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भारत �नवा�चन आयोग मतदाता से वा पोट� ल

ELECTION COMMISSION OF INDIA VOTERS’ SERVICE PORTAL CHELLA PANDI

FORM-6
Form Particulars Form
(See Rules 13(1) and (26) of the Registration of Electors Rules, 1960) 6 Acknowledgement No.
Click section to jump to the respective section
ELECTION COMMISSION OF INDIA (See Rules 13(1) and (26) of the Registration of Electors Rules, 1960)
(To be �lled by o�ce)
ELECTION COMMISSION OF INDIA
Application Form for NewApplication
VotersForm for New Voters
A. Select State, District & AC 

Guidelines English
To,
B. Personal Details  Officer,
The Electoral Registration
No. & Name of Assembly Constituency No. Name: Cumbum
A. Select State, District & Assembly/Parliamentary Constituency
201
Or No. & Name of Parliamentary Constituency@ No. Name:_____________
C. Relatives Details  -
(@Only for Union Territories not having Legislative Assembly)
To,
I submit application for inclusion of my name in the electoral roll for the above constituency.
The Electoral Registration Officer,
D. Contact Details 
State * District
(1)(a.) Name (In Official Language of State)
Tamil Nadu Theni
E. Aadhaar Details  Name திேன��மா� ச
First Name followed by Middle

Surname (if any)

No. & Name of Assembly Constituency*

F. Gender 
(1)(b.) Name (In English in BLOCK LETTERS)
201 Cumbum
First Name followed by Middle Name DHINESHKUMAR C
G. Date of Birth details 
Surname (if any) Or
Disclaimer: If name not filled in English, it will be transliterated by software.
No. & Name of Parliamentary Constituency@*
H. Present Address Details  (@Only for Union Territories not having Legislative Assembly)

*(2)(a.) Name and Surname (in official language of State) of any one of the relatives:-
I. Disability Details 
Father Or Mother No.Or Husband Select PC
Or Wife Or

Legal Guardian in case of orphan/Third Gender

J. Family member Details 
I submit application for inclusion of my name in the electoral roll for the above constituency.
(2)(b.) Name and Surname (In English in BLOCK LETTERS) of the relative mentioned above CHANDRAMURUGAN
ச�திர��க�
K. Declaration 
 Next

(3) Mobile No. of Self (if available). 9 3 6 3 5 1 3 4 9 6

L. Captcha
Of relative mentioned at Item No. 2 - - - - - - - - - -
B. Personal Details
Preview and Submit Save

(4) Email ID of Self (If available)

1. First Name followed by Middle Name * Surname (if any)
OrCancel
Of relative mentioned at Item No. 2 DHINESHKUMAR C

(5) Aadhaar Details திேன��மா�

2 5 6 ச 7 4 
3 6 4 9 3 5 8 

(6) Gender MALE FEMALE THIRD GENDER

Upload Photograph (Unsigned and
Passport size color photograph(4.5 cm X
3.5 cm) showing front view of full face with
(7)(a.)Date of Birth (dd/mm/yyyy) 0 1 size / 0 1 / 2 0 0 4
white background.)(Document
maximum
(b.) Self attested copy of document supporting 2MB,.jpg,.jpeg)
age proof * of the following)
attached (anyone
(i) Document for Proof of Date of Birth ^:- (Any one of these)
Browse… IMG_2024…5433.jpg
1. Birth certificate issued by Competent Local Body/Municipal Authority/Registrar of Births & Deaths
Photo.jpeg
2. Aadhaar Card 3. PAN Card 4. Driving License

5. Certificates of Class X or Class XII issued by CBSE/ICSE/ State EducationBoards, if it contain Date of Birth 6. Indian Passport
 Previous  Next
(ii) Any Other Document for Proof of Date of Birth:- (If no document is available) (Pl. Specify)________________________

(8) (a.) Present Ordinary Residence (Full Address)

C. Name and Surname of any one of the relatives
House/Building/Apartment No. 34/2 34/2 Street/Area/Locality. INDIRA COLONY இ�திரா காலன�

2(a.)உ�தமபாைளய�
Tehsil/Taluqa/Mandal UTHAMAPALAYAM Relatives Town/Village CHINNAOVULAPURAM சி�னஓ�லா�ர�
Father
Post Office CHINNAOVULAPURAM சி�னஓ�லா�ர� Mother Husband State/UTWife
Tamil Nadu Legal Guardian in case of orphan/Third Gender

District Theni Pin Code 625515

b.Name * Surname
(b.) Self-attested copy of address proof either in the name of applicant or any one of parents/spouse/adult child, if already enrolled as elector at the same address (Attach anyone
of them)
CHANDRAMURUGAN
(i) Document for proof of residence ^:-

1. Water/Electricity/Gas connection Bill for that address(atleast 1 year)

ச�திர��க�  
2. Aadhaar Card 3. Current passbook of Nationalized/Scheduled Bank/Post Office 4. Indian Passport

5. Revenue Department's Land Owning records including Kisan Bahi 6. Registered Rent Lease Deed(Incase of tenant)
 Previous  Next
7. Registered Sale Deed(incase of own house)

(ii) Any Other Document for Proof of residence:- (If no document is available) (Pl. Specify) ________________________

D. Contact Details
(9)Category of disability, if any (Optional) Locomotive Visual Deaf &
Dumb
 3. Mobile Number

Self Relative mentioned above

FORM-6
Mobile Number of the above selected Acknowledgement No.
(See Rules 13(1) and (26) of the Registration of Electors Rules, 1960)

+91 ELECTION
9363513496 COMMISSION OF INDIA (To be �lled by o�ce)

Application Form for New Voters

4. Email Id

To, Self Relative mentioned above

The Electoral Registration Officer,
No. & Name of Assembly ConstituencyEmail ID of the above selected No. Name: Cumbum
201
Or No. & Name of Parliamentary Constituency@ No. Name:_____________
-
(@Only for Union Territories not having Legislative Assembly)
I submit application for inclusion of my name in the electoral roll for the above constituency.

(1)(a.) Name (In Official Language of State)  Previous  Next

First Name followed by Middle Name திேன��மா� ச

Surname (if any)

E. Aadhaar
(1)(b.) Name (In English in BLOCK LETTERS) Details
First Name followed by Middle Name DHINESHKUMAR C
5. Aadhaar Details
Surname (if any)
Aadhaar Number I am not able to furnish my Aadhaar Number because I don't have Aadhaar Number.
Disclaimer: If name not filled in English, it will be transliterated by software.

Aadhaar Number

*(2)(a.) Name and Surname (in official language of State) of any one of the relatives:-
●●●●●●●●●●●●
Father Or Mother Or Husband Or Wife Or

Legal Guardian in case of orphan/Third Gender

(2)(b.) Name and Surname (In English in BLOCK LETTERS) of the relative mentioned above CHANDRAMURUGAN  Previous  Next
ச�திர��க�

(3) Mobile No. of Self (if available). 9 3 6 3 5 1 3 4 9 6

F. Gender
Of relative mentioned at Item No. 2 - - - - - - - - - -
6. Gender
Male Female Third Gender
(4) Email ID of Self (If available)
Or
Of relative mentioned at Item No. 2  Previous  Next

(5) Aadhaar Details 2 5 6 7 4 3 6 4 9 3 5 8

G. Date of Birth details

(6) Gender MALE FEMALE THIRD GENDER

7(a.)
Date of Birth *
(7)(a.)Date of Birth (dd/mm/yyyy) 0 1 / 0 1 / 2 0 0 4

(b.) Self attested copy of document supporting01 /age

01proof
/ 2004attached (anyone of the following)
(i) Document for Proof of Date of Birth ^:- (Any one of these)

1. 7(b.)Self
Birth certificate issued by Competent attested
Local copy of document
Body/Municipal supporting
Authority/Registrar age proof
of Births attached
& Deaths
Document for proof of Date of Birth Any other Document for proof of Date of
2. Aadhaar Card 3. PAN Card 4.
Birth (If no document Driving License
is available) (Pl.
Specify)
5. Certificates of Class X or Class XII issued by CBSE/ICSE/ State EducationBoards, if it contain Date of Birth 6. Indian Passport

(ii) Any Other Document for Proof of Date of Birth:- (If no document
Aadhaar Card is available) (Pl. Specify)________________________

(8) (a.) Present Ordinary Residence (Full Address)

Proof of Date of Birth (Document size
House/Building/Apartment No. 34/2 maximum
34/2 2MB,.jpg,.png,.pdf) * Street/Area/Locality. INDIRA COLONY இ�திரா காலன�

Tehsil/Taluqa/Mandal UTHAMAPALAYAM உ�தமபாைளய� Town/Village CHINNAOVULAPURAM சி�னஓ�லா�ர�

Browse… AADHAAR.jpg
Post Office CHINNAOVULAPURAM சி�னஓ�லா�ர� State/UT Tamil Nadu
AADHAAR.jpg
District Theni Pin Code 625515

(b.) Self-attested copy of address proof either in the name of applicant or any one of parents/spouse/adult child, if already enrolled as elector at the same address (Attach anyone
of them)  Previous  Next
(i) Document for proof of residence ^:-

1. Water/Electricity/Gas connection Bill for that address(atleast 1 year)

2. Aadhaar Card H. Present

3. Address Details
Current passbook of Nationalized/Scheduled Bank/Post Office 4. Indian Passport

5. Revenue Department's Land Owning records including Kisan Bahi 6. Registered Rent Lease Deed(Incase of tenant)
8(a.) Present Ordinary Residence (Full Address)

7. Registered Sale Deed(incase House/Building/

of own house) Apartment No * Street/Area/Locality/Mohalla/Road * Village/Town *

(ii) Any Other Document for Proof of residence:- (If no document is available) (Pl. Specify) ________________________
34/2 INDIRA COLONY CHINNAOVULAPURAM

(9)Category of disability, if any (Optional) 34/2 Locomotive  Visual இ�திரா காலன� Deaf &  சி�னஓ�லா�ர� 
Dumb
 Post O�ce * PIN Code * Tehsil/Taluqa/Mandal *

CHINNAOVULAPURAM FORM-6 625515 UTHAMAPALAYAM

(See Rules 13(1) and (26) of the Registration of Electors Rules, 1960) Acknowledgement No.
சி�னஓ�லா�ர�  உ�தமபாைளய� 
ELECTION COMMISSION OF INDIA (To be �lled by o�ce)

Application Form for New Voters

District * State/UT *

To, Theni Tamil Nadu

The Electoral Registration Officer,
No. & Name of Assembly Constituency No. Name: Cumbum
8(b.) Self-attested copy of address proof either in the name201
of applicant or any one of parents/spouse/adult child, if already enrolled as elector
Or No. & Name of Parliamentary Constituency@ No. Name:_____________
at the same address (Attach anyone of them) -
(@Only for Union Territories not having Legislative Assembly)
Document for Proof of Residence Any other document for Proof of
I submit application for inclusion of my name in the electoral roll for the above constituency. Residence (If no document is available)
(Pl. Specify)

Aadhaar Card
(1)(a.) Name (In Official Language of State)

First Name followed by Middle Name திேன��மா� ச

Surname (if any) Proof of Residence (Document size

maximum 2MB,.jpg,.png,.pdf) *
(1)(b.) Name (In English in BLOCK LETTERS)

First Name followed by Middle Name DHINESHKUMAR

Browse… C AADHAAR.jpg
Surname (if any)
AADHAAR.jpg
Disclaimer: If name not filled in English, it will be transliterated by software.

 Previous  Next
*(2)(a.) Name and Surname (in official language of State) of any one of the relatives:-
Father Or Mother Or Husband Or Wife Or

Legal Guardian in case of orphan/Third Gender

I. Category of Disability, if any (Optional)

(2)(b.) Name and Surname (In English in9. Category

BLOCK LETTERS) of the relative mentioned above CHANDRAMURUGAN
ச�திர��க�
Locomotive Visual Other Other Disability
(3) Mobile No. of Self (if available). Deaf & Dumb
9 3 6 3 5 1 3 4 9 6
Percentage of
Of relative mentioned at Item No. 2 disability
- - - - - - - - - -

%
(4) Email ID of Self (If available)
Or
Certi�cate Attached
Of relative mentioned at Item No. 2

Yes No
(5) Aadhaar Details 2 5 6 7 4 3 6 4 9 3 5 8
Disability Certi�cate (Document size
(6) Gender MALE
maximum 2MB,.jpg,.png,.pdf) FEMALE THIRD GENDER

Browse… No file selected.

(7)(a.)Date of Birth (dd/mm/yyyy) 0 1 / 0 1 / 2 0 0 4

(b.) Self attested copy of document supporting age proof attached (anyone of the following)
(i) Document for Proof of Date of Birth ^:- (Any one of these)  Previous  Next

1. Birth certificate issued by Competent Local Body/Municipal Authority/Registrar of Births & Deaths

2. Aadhaar Card 3. PAN Card 4. Driving License

J. The details of my family member already included in the electoral roll at current address with whom I currently reside are as
5. Certificates of Class X or Class XII issued by CBSE/ICSE/ State EducationBoards, if it contain Date of Birth 6. Indian Passport
under
(ii) Any Other Document for Proof of Date ofFamily
10. Birth:- (If no document is available) (Pl. Specify)________________________
Member

(8) (a.) Present Ordinary Residence (Full Address)

Name of Family Member Relationship with applicant His/Her EPIC Number

MURUGAN
House/Building/Apartment No. 34/2 34/2 Father
Street/Area/Locality. INDIRA COLONY இ�திரா காலன�CRN1861681

Tehsil/Taluqa/Mandal UTHAMAPALAYAM உ�தமபாைளய� Town/Village CHINNAOVULAPURAM சி�னஓ�லா�ர�

Post Office CHINNAOVULAPURAM சி�னஓ�லா�ர� State/UT Tamil Nadu

District Theni Pin Code 625515  Previous  Next

(b.) Self-attested copy of address proof either in the name of applicant or any one of parents/spouse/adult child, if already enrolled as elector at the same address (Attach anyone
of them)
(i) Document for proof of residence ^:-
K. Declaration
1. Water/Electricity/Gas connection Bill for that address(atleast 1 year)
I Hereby declare that to the best of My knowledge and belief.
2. Aadhaar Card 3. Current passbook of Nationalized/Scheduled Bank/Post Office 4. Indian Passport
(i) I am a citizen of India and place of my birth is
5. Revenue Department's Land Owning records including Kisan Bahi 6. Registered Rent Lease Deed(Incase of tenant)
Village/Town * State/UT * District
7. Registered Sale Deed(incase of own house)
CHINNAOVULAPURAM Tamil Nadu Theni
(ii) Any Other Document for Proof of residence:- (If no document is available) (Pl. Specify) ________________________

(ii) I am ordinarily a resident at the address mentioned at Section 8(a) in Form 6 since *
04-2024
(9)Category of disability, if any (Optional) Locomotive Visual Deaf &
Dumb
 (iii) I am applying for inclusion in Electoral Roll for the first time and my name is not included in any Assembly Constituency/Parliamentary
Constituency.

FORM-6
(iv) I don’t possess any of the mentioned documents for proof of Date of Birth/Age. Therefore, I have enclosed, below mentioned document in
support of age proof.
(See (Leave
Rules blank,
13(1) and if of
(26) notthe
applicable).
Registration of Electors Rules, 1960) Acknowledgement No.

ELECTION COMMISSION OF INDIA (To be �lled by o�ce)

Application Form for New Voters

(v) I am aware that making the above statement or declaration in relation to this application which is false and which I know or believe to be false or
To,
The Electoral Registration Officer, do not believe to be true, is punishable under Section 31 of Representation of the People Act,1950 (43 of 1950) with imprisonment for a term which
may extend to one year or with fine or with both.No.
No. & Name of Assembly Constituency Name: Cumbum
201
Or No. & Name of Parliamentary Constituency@
Place * No. Date Name:_____________
-
(@Only for Union Territories not having Legislative Assembly)
CHINNAOVULAPURAM
I submit application for inclusion of my name in the electoral roll for the above constituency.
03 / 04 / 2024

(1)(a.) Name (In Official Language of State)

 Previous  Next
First Name followed by Middle Name திேன��மா� ச

Surname (if any)

(1)(b.) Name (In English in BLOCK LETTERS)

L. Captcha
First Name followed by Middle Name DHINESHKUMAR C

Surname (if any)

Disclaimer: If name not filled in English, it will be transliterated by software.

Captcha
*(2)(a.) Name and Surname (in official language *
of State) of any one of the relatives:-
Father Or Mother Or Husband Or Wife Or
Enter Captcha Send OTP
Legal Guardian in case of orphan/Third Gender
OTP will be sent to 9363513496

(2)(b.) Name and Surname (In English in BLOCK LETTERS) of the relative mentioned above CHANDRAMURUGAN
ச�திர��க�

Preview and Submit Save Cancel

(3) Mobile No. of Self (if available). 9 3 6 3 5 1 3 4 9 6

Of relative mentioned at Item No. 2 - - - - - - - - - -

(4) Email ID of Self (If available)

Or
Of relative mentioned at Item No. 2

(5) Aadhaar Details 2 5 6 7 4 3 6 4 9 3 5 8

(6) Gender MALE FEMALE THIRD GENDER

(7)(a.)Date of Birth (dd/mm/yyyy) 0 1 / 0 1 / 2 0 0 4

(b.) Self attested copy of document supporting age proof attached (anyone of the following)
(i) Document for Proof of Date of Birth ^:- (Any one of these)

1. Birth certificate issued by Competent Local Body/Municipal Authority/Registrar of Births & Deaths

2. Aadhaar Card 3. PAN Card 4. Driving License

5. Certificates of Class X or Class XII issued by CBSE/ICSE/ State EducationBoards, if it contain Date of Birth 6. Indian Passport

(ii) Any Other Document for Proof of Date of Birth:- (If no document is available) (Pl. Specify)________________________

(8) (a.) Present Ordinary Residence (Full Address)

House/Building/Apartment No. 34/2 34/2 Street/Area/Locality. INDIRA COLONY இ�திரா காலன�

Tehsil/Taluqa/Mandal UTHAMAPALAYAM உ�தமபாைளய� Town/Village CHINNAOVULAPURAM சி�னஓ�லா�ர�

Post Office CHINNAOVULAPURAM சி�னஓ�லா�ர� State/UT Tamil Nadu

District Theni Pin Code 625515

(b.) Self-attested copy of address proof either in the name of applicant or any one of parents/spouse/adult child, if already enrolled as elector at the same address (Attach anyone
of them)
(i) Document for proof of residence ^:-

1. Water/Electricity/Gas connection Bill for that address(atleast 1 year)

2. Aadhaar Card 3. Current passbook of Nationalized/Scheduled Bank/Post Office 4. Indian Passport

5. Revenue Department's Land Owning records including Kisan Bahi 6. Registered Rent Lease Deed(Incase of tenant)

7. Registered Sale Deed(incase of own house)

(ii) Any Other Document for Proof of residence:- (If no document is available) (Pl. Specify) ________________________

(9)Category of disability, if any (Optional) Locomotive Visual Deaf &

Dumb