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¿Fu E 13 1 VKSJ 26 NSF (K, À

This document appears to be an application form (Form 6) for inclusion of a person's name in the electoral roll of a constituency in India. The form requests information such as the applicant's name, age, gender, address, relationship to other family members already included in the electoral roll, and a declaration that the applicant is a citizen of India residing at the address provided. It also states that if the applicant was previously included in the electoral roll of another constituency, their name will be removed from that roll upon approval of this application.

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Baljeet Singh
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© Attribution Non-Commercial (BY-NC)
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0% found this document useful (0 votes)
102 views5 pages

¿Fu E 13 1 VKSJ 26 NSF (K, À

This document appears to be an application form (Form 6) for inclusion of a person's name in the electoral roll of a constituency in India. The form requests information such as the applicant's name, age, gender, address, relationship to other family members already included in the electoral roll, and a declaration that the applicant is a citizen of India residing at the address provided. It also states that if the applicant was previously included in the electoral roll of another constituency, their name will be removed from that roll upon approval of this application.

Uploaded by

Baljeet Singh
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Hkkx la[;k@Part No.

------------------

iz:i 6

fu;e 13 1 vkSj 26 nsf[k,


fuokZpd ukekoyh esa uke lfEefyr fd, tkus ds fy, vkosnu
lsok esa

gky gh esa [khapk x;k


ikliksVZ vkdkj dk QksVks
3-5 ls0eh0 x 3-5 ls0eh0]
ftlesa bl ckWDl ds Hkhrj
iwjs psgjs ds lkeus dh
vkd`fr Li"V gks] fpidkus
ds fy, LFkku

fuokZpd jftLVhdj.k vf/kdkjh]


------------------------------fo/kku lHkk@lalnh; fuokZpu&{ks=

egksn;]
eSa izkFkZuk djrk gw fd mDr fuokZpu&{ks= ds fy, fuokZpd ukekoyh esa esjk uke lfEefyr dj fy;k tk, A fuokZpd ukekoyh
esa lfEefyr fd, tkus ds fy, esjs nkos ds leFkZu esa C;kSjs uhps fn;s x;s gSa A
uke
miuke ;fn dksbZ gS
I. vkosnd dk C;kSjk

1 tuojh-------------------------# dks vk;q

o"kZ%

ekl%

fyax iq:"k@L=h@vU;%

tUe frfFk] ;fn Kkr gS%

fnu%

Ekkl%

o"kZ%

tUe dk LFkku%

xzke@uxj%

*firk@ekrk@ifr dk uke

ftyk%

jkT;%

uke

miuke ;fn dksbZ gS

II. ekewyh rkSj ls fuokl LFkku dk fooj.k iwjk irk


edku@x`g la[;k%
xyh@{ks=@ifj{ks=@
eksgYyk@lM+d%
uxj@xzke%
Mkd?kj%

fiu dksM

rglhy@rkyqd@eaMy@Fkkuk%
ftyk%
III. fuokZpu {ks= dh orZeku fuokZpd ukekoyh esa igys ls gh lfEefyr fd, x, vkosnd ds ifjokj ds lnL;;ksa dk C;kSjk%
uke
vkosnd ds lkFk fuokZpu&{ks=
ml Hkkx esa e fuokZpd dh QksVks igpku&i= la[;k
lEca/k
dh
ukekoyh la[;k
dh Hkkx la[;k
12
#

mu la?k jkT;ksa {ks=ksa ftuesa fo/kku lHkk ugha gSa vkSj tEew vkSj d'ehj jkT; ds ekeys esa A
i;k o"kZ mfYyf[kr djsa tSls 2011] 2012 vkfn A
vuqi;qDr fodYi dks dkV nsa A

iz:i 6 e'k------IV. ?kks"k.kk


eSa ?kks"k.kk djrk gw fd vius loksZke Kku vkSj fo'okl ds vuqlkj %&
(i)
eSa Hkkjr dk ukxfjd gw (
(ii)
eSa------------------------------------------ rkjh[k] ekl] o"kZ ls mi;qZDr Hkkx&II esa fn, x, irs ij ekewyh rkSj ls fuoklh gw (
(iii)
eSaus fdlh vU; fuokZpu&{ks= dh fuokZpd ukekoyh esa viuk uke lfEefyr fd, tkus ds fy, vkosnu ugha fd;k gS (
(iv)
*bl ;k fdlh vU; fo/kku lHkk fuokZpu&{ks= dh fuokZpd ukekoyh esa esjk uke igys ls gh lfEefyr ugha fd;k x;k gS
;k
*esjk uke ------------------------------------------------ jkT; ds -------------------------------------------fuokZpu&{ks= ds] ftlesa eSa uhps mfYyf[kr irs ij
igys ls gh ekewyh rkSj ls fuokl dj jgk Fkk] fuokZpd ukekoyh esa lfEefyr dj fy;k x;k gksxk vkSj ;fn ,slk gS rks eSa
izkFkZuk djrk gw fd mls ml fuokZpd ukekoyh ls gVk fn;k tk, A
iwjk irk ekewyh rkSj ls fuokl dk iwoZ LFkku
&&&&&&&&&&&&&&&&&&&&&&&&&&&
&&&&&&&&&&&&&&&&&&&&&&&&&&&
&&&&&&&&&&&&&&&&&&&&&&&&&&&
&&&&&&&&&&&&&&&&&&&&&&&&&&&

fuokZpd QksVks igpku&i= la[;k ;fn igys ls gh tkjh gS


&&&&&&&&&&&&&&&&&&&&&&&&&
tkjh djus dh rkjh[k&&&&&&&&&&&&

LFkku%
rkjh[k%

vkosnd ds gLrk{kj ;k vaxwBs dk fukku

d`i;k viuk eksckbZy uEcj @ bZ&esy vkbZ-Mh- nsa ,sfPNd&&&&&&&&&&&&&&&&&&


fVIi.kh%& dksbZ O;fDr ,slk dFku ;k ?kks"k.k djrk gS tks feF;k gS vkSj ftlds feF;k gksus dk ;k rks mls Kku ;k fookl gS ;k
ftlds lR; gksus dk mls fookl ugha gS] og yksd izfrfuf/kRo vf/kfu;e] 1950 1950 dk 43 dh /kkjk 31 ds v/khu
naMuh; gksxkA
*vuqi;qDr fodYi dks dkV nsa A
dh xbZ dkjZokbZ ds C;kSjs
fuokZpu&{ks= ds fuokZpd jftLVhdj.k vf/kdkjh }kjk Hkjk tkuk gS
Jh@Jherh@dqekjh----------------------------------------------------- ds fuokZpd ukekoyh esa uke lfEefyr fd, tkus gsrq iz:i 6 esa fn;s x;s
vkosnu dks *Lohdkj dj fy;k x;k gS@ *ukeatwj dj fn;k x;k gSA
*Lohdkj djus fu;e 18* @20* @264 ds v/khu ;k mlds vuqlj.k esa ;k *ukeatwj djus fu;e 17@20* @264 ds v/khu
;k mlds vuqlj.k esa ds fy, foLr`r dkj.k%
LFkku%
fnukad%

fuokZpd jftLVhdj.k vf/kdkjh ds gLrk{kj


fuokZpd jftLVhdj.k vf/kdkjh dh eqgj
fuokZpd ukekoyh ds vafre izdk'ku ds i'pkr~ mlds lrr~ v|rhdj.k ds nkSjku A
*
vuqi;qDr fodYi dks dkV nsa A
&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
{ks=h; inkf/kdkjh vFkkZr~ cwFk yscy vf/kdkjh] inkfHkfgr vf/kdkjh] i;Zos{kh vf/kdkjh dh fVIif.k;ka

;g i`B bruk l?ku gksuk pkfg, fd ;g Mkd }kjk Hksts tkus ij fod`r@{kfrxzLr u gks

iz:i 6 e'k----------------

d`r dk;Zokgh dh lwpuk


vkoshndj.k
u dhvf/kdkjh
ikorh }kjk Hkjk tk;sxk ,oa vkosnd }kjk Hkkx&I esa nkkZ,
bl i`B dk Hkkx&II fuokZpu {ks= ds fuokZpd jftLV
x;s irs ij vkosnd dks Hkstk tk;sxk
------------------------------------------------------------------------------------------------------------------izFke eksM+-----------------------------------------------------------------------------------------------------------------------

Hkkx&I
Mkd izs"k.k ds
le; fuokZpd
jftLVhdj.k
izkf/kdkjh }kjk
Mkd fVdV
fpidk;k tk,

iz:i&6 ij **Jh @Jherh @dqekjh-----------------------------------------------------------------------------dk vkosnu i=


** iwjk irk
edku@x`g la[;k %
xyh@{ks=@ifj{ks=@eksgYyk@lM+d%
uxj @ xzke %
Mkd ?kj %
fiu dksM %
rglhy @ rkyqd @ %
e.My @ Fkkuk
ftyk %
**vkosnd }kjk Hkjk tk;sxkA
----------------------------------------------------------------------------------------------------------f}rh; eksM+------------------------------------------------------------------------------------------------------------------------Hkkx&II
d
Lohd`r dj fy;k x;k gS vkSj Jh@Jherh@dqekjh----------------------------------------------------------------------------------------------dk uke fo/kku lHkk
fuokZpu {ks= -------------------------------------------------------dh Hkkx la[;k-----------------------------------------------dh ekad---------------------------ij iathd`r dj
fy;k x;k gSA
[k
------------------------------------------------------------------------------------------------------------------------------------------- dkj.k ls vLohd`r fd;k x;k gSA
fnukad ------------------------------

fuokZpd jftLVhdj.k vf/kdkjh


irk ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------fNnz.k------------------------------------------------------------------------------------------------------------------------------

vkosnu dh ikorh
**Jh@Jherh@dqekjh -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------**irk -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ls iz:i 6 esa vkosnu izkIr fd;k A
fnukad%-----------------------------------------

fuokZpd jftLVhdj.k vf/kdkjh


dh vksj ls vkosnu izkIr djus
okys vf/kdkjh ds gLrk{kj
irk------------------------------------------------------------------------------------------------------

* * vkosnd }kjk Hkjk tk, A


&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&

vkosnu iz:i&6 Hkjus ds fy, fn'kk&funsZ'k


lkekU; vuqnsk
iz:i&6 dkSu nkf[ky dj ldrk gS
1-

ml o"kZ dh tuojh dh igyh rkjh[k dks ftlds lanHkZ esa fuokZpd ukekoyh dk iqujh{k.k fd;k tk jgk gS] 18 o"kZ ;k mlls vf/kd
mez dk O;fDr tks igyh ckj vkosnu ns jgk gSA

2-

fdlh fuokZpu&{ks= dh fuokZpd ukekoyh esa igys ls gh jftLVhd`r og fuokZpd ftldk ekewyh rkSj ij fuokl LFkku vU; fuokZpu
{ks= esa LFkkukarfjr gks x;k gSA

iz:i&6 dc nkf[ky fd;k tk ldrk gS


1-

fuokZpu&{ks= ds fuokZpd ukekoyh ds izk:i izdk'ku ds i'pkr~ vkosnu nkf[ky fd;k tk ldrk gS A vkosnu] bl iz;kstu ds fy,
fofufnZ"V fnuksa ds Hkhrj gh nkf[ky fd;k tkuk gksrk gS A tc iqujh{k.k dk;Ze dh mn~?kks"k.kk gksrh gS] rc mi;qZDr vof/k ds fo"k;
esa O;kid izpkj fd;k tkrk gS A

2-

vkosnu dh dsoy ,d izfr gh nkf[ky djuh gksrh gS A

3-

uke lfEefyr djus ds fy, vkosnu iqujh{k.k dk;Ze tkjh ugha jgus ij Hkh o"kZ esa dHkh Hkh nkf[ky fd;k tk ldrk gS A
xSj&iqujh{k.k vof/k ds nkSjku vkosnu nks izfr;ksa esa nkf[ky fd;k tkuk pkfg, A

iz:i&6 dgka nkf[ky fd;k tk,


1-

iqujh{k.k vof/k ds nkSjku vkosnu mu vfHkfgr LFkkuksa k;% ernku dsU LFkyksa ij] tgka k:i fuokZpd ukekoyh iznfkZr dh tkrh
gS] ds lkFk&lkFk fuokZpu&{ks= ds fuokZpd jftLVhdj.k vf/kdkjh ds ikl nkf[ky fd;k tk ldrk gSA

2-

o"kZ dh vU; vof/k ds nkSjku tc iqujh{k.k dk dk;Z ugha py jgk gks] rc vkosnu dsoy fuokZpd jftLVhdj.k vf/kdkjh ds ikl gh
nkf[ky fd;k tk ldrk gS A

iz:i&6 dSls Hkjsa


1-

vkosnu ml fuokZpu&{ks= ds fuokZpd jftLVhdj.k vf/kdkjh dks lacksf/kr fd;k tkuk pkfg,] tgka vki jftLVh djokuk pkgrs gSa A
[kkyh LFkku esa fuokZpu&{ks= ds uke dk mYys[k fd;k tkuk pkfg, A

2-

uke nLrkosth lk{; ds lkFk


uke] tSlk fd mls fuokZpd ukekoyh rFkk fuokZpd QksVks igpku i= bZ-ih-vkbZ-lh- esa gksuk pkfg,] mfYyf[kr fd;k tkuk pkfg, A
miuke dks NksM+dj iwjk uke igys [kkus esa fy[kk tkuk pkfg, rFkk miuke nwljs [kkus esa fy[kk tkuk pkfg, A vkidk miuke ugha
gksus dh n'kk esa dsoy fn;k x;k uke gh fy[ksa A ,sls ekeys] tgka tkfr ds uke dk mYys[k fuokZpd ds uke ;k miuke ds va'k ds
:i esa iz;qDr gS dks NksM+dj] vU;= ugha fd;k tkuk pkfg, A lEeku lwpd info;ksa tSls Jh] Jherh] dqekjh] [kku] csxe] iafMr
bR;kfn dk mYys[k ugha fd;k tkuk pkfg, A

3-

mez nLrkosth lk{; ds lkFk


ml o"kZ dh 1 tuojh] ftlds lanHkZ esa fuokZpd ukekofy;ksa dk iqujh{k.k fd;k tk jgk gS] dks vkosnd dh mez vBkjg o"kZ ;k vf/kd
gksuh pkfg, A mez o"kZ vkSj eghuksa esa n'kkZ;h tkuh pkfg, A
mnkgj.k ds :i esa og O;fDr ftldk tUe 01-01-1991 dks ;k mlds igys gqvk gS] 01-01-2009 ds lanHkZ esa iqujhf{kr fuokZpd
ukekoyh esa viuk uke lfEefyr djk, tkus dk ik= gksxk A ftl O;fDr dk tUe 02-01-1991 ;k mlds ckn rFkk 01-01-1992
rd gqvk gS] og 01-01-2010 ds lanHkZ esa gksus okys iqujh{k.k ds lanHkZ esa uke lfEeyu ds fy, ik= gksxk A

4-

fyax
fn, x, LFkku esa vius fyax dk Li"V :i ls mYys[k djsa] tSls fd iq:"k@efgyk A ;fn vkosnd iq:"k ;k efgyk dk mYys[k djuk
ugha pkgrs rks os vius fyax dks vU; fy[k ldrs gSaA

5-

tUe frfFk nLrkosth lk{; ds lkFk


tUe frfFk dks fnukad@ekg@o"kZ bl e esa fu/kkZfjr LFkku esa vadksa esa HkjsaA tUefrfFk ds izek.k ds :i esa fuEufyf[kr lk{; layXu
djsa%&
(i)

uxj ikfydk izkf/kdkfj;ksa ;k ftyk fuca/kd] tUe o e`R;q iathdj.k ds dk;kZy; }kjk tkjh fd;k x;k tUe izek.k&i= ;k
cSIVhte izek.k&i= ( ;k

(ii)

vkosnd }kjk nkf[kyk fy, x, vafre ljdkjh@ekU;rk izkIr fo|ky; ;k vU; ekU;rkizkIr 'kS{kf.kd laLFkku ls izkIr tUe
izek.k&i= ( ;k

(iii)

;fn O;fDr us nloha d{kk ;k blls vf/kd mkh.kZ dh gks] rks mls nloha d{kk dh vadrkfydk dh izfrfyfi nsuh pkfg,
;fn mlesa lk{; ds :i esa tUe frfFk vUrfoZV dh xbZ gks] ;k

(iv)

vkBoha d{kk dh vadrkfydk ;fn mlesa tUe frfFk vUrfoZV gks] ;k

(v)

ikapoha d{kk dh vadrkfydk ;fn mlesa tUe frfFk vUrfoZV gks] ;k

(vi)

;fn O;fDr nloh d{kk rd fkf{kr ugha gS rks mlds ekrk &firk }kjk fu/kkZfjr izi= vuqcU/k&1 ij ?kksk.kk dh tkuh gS
mu ekeyksa esa tgkaW vk;q ds lk{; ds :i esa iSr`d ?kksk.kk dh tkrh gS] vkosnd dks lR;kiu gsrq cwFk ysoy vf/kdkjh@
fuokZpd jftLVhdj.k vf/kdkjh@ lgk;d fuokZpd jftLVhdj.k vf/kdkjh ds le{k Lo;a mifLFkr gksuk gksxkA

(vii)

fVIi.kh%&

6-

;fn O;fDr nloh d{kk rd fkf{kr u gks ,oa nksuksa ekrk&firk thfor u gks] rks lEcfU/kr xzke iapk;r ds iz/kku@ljiap
;k lEcfU/kr uxj fuxe@ uxj ikfydk ds lnL; }kjk tkjh fd;k x;k mldh vk;q dk izek.k&i= fn;k tk,A
vk;q lEcU/kh nLrkosth lk{; dsoy mu ekeyksa esa gh vko;d gksaxs tgkaW vkosnd dh vk;q 18 vkSj 21 okkZsa ds e/;
gks A vU; lHkh ekeyksa esa vkosnd ds }kjk viuh vk;q ds lEcU/k esa dh xbZ ?kksk.kk] vk;q lk{; ds :i esa yh tk;sxh A

tUe LFkku
tUe LFkku Hkkjr esa gksus dh n'kk esa] d`i;k LFkku dk uke tSls xzke@'kgj] ftyk] jkT; dk mYys[k djsa A

7-

ifjokj ds vU; lnL; dk uke%


vfookfgr efgyk vkosnd ds ekeys esa firk@ekrk ds uke dk mYys[k fd;k tk, A fookfgr efgyk vkosnd ds ekeys esa ifr ds
uke dk mYys[k fd;k tk, A bl LraHk ls vuqi;qDr fodYiksa dks dkV nsa A

8-

orZeku ekewyh rkSj ls fuokl dk LFkku


fn, x, LFkku esa fiu dksM lfgr ml txg dk iwjk Mkd&irk mfYyf[kr djsa] tgka vki ekewyh rkSj ls fuokl djrs gSa rFkk
iathdj.k djkuk pkgrs gSa A
orZeku ekewyh rkSj ls fuokl LFkku ds fy;s fuEufyf[kr lk{; layXu djsa %

fVIi.kh%&

(i)

cSad@fdlku@Mkd&?kj dk pkyw iklcqd] ;k

(ii)

vkosnd dk jk'ku dkMZ@ikliksVZ@Mkbfoax ykblsal@vk;dj fjVuZ ;k fu/kkZj.k vkns'k ( ;k

(iii)

vkosnd ;k muds fudV laca/kh tSls ekrk&firk vkfn ds uke ls ml irs ij v|ru ty@VsyhQksu@ fctyh@xSl
dusD'ku fcy ( ;k

(iv)

Mkd foHkkx }kjk fn, x, irs ij izkIr dh xbZ@lqiqnZ dh xbZ Mkd A


cs?kj O;fDr;ksa ds ekeys esa cwFk ysoy vf/kdkjh dks vfHkfupr djus gsrq iz:i 6 esa fn;s x, irs ij jkf= esa tkuk gksxk fd
cs?kj O;fDr LFkku ij okLro esa lksrk gS tSlkfd mlus iz:i 6 esa viuk irk fn;k gSA ;fn cwFk ysoy vf/kdkjh lR;kiu djus
esa leFkZ gks tkrk gS fd cs?kj O;fDr ml LFkku esa okLro esa lksrk gS] rks vkoklh; LFkku ds nLrkosth lk{; ysus vko;d ugha
gksaxsA cwFk ysoy vf/kdkjh dks ,sls lR;kiu djus gsrq ,d jkr ls vf/kd ckj tkuk pkfg,A

9-

fuokZpd ukekoyh esa igys ls lfEefyr ifjokj ds lnL;ksa ds C;kSjs d`i;k fudV ikfjokfjd lacaf/k;ksa tSls
firk@ekrk@HkkbZ@cgu@ifr@iRuh dk uke o vU; C;kSjs mfYyf[kr djsa ftudks orZeku fuokZpd ukekoyh esa 'kkfey dj fy;k
x;k gSA fdlh vU; lEca/kh tSls pkpk] pkph] ppsjs HkkbZ@cgu vkfn ds uke dk mYys[k ugha fd;k tkuk gSA

10-

?kks"k.kk
d`i;k ml frfFk dks bafxr djsa] tc ls vki fn, x, irs ij fuokl dj jgs gSa A ;fn fuf'pr frfFk] Kkr u gks rks eghuk o o"kZ
dk mYys[k djsa A
;fn vkidk uke igys gh fdlh vU; fuokZpu {ks= dh fuokZpd ukekoyh esa lfEefyr fd;k tk pqdk gS] rks d`i;k fiu dksM ds lkFk
viuk iwoZ dk iw.kZ irk Li"V v{kjksa esa fy[ksa A
;fn vkids ikl igys ls fuokZpu vk;ksx }kjk tkjh QksVks igpku i= gS] rks i;k igpku i= dk ekad lkeus dh vksj eqfnzr ,oa
mlds tkjh gksus dh frfFk ihNs dh vksj eqfnzr vkosnu i= ds iznk LFkku esa mfYyf[kr djsaA i;k igpku i= ds nksuks rjQ dh
Nk;kizfr LovfHkizekf.kr dj layXu djsaA

fofo/k
dbZ LFkkuksa ij fuokZpd ukekoyh esa fuokZpd dh QksVks Hkh eqfnzr gS A vkids ikl izk:i ds lkFk ,d ikliksVZ vkdkj dh uohure jaxhu QksVks
tek djus dk fodYi gSA ;fn visf{kr gqvk] rks bl QksVksxzkQ dk mi;ksx fuokZpd ukekoyh ij vkidh Nfo eqfnzr djus rFkk QksVks igpku
i= tkjh djus ds fy;s fd;k tk,xkA
d`i;k lwpuk rFkk ikorh ds Hkkx esa viuk iwjk uke ,oa irk Hkh fy[ksa A
d`i;k iz:i esa viuk eksckbZy uEcj ,oa bZ&esy vkbZ-Mh- nsa] tksfd ,sfPNd gS] D;ksafd ;g] ;fn fn;k x;k gks] rks fuokZpd
jftLVhdj.k vf/kdkjh }kjk tc Hkh vko;d gks vkosnd ds lkFk vkxkeh i=&O;ogkj@lEidZ gsrq iz;ksx fd;k tk ldrk gSA

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