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  • Application For Inclusion of Name in Electoral Roll For First Time Voter OR On Shifting From One Constituency To Another Constituency

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    KAUSTUB CHAUHAN
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    This document is an application form for inclusion in the electoral roll for the first time. It contains details of the applicant such as name, father's name, age, gender, current and permanent addresses, and a declaration that the applicant is eligible for inclusion. The applicant, Kaustub Chauhan, is requesting to be added to the electoral roll of the Gwalior Assembly/Parliamentary Constituency in Madhya Pradesh as a first time voter. He declares that he is a citizen of India, ordinarily resides at the stated address in Gwalior since 2002, and has not applied to be included in any other constituency's electoral roll.

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    This document is an application form for inclusion in the electoral roll for the first time. It contains details of the applicant such as name, father's name, age, gender, current and permanent addresses, and a declaration that the applicant is eligible for inclusion. The applicant, Kaustub Chauhan, is requesting to be added to the electoral roll of the Gwalior Assembly/Parliamentary Constituency in Madhya Pradesh as a first time voter. He declares that he is a citizen of India, ordinarily resides at the stated address in Gwalior since 2002, and has not applied to be included in any other constituency's electoral roll.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    73 views2 pages

    Application For Inclusion of Name in Electoral Roll For First Time Voter OR On Shifting From One Constituency To Another Constituency

    Uploaded by

    KAUSTUB CHAUHAN
    This document is an application form for inclusion in the electoral roll for the first time. It contains details of the applicant such as name, father's name, age, gender, current and permanent addresses, and a declaration that the applicant is eligible for inclusion. The applicant, Kaustub Chauhan, is requesting to be added to the electoral roll of the Gwalior Assembly/Parliamentary Constituency in Madhya Pradesh as a first time voter. He declares that he is a citizen of India, ordinarily resides at the stated address in Gwalior since 2002, and has not applied to be included in any other constituency's electoral roll.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    Download as pdf or txt
    of 2

    11/8/21, 1:14 PM @ViewBag.

    Title

                                                           
    ELECTION COMMISSION OF INDIA
                                                                        FORM-6
                                                                                                        
    (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,Madhya Pradesh GWALIOR Assembly / Parliamentary
    Consitituency
    I request that my name be included in the electoral roll for the above Constituency.

    (✓) first time voter

    Particulars in support of my claim for inclusion in the electoral roll are given below:-
    Mandatory Particulars
    (a)Name Kaustub कौस्तुब
    (b)Surname(if any) Chauhan चौहान
    (c) Name and surname of Relative
    Ashok
       अशोक
      
    of Applicant [see item (d)]
    (d) Type of Relation Father
    ☑
        
    Mother
    ☐
        
    Husband
    ☐
        
    Wife
    ☐
    (e) Age [as on 1st January of current calendar year
    2022]
    (f) Date of Birth (in DD/MM/YYYY format)(if
    15/05/2002
    known)
    (g) Gender of Applicant (Tick appropriate box) Male
    ☑
        
    Female
    ☐
        
    Third Gender
    ☐
    (h)Current address where applicant is
    House No. GL-344 जीएल-344
    ordinarily resident
    Street/Area/Locality G-Sector, Deen Dayal Nagar जी-सेक्टर, दीन दयाल नगर
    Town/Village Gwalior ग्वालियर
    जी-सेक्टर, दीन दयाल
    Post Office Deen Dayal Nagar Pin Code 474012
    नगर
    District GWALIOR State/UT Madhya Pradesh
    (i) Permanent address of
    House No
    applicant
    Street/Area/Locality
    Town/Village
    Post Office Pin Code
    District State/UT
    (j)EPIC No. (if issued)
    Optional Particulars
    (k) Disability (if any) Visually Impared
    ☐
      
    Speech hearing disabled
    ☐
      
    Locomotor disability
    ☐
      
    Other
    _________
    (l) Email id (optional) kaustubc63@gmail.ocm
    (m) Mobile No.
    8319168091
    (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 Gwalior District GWALIOR State Madhya Pradesh

    (ii) I am ordinarily resident at the address given at (h) above since 15/05/2002 .
    (iii)I have not applied for the inclusion of my name in the electoral roll for any other constituency.

    1/2
    11/8/21, 1:14 PM @ViewBag.Title

    *(iv)My name has not already been included in the electoral roll for this or any other assembly / parliamentary
    constituency
    Applicant Place
    Gwalior
    Applicant Date
    08/11/2021

    2/2

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