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Form6 Hindi

This document appears to be an application form for inclusion in the electoral roll of a constituency in India. It requests the name and details of the applicant be included in the electoral roll. It asks for personal details like name, age, gender, address, relationship to other enrolled voters if any. It contains declarations by the applicant that they are a citizen of India, resident of the given address and haven't applied to another constituency. Space is provided for remarks by election officials processing the application.

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yeshpar
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0% found this document useful (0 votes)
98 views4 pages

Form6 Hindi

This document appears to be an application form for inclusion in the electoral roll of a constituency in India. It requests the name and details of the applicant be included in the electoral roll. It asks for personal details like name, age, gender, address, relationship to other enrolled voters if any. It contains declarations by the applicant that they are a citizen of India, resident of the given address and haven't applied to another constituency. Space is provided for remarks by election officials processing the application.

Uploaded by

yeshpar
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.

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

izk: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 fgUnh esa
miuke ;fn dksbZ gS fgUnh esa
I. vkosnd dk C;kSjk
uke vxzsth esa Capital Letter esa

miuke ;fn dksbZ gS vxzsth esa Capital Letter esa

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 fgUnh esa

miuke ;fn dksbZ gS fgUnh esa

uke vxzsth esa Capital Letter esa

miuke ;fn dksbZ gS vxzsth esa Capital Letter esa

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%
eksckbZy uEcj %

bZ&esy vkbZ0Mh0 %

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

izk: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
&&&&&&&&&&&&&&&&&&&&&&&&&&&
&&&&&&&&&&&&&&&&&&&&&&&&&&&
&&&&&&&&&&&&&&&&&&&&&&&&&&&
&&&&&&&&&&&&&&&&&&&&&&&&&&&
LFkku%
rkjh[k%

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


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

vkosnd ds gLrk{kj ;k vaxwBs dk fukku


d`i;k viuk eksckbZy uEcj ;k bZ&esy vkbZ-Mh- ;FkkLFkku vafdr djus dk d"V djsa

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 izk: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 dk 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; vf/kdkjh vFkkZr~ cwFk yscy vkfQlj] inkfHkfgr vf/kdkjh] i;Zos{kh vf/kdkjh dh fVIif.k;ka

izk:i 6 e'k------d`r dk;Zokgh dh lwpuk


nu dhhdj.k
ikorh
bl ist dk Hkkx&II lacaf/kr fuokZpu {ks= ds fuokZpvkos
d jftLV
vf/kdkjh }kjk Hkjk tk;sxk ,oa vkosnd }kjk Hkkx&I esa
fn;s x;s irs ij Hkstk tk;sxk
-----------------------------------------------------------------------------------------------izFke eksM+-----------------------------------------------------------------------------------------

Hkkx&I
Mkd izs"k.k gsrq
fuokZpd
jftLVhdj.k
vf/kdkjh Mkd
fVdV ;gka
fpidk;k tk;

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


**iwjk uke
edku@njoktk uEcj %
LVhV@{ks=@eqgYyk@jksM+ %
uxj @ xzke dk uke %
iksLV vkfQl %
fiu dksM %
rglhy @ rkyqdk @ %
e.My @ Fkkuk
ftyk %
eksckbZy uEcj %
bZ&esy vkbZ0Mh0
**vkosnd }kjk Hkjk tk;sxkA
-----------------------------------------------------------------------------------------------f}rh; eksM+----------------------------------------------------------------------------------------d
[k

Hkkx&II
Jh@Jherh@dqekjh--------------------------------------------------- }kjk izk:i&6 ij izLrqr vkosnu@nkok Lohd`r dj fy;k x;k gS ,oa fo/kku
lHkk fuokZpu {ks= dh laa[;k ,oa uke-----------------------------------------------------------------------ds Hkkx la[;k------------------------------------------------------ds
ekad---------------------------------ij iathd`r dj fy;k x;k gSA
vkosnu@nkok vLohd`r dj fy;k x;k gSA dkj.k --------------------------------------------------------------------------------------------------------------------------------------

fnukad ------------------------------

fuokZpd jftLVhdj.k vf/kdkjh


irk---------------------------------------------------------------------------------------------------------------------------------

------------------------------------------------------------------------------- fNnz.k-------------------------------------------------------------------------------izk:i&6 ij izkIr vkosnu i= dh izkfIr jlhn


**Jh@Jherh@dqekjh ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------**irk ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------fnukad%----------------------------------------fuokZpd jftLVhdj.k vf/kdkjh
dh vksj ls vkosnu izkIr djus
okys vf/kdkjh dk gLrk{kj
irk-----------------------------------------------------------------------------------------------------* * vkosnd }kjk Hkjk tk, A
&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&

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


lkekU; vuqnsk

izk:i&6 dkSu nkf[ky dj ldrk gS


1ml 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
2fdlh 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
izk:i&6 dc nkf[ky fd;k tk ldrk gS
1fuokZpu&{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
2vkosnu dh dsoy ,d izfr gh nkf[ky djuh gksrh gS A
3uke 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
izk:i&6 dgka nkf[ky fd;k tk,
1iqujh{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
2o"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
izk:i&6 dSls Hkjsa
1vkosnu 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
2uke 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
3mez 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
4fyax
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
5tUe 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)
vf'kf{kr ;k vYi f'kf{kr vkosnd dks ftuds ikl mi;qZDr esa ls dksbZ Hkh nLrkost ugha gSa] vius ekrk ;k firk] ftudk uke igys ls gh fuokZpd
ukekoyh esa lfEefyr gS] }kjk vkosnd dh vk;q ds leFkZu esa fofgr izk:i esa ,d ?kks"k.kk&i= layXu djuk gksxkA fofgr izk:i ekaxs tkus ij
miyC/k djk;k tk,xkA
fVIi.kh%&
vkosnd dh tUe frfFk 26-01-1989 dks ;k mlds ckn gksus dh fLFkfr esa] dsoy uxjikfydk izkf/kdkfj;ksa ;k tUe&e`R;q iathdj.k ftyk dk;kZy;
}kjk tkjh fd;k x;k tUe ek.k&i= gh Lohdk;Z gksxk A
6-

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
7ifjokj 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
8orZeku ekewyh rkSj ls fuokl dk LFkku
fn, x, LFkku esa fiu dksM lfgr ml txg dk iwjk Mkd&irk mfYyf[kr djs]a 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 %
(i)
cSad@fdlku@Mkd&?kj dk pkyw iklcqd] ;k
(ii)
vkosnd dk jk'ku dkMZ@ikliksVZ@Mkbfoax ykblsal@vk;dj 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
fVIi.kh%&
;fn dksbZ vkosnd irs ds izek.k ds :i esa dsoy jk'ku dkMZ izLrqr djrk gS] rks mls mi;qZDr esa ls ,d vkSj izek.k layXu djuk gksxk A
9fuokZpd 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/kdbZ 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 jlhn ,oa lwpuk okys Hkkx izkfIr okys Hkkx ij viuk iwjk uke ,oa irk vo'; vafdr djsaA
d`i;k izk:i ij ;FkkLFkku viuk eksckbZy uEcj ,oa bZ&esy vkbZ0Mh0 (optional) vafdr djus dk d"V djsa rkfd vko';drk iM+us ij lacaf/kr fuokZpu
jftLVhdj.k vf/kdkjh }kjk vkosnd ls lEidZ fd;k tk ldsA

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