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                                       ELECTION COMMISSION OF INDIA
                                                 FORM-8
                                                                  (See Rules 13(1) and 26) of Registration of Electors Rule-1960

Application for Correction to Particulars Entered in Electoral Roll

To, The Electoral Registration Of cer, West Bengal Bagda Assembly / Parliamentary Consitituency
SPACE FOR
I request that entry relating to myself appearing in the electoral roll the
PASTING ONE
above Constituency is not correct and it should be corrected.
RECENT PASSPORT
(a)Name Eva ইভা
SIZE
(b) Surname(if any) Sarkar সরকার

(c) Details of registration with electoral roll

Name of Assembly/ Parliamentary Constituency Bagda
Part No. of Electoral Roll 31                 Serial No. of Electoral Roll    678

(d) EPIC No. (If

CTG3674702
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:-

Name Iva ইভা

Surname(if any) Sarkar সরকার

(g) Email Id(optional)

(g) Mobile No.

(optional)

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 : NALDUGARI

Date : 22/09/2019

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