Aotrowlegran: Numbar:-staToroRcznezza2000%2 Submision Date: 27-0-2004 FORMS: (See Rules 13(3) and 26) of the Registration of FoRnio GY 9, Erectors Rules, 1960) Y Y ido ELECTION COMMISSION OF INDIA Voter Application Form for Shifting of Residence/Correction of Entries in Existing Electoral Roll / Replacement of EPIC / Marking of PwD 7, ‘Thefletr ReisatinOfice, No. and ae of AsserblyConstivercy No. [07 Nave Aurangakad (Cental) corha andnane cf etanentay oanstueny No ane (gon funn Tens rat hag legis assay (name oftezpleent- ind bata Kua ECM. cvTINETI96 sathaar Deals (Peas. apropie ) @ sada numba LI LTT [Jo ® anneal uns ry sata hbr ease rt ha Aah obi o4(9) CETTE CI Noslen frat here (alae a CI mal ido af) ral dof ate ay oan ala (W) ‘sibmtapplestonfor (Tiny ens te felomrg) 1 Siting of Rsiere (0) Cconeton of tes stg leo Rl (0 4 sue Relacerent EPIC without eonecon (ot reps trmang ss Peso mig 1. Aplation for hiting of Residence "hare shifted ny siden a equestthat myn may be deleted om the previous aes and shite othe curr aess melon low rues thal arenecamert EPC ma belssud to sve unto changeinmy ads ary tun my ald EE. Present Orinany [_HouseBuldnglaparnert No Sees Lowy Mobaleoad esidresFall | Townsvage rst offce tees) PN Gade Teh Tesi Dee Sat Sattateted copy of adres poo eter inthe nae of appar anyone ofthe parors/epourfadt chi f akeady ele wih at lor atthe ame actose (stich anyone ofthe docurents meron blo“) 1] Weiter adous eles yea 2) mates 2. caer ssseootnsinastsenalt Pot oce 4) sansa 8] reemepepanns nonin csr nt 5. [] etd at eased (ness 7. [_] Registered Sele Deedin case of on house) ary Over (P pect2. Appleton fr Careston of Ene inciting etal ol eae covet olonng dasa Beco PEPE (Mecramofentexpartclrs can be coretd) (Patacek v asp appropnste boxbeloe) Copy fe tested Docurentay Pofin support of clio beatae SPACE FOR PASTING ONE CENT PASSPORT SE 1 [2] New 2 cenit 3 [2] ovate those sto 4] restart 5 een Nae [2] aie Prosar (sc 7 2] mee wont ® ro FRONTAL VEWOF FLL aoe TH MATE BACKORGUND ONL Trecarect parr inten tbe arete ae ane: = PHOTO TOBE CHANGED) SSNOMU OATTATRAVA _KULKARN: (Big Gara rr) pana |e -1-199 SHAM VIVEXANAND NAGAR , HUDCO N'- 12 , AURANGABAD, AURANGABAD. C COLONY So. , 431008 , aurangatad —, Maharastra (ew - 1 = 189, ema RAoric argent 12, atone, Rew vids weak, tin) © [ savoaxz560 Nara Donen support shve clam aches ‘oy Oe Document - MEMBER OF PARLIAMENT AUTHORITY SIGNED ‘oy Oe Document - MEMBER OF PARLIAMENT AUTHORITY SIGNED LETTER Water lecey/as conection Bl for Wat areseatleat 1 ye) « request that aplcemnt EPG maybe eeuatome cat chang my personal cals 1 harby tu my ald EC 7 Alan forts of Replacement EPC wit arecton \rewestht recent Cmey be sudo mes ry org EIS (Puts tick m appropriate box ) 1 jue 2. (7) nto etoremsentaencontl ie nd tral sere 2) mais Un tun mated dE (0 Ihre ached ony of FRc epee eter Ped me seemed at eer sage -¢-appleaton fr Waring Person wth isity caagay of daebiry Tene spo bo for eatagery of aby) Leconte visa (Towra ante (ie deci Prcrtan of ity . cmt stad Tek esprit bn) ve we eLanaON | MERERY DECLARE tht to the best cf my knowisdge and bla that 1am a ctzen of India and | am ane that making a statement or delation which Is fle and which | know 0: Bebite to be false or do not beeve to be bu, is pushale under Section 31 of Representation of the People Act 1950 (43 af 1950) with imprisonment for a fem which may exter to one year or with Fie ot with bath Date 272-2008 oc: AURANGABAD {asset nsactonss inthe igntt prensa ot fights of Pesan wth Dabs Act 2075 ang igh ot Parsons win Usain ules, 017, cast person th iralasa aby, ‘sus cee palsy and lp sabes et, sigue cle hand ta mgs of pson with dsb orc saith hub nosso oss el uti lb eit ~ Submission of ceed coy of memoned dovuneTs wi eoie oped deve of eves ee © ‘Aeknonledgever Reva for appeain e © ® coedgaman amber ¢1910708C2762241200002 ose 2702-2008 Recired the plication inFurm Bf Shi/Snt Ms. Sindh atavey Kula Name/Sigatire of RO/AERO/ELO “This is 2 computer geneatd document and dees nol require signature