant's famil alread included in the current electoral roll of the Constitutenc:
Name:
Relationship with
applicant:
RPart number of the
roll of the
Constitutenc:
Serial number in the
Part:
Elector's Photo Identit Card
Number:
1. KOMIRE LINGAIAH FATHER 30 0
2. 0 0
Mobile No: 9030508236 Remarks:
Email-Id: ravinder.goudk@gmail.com
Prin