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Vishnu Rathod has applied for inclusion of his name in the electoral roll for the first time. He provides details such as his name, father's name, age, date of birth, gender, current and permanent addresses, disability status (if any), email, mobile number, and a declaration of his citizenship and ordinary residence at the provided address since 2011. He declares that he has not applied for inclusion in any other constituency's electoral roll and that his name is not already included in any other constituency.

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30 views2 pages

@ViewBag Title

Vishnu Rathod has applied for inclusion of his name in the electoral roll for the first time. He provides details such as his name, father's name, age, date of birth, gender, current and permanent addresses, disability status (if any), email, mobile number, and a declaration of his citizenship and ordinary residence at the provided address since 2011. He declares that he has not applied for inclusion in any other constituency's electoral roll and that his name is not already included in any other constituency.

Uploaded by

pratikshabhoyar2781999
Copyright
© © All Rights Reserved
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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ELECTION COMMISSION OF INDIA

FORM-6
(See Rules 13(1) and 26) of Registration of Electors Rule-1960

Application for Inclusion of Name in Electoral Roll for First time Voter OR on
Shifting from One Constituency to Another Constituency.
To, The Electoral Registration Officer,Maharashtra Maval Assembly / Parliamentary Consitituency
I request that my name be included in the electoral roll for the above Constituency.
(✓) first time voter
Particulars in support of my claim for inclusion in the electoral roll are given below:-
Mandatory Particulars
(a)Name VISHNU विष्णू
(b)Surname(if any) RATHOD राठोड़
(c) Name and surname of Relative of
HARIBHAU RATHOD हरिभाऊ राठोड़
Applicant [see item (d)]
(d) Type of Relation Father ☑ Mother ☐ Husband ☐ Wife ☐
(e) Age [as on 1st January of current calendar year
2022]
(f) Date of Birth (in DD/MM/YYYY format)(if known) 03/07/1979
(g) Gender of Applicant (Tick appropriate box) Male ☑ Female ☐ Third Gender ☐
(h)Current address where applicant is
House No. 16A 16ए
ordinarily resident
Street/Area/Locality KANDPATIL NAGAR -5 कं दपाटिल नगर -5
Town/Village DEHU देहू
Post Office DEHU देहू Pin Code 412109
District Pune State/UT Maharashtra
(i) Permanent address of
House No
applicant
Street/Area/Locality
Town/Village
Post Office Pin Code
District State/UT
(j)EPIC No. (if issued)
Optional Particulars
(k) Disability (if any) Visually Impared ☐ Speech hearing disabled ☐ Locomotor disability ☐ Other _________
(l) Email id (optional)
(m) Mobile No.
8554074433
(optional)
DECLARATION - I hereby declare that to the best of knowledge and belief –
(i) I am a citizen of India and place of my birth is Village/Town AURANGABAD District Aurangabad State Maharashtra
(ii) I am ordinarily resident at the address given at (h) above since 16/09/2011 .
(iii)I have not applied for the inclusion of my name in the electoral roll for any other constituency.
*(iv)My name has not already been included in the electoral roll for this or any other assembly / parliamentary constituency
Applicant Place DEHU
Applicant Date 20/04/2022

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