ranaa 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 ceogperms. ap govinERMSPosialuserdotalls. aspx IIL, Details of member(s) of applicant's family already included in the current electoral roll of the Constitutency: wwsas rons = cinta Yard |Ecur Fh Mey Cad rea iste a Nese: 2 a o HR SOOT Tm Eni: ieaa@ericon ceogperms. ap govinERMSPosialuserdotalls. aspx