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Application for inclusion of name in electoral roll
FORM.6
ApplicationID:14465303
To,
The Electoral Registration Officer
*Assembly Constituency: Gajuwaka
Sir,
request that my name be included in the electoral oll forthe above
Constituency. Particulars in support of my claim for inclusion inthe
electoral roll are given below:
1. Applicant's Details:
‘Name: ‘SARITHA DEVI ba 308 2
Sumnameifany) BASAVA re was
Date ofbithifyoukoow: Day28 _—Momthi10——“Year966 Genser: F
‘Ageas on IstJammry2014: Years? Months?
Place of birth Place of birth
Vilage! Towne BOBBILI
Distt VIZIANAGARAM. State ANDURAPRADESHT
Relation Details
Relation Type H
Fatho'sMothersHusbang's:
‘Name: \VASANTHA KUMAR ‘a seed Bard
Sursaetiany) BASAVA, Bas
pecee
Il, Particulars of place of present ordinary Residence(Full address)
-HouseDoor manber: QRNO:140-C
Sweet /Arca Locality ss
See Ae SECTORS he Aossrareba: BES --6
‘Town! Vilage: UKKUNAGARAM Byowmsse Geb Addo
Tet Taba) Mandal
Gajwaka runs nc: mB
Distt VISAKHAPATNAM PostOffe: _ UKKUNAGARAM POST OFFICE
Prncode: 530032
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IIL, Details of member(s) of applicant's family already included in the current electoral roll of the Constitutency:
wwsas rons
= cinta Yard |Ecur Fh Mey Cad
rea iste a Nese:
2 a o
HR SOOT Tm
Eni: ieaa@ericon
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