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Age Declaration Form

Prashant Tripathi, son of Rajesh Tripathi from Village-Sultanpur Majri Post-Bahadrabad Haridwar(U.K), declared that he has applied for registration in the electoral roll of Jawalapur constituency as his name does not figure in any electoral roll in India. He also declared that he has not been issued any EPIC at any time in the past in any constituency. The declaration was signed by the applicant in Haridwar on 17/01/2022.

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Shashank Tripathi
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765 views1 page

Age Declaration Form

Prashant Tripathi, son of Rajesh Tripathi from Village-Sultanpur Majri Post-Bahadrabad Haridwar(U.K), declared that he has applied for registration in the electoral roll of Jawalapur constituency as his name does not figure in any electoral roll in India. He also declared that he has not been issued any EPIC at any time in the past in any constituency. The declaration was signed by the applicant in Haridwar on 17/01/2022.

Uploaded by

Shashank Tripathi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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ANNEXURE.III
(For Form-6)

DEGLARATION*
(For an elector of 21+ age group seeking fresh registration for the first
time)
1,......
Prashant Tripathi......, Son/DaughterMife ofRajesh ..... R/oVillage-Sultanpur Majri
Tripathi
Post-Bahadrabad Haridwar(U.K) declare as under: -

....
I have applied for registration in the etectorar roll of Jawalapur constituency,
as my name does not figure in electoral rollanywhere in lndia,

2. I have not been issued any EPIC at any time in the past in any constituency.

place:
Haridwar
Signature of the Applicant
Date: 17/01/2022
*(Making false declaration in matters related to
preparation/revision of electorat roll is an offence
punishable under section 3i of the Representation of the
People Act, 1951, and also under the provisions of the
lndian Penat Code)

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