Guidelines for filling-up the BLO H2H survey format

 The BLO register is being printed in two varieties:

i) One set to cover 200 households ii) Another set which can cover 100 households.
BLOs of the polling booths covering more than 200 households will be provided with a
second register of either of the varieties noted above, considering the number of
households in that particular part. If a single register is used for a polling station then
BLO shall indicate the book nos. as ‘’ Book no.1 / 1’ . If more than one register is being
used for a polling station then BLO shall indicate the book nos. as ‘ Book no. 1 /2’ and
Book no. 2/2’.
 The BLO will prominently note the number and name of the Assembly Constituency
and number and name of the Polling Station on the cover page of the Register.
 Map-There is space for providing Nazari Naksha of Polling Station Area which has to
be hand-drawn by the BLO.
 House to House Survey Format- Data for every household/family shall be captured in
a single unified format covering 02 pages of the register. The Following point-wise
information may be captured:
i) House Number- The house number as available in the E-Roll i.e either the actual
no. as per Panchayat/ Municipal Register or NHN(notional house number)of E.Roll
is to be written
ii) Section no.-to be written from E.Roll
iii) Total persons in the family- In the page 1 of the register in the top portion (before
the table to capture the detailed information of the individual members) the count
in numbers of all living members of the family including children from 0(zero) years
of age to be written along with the gender data. This information will help calculate
EP ratio of the polling station area more precisely.
iv) Particulars of Enrolled Family Members-The details to be captured in the tabular
format regarding, serial number/ gender/ DOB/ relationship with head of family/
PWD status/ Photograph quality/ Error in EPIC or entry in E.roll, /whether shifted
or deceased.
v) Particulars of the Un-enrolled Family members- The details to be captured in the
tabular format with information of the un-enrolled family members starting from
the age group of 15+ or above as on 01.01.2023 and in the subsequent qualifying
dates i.e. 01/4/2023, 1/08/23, 1/10/23.
 Synoptic Report in 04 additional formats on the following reporting parameters needs
to be prepared:
 i) Format A-List of un-enrolled eligible 18+ citizens
ii) Format B- List of prospective electors of 15+/16+/17+ who will be eligible
for enrolment in each of the four quarter in the following years
iii) Format C- List of dead/ permanently shifted electors
iv) Format-D- List of PWD electors with type of disability
v) Format E- List of electors with blurred/non-standard images to whom form-
8 has been given
This year only the formats for the 1st survey has to be prepared. These format reports will be
utilized for digitization of the records after the BLO H2H survey.
 Notes- the 2 blank pages provided as ‘ notes’ maybe utilized for recording any
important notes by the BLO including information on prospective oversees electors,
new settlements coming up etc.
 Ink to be used for filling up the BLO register- A BLO register is designed for a period
of 3 years. To identify the year- wise work done different colored ink is to be used.
The year wise color of ink to be used as follows:
- 1st Year(2022)- Blue Ink
- 2nd Year (2023)- Green Ink
- 3rd year (2024)- Red Ink
 House to House Survey Format for preparation of BLO Register
Number of Total person in the family (all living members
including children from 0 yr) :-
Name of Polling station :- Part No.:- HouseHold No.:- Male:- Female: Third Gender:

If, Whether
Whether
Year of eligability in appropiate quarter as per DOB Permanently Whether ***If Yes Form
Enrollment Sl No. in E-Roll (for enrolled Whether Whether Whether Photograph Whether
mentioned in col 11. (for unenrolled 18+/17+/16+/15+ Shifted / **If PWD write correction please 6/7/8
status *Relation members) EPIC Number ( in case Date of Birth Aadhar if no, whether Permanentl Certificate of is Non Form
Name of the Family Sex (M/F/ members) Dead then category of Percentage is required specify as Received
Sl No. (Enrolled/Un- with Head of enrolled or enrolled (DD/MM/YYY Mobile No E-Mail id already Form 6B y Shifted disability is Standard/Bl 6/7/8
Members TG) from which disability as VI / of disability in entries (any Four) Back
enrolled) of Family in different ac/part) Y) verified collected (Y/N) (S) / Dead available ack & white/ Distribute
Year & SHD / LD / O of E-roll or N/G/D/RT/
[E/U] (Y/N) (D) (Y/N) Blurred d
1st qtr(01 2nd qtr(01 3rd qtr(01 4th qtr(01 Month EPIC (Y/N) RN/A/M/P
!st Yr 2nd Yr 3rd yr (Y/N)
January) April) July) october) (MM/YYYY)
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
Self

* Relationship- Head of the Family(Self),Husband(H),Wife (W), Son (S), Daughter (D), Son-in-law (SL), Daughter-in-Law (DL), Grand Son (GS), Grand Daughter (GD), Brother(B),Sister(S),Others (O)

** Visual impairment (VI); Speech & hearing disability (SHD); Locomotor disability (LD); Others (O)
***Name (N); Gender (G); DoB/Age (D); Relation Type (RT); Relation Name (RN); Address (A) Mobile Number (M); Photo (P)

Date of 1st Vist : Signature of BLO : Date of 2nd Vist : Signature of BLO : Date of 3rd Vist : Signature of BLO :

Signature of family Signature of family

Signature of family member :
member : member :
 List of un-enrolled eligible 18+ citizens - Who are yet to be enrolled
Format - A
AC No. and Name: Part Number:
Details of Relative already enrolled in E-Roll
Details of Eligible Person in the same Part
**If PWD
House write *Relation
Sl. Number Whether
category Whether with the
No. (actual/ Sex Form 6
of Form 6 un-
NHN) Name of the Person (M/F/ Mobile no. E-mail id received Name EPIC no.
disability distributed enrolled
TG) back
as VI / (Y/N) eligible
(Y/N)
SHD / LD person
/O
1 2 3 4 5 6 7 8 9 10 11 12

Signature of BLO
Name of BLO
* Relationship- Father (F), Mother (M), Spouse (S), Other (O)
** Visual impairment (VI); Speech & hearing disability (SHD); Locomotor disability (LD); Others (O)
 List prospective electors of 17+ - Who will be eligible for enrolment in the 4 quarters of 2023
Format - B
AC No. and Name: Part Number:
Details of Eligible Person (Quarter-wise) Details of Relative already enrolled in E-
Action taken
Hous Roll in the same Part
e
Num **If PWD *Relation
Sl. Whether Whether If enrolled, Sl. no. in
ber Sex write category with the un-
No. Form 6 Form 6 E-Roll
(actu Name of the Person (M/F/ of disability as Name enrolled EPIC no.
al/N distributed received (to be filled-up
TG) VI / SHD / LD eligible
HN) (Y/N) back (Y/N) subsequently)
/O person

1 2 3 4 5 6 7 8 9 10 11

Signature of BLO
Name of BLO

* Relationship- Father (F), Mother (M), Spouse(S)), Other (O)

** Visual impairment (VI); Speech & hearing disability (SHD); Locomotor disability (LD); Others (O)
 List of Dead/Permanently Shifted Electors/Multiple entries
Format - C
AC No and Name: Part Number:

House Proposed reason for Dead/Permanently Form -7

Sex Sl No.
Sl. Number deletion Shifted from which collected or
Name of the Elector (M/F/ in E- EPIC No.
No. (actual/N (Dead/Permanently Year & Month Notice issued
TG) Roll
HN) Shifted electors) (MM/YYYY) (Y/N)

1 2 3 4 5 6 7 8 9

1st Survey
Signature of BLO
Name of BLO
 List of PWD electors with type of disability
Format - D
AC No and Name: Part Number:

Type of Disability
Whether
House Sl No. Speech & Percentage
Name of the Sex (M/F/ Visual Locomotor Certificate
Sl. No. Number in E- EPIC No. Mobile No. E-mail id hearing Others of
Elector TG) impairment disability available
(actual/NHN) Roll disability (O) disability
(VI) (LD) (Y/N)
(SHD)

1 2 3 4 5 6 7 8 9 10 11 12 13 14

1st Survey
Signature of BLO
Name of BLO
 List of electors with Non Standard/Black & white/ Blurred images
Format - E
AC No and Name: Part Number:

Form 8 for
Whether Photograph is Form 8
House Number Name of the Sex (M/F/ Sl No. in E- Photo
Sl. No. EPIC No. Mobile No. E-mail id Non Standard/Black & returned
(actual/NHN) Elector TG) Roll Correction
white/ Blurred (Y/N) back
issued

1 2 3 4 5 6 7 8 9 10 11

1st Survey
Signature of BLO
Name of BLO