Form6 S06005O6N1203241200023 PDF

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FORM-6 (Se Fuls 12) an (28 fe Registrar o Ets Rules, 90) Actrolgenet ‘ OG FIECTION COMMISSION OF EIA | voSuesonsozeos Y ELECTION COMMISSION OF INDIA (Tobey) Application Form for New Voters To, The Ector Rgisaton fice, No. BNameot Asan Centtueney No Name: Gandia Na 8 Naneot atanerta Contueny® No (On fein Teries nothing Lear Asamy |suimt plcatonforncse ofmy anelnte ctrl fh shove canter. (1)}a)Nane none Language of Sia) First Name followes by Micde Name Ales deg Sumane i ery) eis (19) Namen Engin BLOCK LETTERS) Fest ame flows by MédeNane MATIC RTESHKUMAR, Suma i ey) TANK Dislsmer ramen len Engh tl beans ty softs. "2a Nar and Surname fro langvage of Stat of ans neo the eles Faber [ Or Motes Or Hustard o wie o ly Lesa un cas of orn Thies Genser I (2) Nameand Sumame(hEnglsh in BLOCK LETTER) fhe eae mention above RTESH TANK Baeiais (2) Mabie No Se it rae) fate manor at em Ne 2 (@)EalD cf Se (fatale) naftturar336p9nlLcom o fave manor at em Ne 2 (5) Aathaar etic (sender (7)@)pateor ern (cums) (b) Sat teste op of ovum supartng age poo athe anjoe a he allowing) () documento Pra ef Date ct Bet)" (yen hes) Biren ised Competent orl Byun Atory Rest of Bis & Det a) taro al] pancas AT) brig ease 5] | Cnieates of Class Xor es lsuedbyCBSENGSE/ Site EdveatarBos it com Date of Birth 6) Indian Passpon (Any Oe Decent fo roa of Dato Bit io document is aalte (. Spy (Ba) Present Orda esdence Fa Ades) HoustBuldng/aparmentNo. lotNa129, uray No.8 vo, 1294838 | sveeirearocay vnayanapar soety Fes aa aauo2l “Teh auga/Mantl Gandia tie Townyitage Antal ear Post Ofice Antajlelaene Sate Guat Dstt Kacedh cose sraz0s (b)Setsteste ony of ates pot etherin the name oan or ary one of parents spowead shi. aes eral a ecto at the ear des (ch amae of the) (9 doeamentor pot of eedence 1) Waterexetitycas coenectn Born attests 1 yea) (curertpasheok of Norse Schedule ant Post Ofce al] nda Passport eran Deporiments Land Owning eco ncuing Kn Bahl 6[ | nagsteret rent easeDeed(naseot tra) 2) dataarcae Registre Sate Dedincasof om house) (try Oe Decuentfor roa of rein to dcunt sabe. Speci) (syaegery of sbi. ny Opto) Locomete sat esta LJ oa any omer (Ge csertn: Percentage ct dsabiy Fcenicateatisced(Tektheapromstedo) Yes) No (107 eta of ry oily ender steady nun he etal curr aes wih wom] cuent rs rea under Nome ot amy meter RITESH TANK Pltorshp wth apa ater mer EPC DECLARATION: | HEREBY DECLARE ato he bet of ny kroledge ad bale (1am actzn of nia an place of my bith is-Touniage Bata Diet Katee Ste: iat (i) ae oral ein th tees manoned tS No, infor sae: 2011-06 (aan eppying for ncuson Ector Rotor the ine and my ane tinued nay AsseniyConstueny/ Patent Corstiueny (in) do psees ayo the dcuments of age pro. Therefore, have enlse: Name te document ie support fae pra (Stike fi ot appeal) (0) Lam aware tat making the above statement or declan in elton tis sppeaton ich fee and whic know aber tobe fale cd ot bleve io be tu, punishable under Sestn 31 ‘of eeasonatin fh Pople et, 950 (43 of 98) wth mprsonment ors em wich may xan tan yer rw eo with bath DaTest203-2024 PLACE ANOHIDHAM ‘Access Instruction nthe ght of prosos eg of Peron with ibis Ac 201 and igs of Person wth Diels les, 2017,n at of person with ileal aby atin, cerebral ply an mpl bites ee, satu ort and thumb impression of econ ith deity or satu or ethan thunk impression of hers uaa wil berequre tae * [Incas marie foal applet same asband may prea be mentioned |Site ase atiested copy of docunert wil esa speedy avery of sevice. Incase ae ofthe documents iva eld vefatns mus As fr erampl category Ike homeless Ilan izes who ae others eigleo became eects but oot possess ay acura pot fray eine, eta Repistatin Ofer sal einate anole fr el vieaton laautgenecet Aetnnlgener Number SDsSOEN202 2023 are rayne Ace be apatin n Fm 6 Sh/SMs NATCRITESHRUNARTANK Gs eg is [gliat cane the Sennen No. tchck thst of pict “This fsa computer generated document and does ot require signature

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