FORM-6

[See rules 13(1) and 26 of Registration of Electors Rules - 1960]

FORM No./ __________
[ ]
(To be filled by office /
ELECTION COMMISSION OF INDIA
Application Form for New Voters
To,
The Electoral Registration Officer,

No. & Name of Assembly Constituency No. Name/ _______________________________

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 electroral roll for the above constituency.

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

Space for Pasting One Recent
First Name Followed by Middle Name
Unsigned Passport Size Color
Photograph (4.5 CM X3.2 CM)
Showing Frontal View of Full
Face With White Background
Surname (if any)
(1) (b) Name (In English in BLOCK LETTERS)
First Name Followed by Middle Name

Surname (if any)

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

*(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/Guru in case of Third Gender

*(2) (b) Name and Surname (In English in Block Letters) of the relative mentioned above
*

(3) Mobile No. of Self (if available) (or)

of relative mentioned at Item No. 2
(4) Email ID of Self (If available)
of relative mentioned at Item No. 2
(5) Aadhaar Details :- (Please tick the appropriate box)

(a) Aadhaar Number or

(b) Iam not able to furnish my Aadhaar Number because I don't have Aadhar Number

(6) Gender Male Female Third Gender

(7) (a) Date of Birth d d / m m / y y y y

(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) i

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

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

5. Certificates of Class X or Class XII issued by CBSE/ICSE/State 6. Indian Passport

Education Boards, if it contains Date of Birth.

(ii) Any Other Document for Proof of Date of Birth :- (If none of the above documents is available) (PI. Specify) ______________
ii _________________

(8) (a) Present House/Building/Apartment No. Street/Area/Locality/Mohalla/Road

Ordinary
Residence
(Full Address)
Town/Village Post Office
PIN Code Tehsil/Taluqa/Mandal
District State/UT
(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 :- i :- (Any one of these)

1. Water/Electricity/Gas connection Bill for that address (atlest 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 (in case of tenant) 7. Registered Sale Deed (In case of own house)

(ii) Any Other document for Proof of residence :-

(if none of the above documents is available) (Pl. Specify) # _________________________________________________
# _________________________________________________
(9) Category of disability, if any (Optional) Locomotive Visual Deaf & Dumb

If any other (Give description) ______________________________________________

Percentage of disability : % Certificate attached (Tick the appropriate box) Yes No

(10) The details of my family member already included in the electoral roll at current address with whom l currently reside are as under :

Name of family member : _____________________________ Relationship with applicant __________________________

___________________________________ ____________________________
His/her EPIC no. : _______________________________________________
_______________________________
 DECLARATION
I HEREBY DECLARE that to the best of my knowledge and belief-

(i) I am a citizen of India and place of my birth is:- Village/Town _____________________________

i _______________________________
District ____________________ State/UT _______________________
_______________________ _____________________
(ii) I am ordinarily a resident at the address mentioned at Sr. No. 8(a) in Form 6 since ______________ (mention month and year)
(ii) __________________
(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.
(iii)

(iv) I don't possess any of the documents mentioned at (7)(b)(i) aboce for proof of Date of Birth/Age. Therefore, I have enclosed
_________________________ (Name of the document) in support of age proof (Strike off, if not applica ble).
(iv)
_______________
(v) I am aware that making the above statement or declaration in relation to this application which is false and which I know
or belive to be false or 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.
(v)

Date : __________________
Signature of Applicant/Left Hand Thumb Impression
Place : __________________
Accessibility Instructions :- In the light of provisions of Rights of Persons with Disabilities Act 2016 and Rights of Persons with Disabilities
Rules, 2017 in case of persons with intellectual disability, autism, cerebral palsy and multiple disabilities etc., signature or left hand thumb
impression of person with disability, or signature or left hand thumb impression of his/her legal guardian will be required.

Note -
In case of a married female applicant, name of Husband may preferably be mentioned.
*

v Submission of self-attested copy of mentioned document will ensure speedy delivery of services.

In case none of the mentioned documents is available, fileld verification is must. As for example, category like home-
less Indian citizens who are otherwise eligible to become electros but do not prossess any documentary proof of
# ordinary residence, Electoral Registration Officer shall designate an officer for field verfication.

Acknowledgement/Receipt for application

Acknowledgment Number ________________________________________ Date ________________________

________________________________________ _________________________
Received the application in Form 6 of Shri / Smt./Ms. ____________________________________________ (Applicant can
refer the Acknowledgement No. to check the status of application.)
___________________________________

Name /Signature of ERO/AERO/BLO

 To be appended to Form-6

(The filed marked with * are mandatory)

*
ELECTION COMMISSION OF INDIA
GUIDELINES FOR FILLING UP THE APPLICATION

FORM - 6

1. General Instructions :-

(a) The application will be addressed to the Electoral Registration Officer (ERO) of the Assembly Constituency (AC)/
Parliamentary Constituency (PC) in which the applicant is ordinarily residing. In case the applicant does not know or has
any doubt about number and name of Assembly Constituency / Parliamentary Constituency, assistance may be ex-
tended by the Electroral Registration Officer and the application will not be rejected on the ground of not mentioning of
number and name of Assembly Constituency / Parliamentary Constituency.

(b) The applicant can fill entries of the application either in English or official language of the state and this will not be a
ground for rejection of application.

(c) A Service personnel, applying for enrolment as general elector in the electoral roll at his place of posting at a peace
station, should ensure that he is not already enrolled as service elector or general elector in some other consituency.

*(d) Photograph : A recent good quality passport size unsigned colour photograph (4.5cmx3.5cm) with white background
should be pasted in the space provided. Eyes must be open and edges of face must be clearly visible.
*

(e) Elector's Photo Identity Card (EPIC) : EPIC wil be delivered at given postal address after enrolment, free of cost through
speed post under proper acknowledgement.

2. Item (1) * (Name) : The exact name and spelling should be furnished in both official language of the State and English.
If filled in only one language, system will transliterate automatically in other language which may lead to spelling
mistakes.
*

3. Item (2a) & (2b) (Name and Surname of Relative) : In case of a married female applicant, name of husband may
preferably be mentioned. (Strike off the inapplicable options in the column).

4. Item (5) Aadhaar Details) : Aadhaar Number should be furnished for the purpose of authentication of entries. If the
applicant does not have Aadhaar number, the same may be mentioned in box at item 5 (b).
5. Item (6) (Gender) :
* (a) Gender in the appropriate box provided for 'Male' / 'Female' / 'Third Gender' should clearly be tick marked.
(b) Applicants belonging to Third Gender may indicate their sex as 'Male' or as 'Female' or as 'Third Gender'

6. Item 7(a)(b) (Date of Birth) :

*(a) A self-attested copy of one of the documents mentioned in the form can be attached as age proof. Submission of a
document mentioned in the form will ensure speedy registration and delivery of services.
(b) If none of the documents mentioned in the form is available, the applicant should enclose some other document in
support of age proof, and name of the said document should be mentioned in item 7 (ii) and item (iv) of 'DECLARATION'
part in Form. In such case, the applicant will have to appear personally before Electoral Registration Officer or any other
officer designated by him for verification.

(ii) (iv)

7. *Item 8 (Present Ordinary Residence) :

*(a) Complete postal address with PIN code should be mentioned along with a self`attested copy of any of the mentioned
documents in name of applicant/parents/spouse as proof of ordinary residence.
(b) Necessary field verification shall be made in cases of Homeless Indian Citizens living in sheds/pavements and sex
workers having no documentary proof of ordinary residence, provided they are otherwise eligible for enrollment.
(c) Students, who are eligible for enrollment, can be enrolled either at their parent's place or at the hostel/mess where they
are ordinarily residing.

8. *DECLARATION : All entries in "DECLARATION" portion should be completed in all respects. Please note that giving
any false statement mede in the DECLARATION portion is a punishable offence under section 31 of the Represen-
tation of the People Act, 1950 (43 of 1950) with imprisonment with a term which may extend to one year or with fine
or with both.
*
 FORM-6B
[See rules 26A of Registration of Electors Rules - 1960]
[ ]
ELECTION COMMISSION OF INDIA
Letter of Information of Aadhaar number for the purpose of electoral roll authentication

I .............................................................................. (Name of Elector) am enrolled in electoral roll of ................................................

(Name of Assembly / Parliamentary Constituency)

having EPIC Number

I hereby submit the following information for the purpose of authentication of my entry in electoral roll:-

(Please tick the appropriate box)

(i) Aadhaar No. or

(ii) I am not able to furnish my Aadhaar Number because I don't have Aadhaar number
Therefore, I hereby submit a copy of one of the following documents :-

(Please tick any one in the appropriate box)

MGNREGA Job Card.

Passbooks with photograph issued by Bank/Post Office.

Health Insurance Smart Card issued under the scheme of Ministry of Labour.

Driving License.

PAN Card

Smart Card issued by RGI uder NPR.

Indian Passport.

Pension document with photograph.

Service Identity card with photograph issued to employees by Central/State Govt./PSUs/Public Limited Companies.

Official Identity Card issued to MPs/MLAs/MLCs.

Unique Identity ID (UDID) Card, issued by M/o Social Justice and Empowerment, Government of India.

Signature of the elector .............................................................

................................................................................
Place : ........................................
Name of the elector ...................................................................
...........................................
......................................................................................
Date : .......................................... E-mail ID/Mobile Number .........................................................
............................................. ............................................................
 FORM-7
[See rules 13(2) and 26 of Registration of Electors Rules - 1960]
FORM No./ __________
[ ]
(To be filled by office /
ELECTION COMMISSION OF INDIA
Application Form for Objection for Proposed Inclusion/
Deletion of Name in Existing Electoral Roll

To,
The Electoral Registration Officer,

No. & Name of Assembly Constituency No./ Name/ _____________________________

Or No. & Name of Parliamentary Constituency @ No./ Name/ _____________________________

(@ only for Union Territories not having Legislative Assembly)

@
I submit application for objection for proposed inclusion/deletion of name in existing electoral roll.

(1) Name of the applicant

EPIC No. _____________________________________________

_______________________________
Mobile No. of Self or

Mobile No. of Relative

(2) Option of application/objection :- (Tick the appropriate option) (Any one)

(i) I request to delete name of the person mentioned below already included in the current roll due to any one of the
following reasons :- (tick any one)
(i)

Death Under Age Absent / Permanently shifted

Already enrolled Not Indian Citizen

(ii) I object to proposed inclusion of name of the person mentioned below due to any one of the following reasons
(tick any one)
(ii)

Death Under Age Absent / Permanently shifted

Already enrolled Not Indian Citizen

(iii) I request to delete my name from electoral roll due to any one of the following reasons-(tick any one)
(iii)
Permanently shifted Already enrolled Not Indian Citizen

Death Certificate attached (Tick the appropriate option) Yes No

(3) The details of the person in respect of whom objection has been raised, are as below:-

Name _________________________ Surname______________________ EPIC No. (If available)__________________

_________________________ ______________________ _________________________
 Address House/Building/Apartment No. Street/Area/Locality/Mohalla/Road

Town/Village Post Office

PIN Code Tehsil/Taluqa/Mandal
District State/UT

DECLARATION
I HEREBY DECLARE that to the best of my knowledge and belief that i am aware that making a statement or declaration which
is false and which I know or believe to be false or 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 terrm which may extend to one year or with fine or with both.

Date : __________________
Signature of Applicant/Left Hand Thumb Impression
Place : __________________

Accessibility Instructions :- In the light of provisions of Rights of Persons with Disabilities Act 2016 and Rights of Persons with
Disabilities Rules, 2017, in case of persons with intellectual disability, autism, cerebral palsy multiple disabilities etc., signatre
or left hand thumb impression of person with disability, or signature or left hand thumb impression of his/her legal guardian
will be required.

Acknowledgement/Receipt for application

Acknowledgment Number ___________________________________________ Date ___________________________

__________________________________________________ ____________________________
Received the application in Form 7 of Shri / Smt./Ms. __________________________________________________________
________________________________________________
(Applicant can refer the Acknowledgement No. to check the status of application.)

Name /Signature of ERO/AERO/BLO

 FORM-8
[See rules 13(3) and 26 of the registration of electors rules, 1960] FORM No./ __________
[ ] (To be filled by office /
ELECTION COMMISSION OF INDIA
Voter Application Form for shifting of Residence/Correction of
Entries in Existing Electoral Roll/Replacement of EPIC/Marking of PwD

To,
The Electoral Registration Officer,

No. & Name of Assembly Constituency No./ Name/ _______________________________

Or No. & Name of Parliamentary Constituency @ No./ Name/ ________________________________

(@ only for Union Territories not having Legislative Assembly)

@

(1) Name of the applicant

EPIC No. _____________________________________________

_______________________________
Aadhaar Details :- (Please tick the appropriate box)

(a) Aadhaar Number or

(b) I am not able to furnish my Aadhaar Number because I don't have Aadhar Number.

Mobile No. of Self (or)

Mobile No. of Father/Mother/Any other relative (if available)

Email ID of Self (or) __________________________________________________________________________

_________________________________________________________________________
Email ID of Father/Mother/Any other relative (if available) ______________________________________________
_________________________________________

(II) I submit application for (Tick any one of the following)

1. Shifting of Residence (or)

2. Correction of Entries in Existing Electoral Roll (or)

3. Issue of Replacement EPIC without correction (or)

4. Request for marking as Person with Disability

1. Application for Shifting of Residence

I have shifted my residence and I request the my name be deleted from the pervious address and shifted to the current
address mentioned below. I request that a replacement EPIC may be issued to me due to change in my address. I hereby
return my old EPIC.
 Present House/Building/Apartment No. Street/Area/Locality/Mohalla/Road
Ordinary
Residence
(Full Address) Town/Village Post Office

PIN Code Tehsil/Taluqa/Mandal

District State/UT
Self-attested copy of address proof either in the name of applicant or anyone of the parents/spouse/adult child, if already
enrolled with as elector at the same address (Attach any one of the documents mentioned below):-

1. Water/Electricity/Gas connection Bill for that address (atleast 1 year) 2. Aadhaar Card

3. Current passbook of Nationalized/Scheduled Bank/Post Ofiice 4. Indian Passport

5. Revenue Department's Land Owning records including Kisan Bahi

6. Registered Rent Lease Deed (In case of tenant) 7. Registered Sale Deed (In case of own house)

Any Other :- (PI. Specify) _____________________________________________________________________

________________________________________________________________
2. Applicarion for Correction of Entries in Existing Electoral Roll

Please correct my following details in Electoral Roll / EPIC :

(Maximum of 4 entries/particulars can be corrected)

SPACE FOR PASTING ONE RECENT
PASSPORT SIZE UNSIGNED COLOR
(Put a tick in appropriate box below.) PHOROGRAPH (4.5 CM X 3.5 CM)
SHOWING FRONTAL VIEW OF FULL FACE
Copy of self-attested Documentary Proof in support of claim to be attached. WITH WHITE BACKGROUND (ONLY IF
PHOTO TO BE CHANGED)
1. Name 2. Gender 3. DOB/Age

4. Relation Type 5. Relation Name 6. Address

7. Mobile Number 8. Photo

The correct particulars in the entry to be corrected are as under :-

Name of Document in support of above claim attached

I request that a replacement EPIC may be issued to me due to change in my personal details.

I hereby retuen my old EPIC.

3. Application for Issue of Replacement EPIC without correction

I request that a replacement EPIC may be issued to me as my original EPIC is-

(Put a tick in appropriate box)

Lost Destroyed due to reason beyond control like floods, fire, other natural disaster etc.

Mutilated

I hereby return my mutilated / old EPIC (OR) I have attached copy of FIR/Police report for lost EPIC & I undertake to return
the earlier EPIC issued to me if the same is recovered at a letter stage.

4. Application for Marking Person with Disability

Category of disability (Tick the appropriate box for category of disability)

Locomotive Visual Deaf & Dumb If any other (Give description) _________________

Percentage of disability : %, Certificate attached (Tick the appropriate box) Yes No

DECLARATION
I HEREBY DECLARE that to the best of my knowledge and belief that i am a citizen of India and I am aware that making a
statement or declaration which is false and which I know or believe to be false or 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 terrm which may extend to one year
or with fine or with both.

Date : __________________
Signature of Applicant/Left Hand Thumb Impression
Place : __________________
Accessibility Instructions :- In the light of provisions of Rights of Persons with Disabilities Act 2016 and Rights of Persons with
Disabilities Rules, 2017, in case of persons with intellectual disability, autism, cerebral palsy multiple disabilities etc., signatre
or left hand thumb impression of person with disability, or of signature or left hand thumb impression of his/her legal guardian
will be required.

Submission of self-attested copy of mentioned documents will ensure speedy delivery of services.

Acknowledgement/Receipt for application

Acknowledgment Number ___________________________________________ Date ___________________________

__________________________________________________ ____________________________
Received the application in Form 8 of Shri / Smt./Ms. __________________________________________________________
________________________________________________
(Applicant can refer the Acknowledgement No. to check the status of application.)

Name /Signature of ERO/AERO/BLO