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  • Gudiya Kumari Voter Form 6

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    Anil Sharma
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    Gudiya Kumari has applied for inclusion of her name in the electoral roll for the first time. She provides her personal details such as name, father's name, age, gender, address, relationship status, and contact information. She declares that she is a citizen of India, ordinarily resides at the address provided, has not applied for inclusion in any other constituency, and that her name is not already included in any other electoral roll.

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    Gudiya Kumari has applied for inclusion of her name in the electoral roll for the first time. She provides her personal details such as name, father's name, age, gender, address, relationship status, and contact information. She declares that she is a citizen of India, ordinarily resides at the address provided, has not applied for inclusion in any other constituency, and that her name is not already included in any other electoral roll.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    552 views2 pages

    Gudiya Kumari Voter Form 6

    Uploaded by

    Anil Sharma
    Gudiya Kumari has applied for inclusion of her name in the electoral roll for the first time. She provides her personal details such as name, father's name, age, gender, address, relationship status, and contact information. She declares that she is a citizen of India, ordinarily resides at the address provided, has not applied for inclusion in any other constituency, and that her name is not already included in any other electoral roll.

    Copyright:

    © All Rights Reserved
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    of 2

    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,Bihar Barharia 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 Gudiya गुिडया
    (b)Surname(if any) Kumari कुमारी
    (c) Name and surname of Relative of
    Dinesh Kumar िदनेश कुमार
    Applicant [see item (d)]
    (d) Type of Relation Father ☐ Mother ☐ Husband ☑ Wife ☐
    (e) Age [as on 1st January of current calendar year ]
    (f) Date of Birth (in DD/MM/YYYY format)(if known) 01/01/1995
    (g) Gender of Applicant (Tick appropriate box) Male ☐ Female ☑ Third Gender ☐
    (h)Current address where applicant is ordinarily
    House No. 186 186
    resident
    Street/Area/Locality Pachrukhi पच खी
    Town/Village Pachrukhi पच खी
    Post Office Pachrukhi पच खी Pin Code 841241
    District SIWAN State/UT Bihar
    (i) Permanent address of applicant House No
    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. (optional) 8294594300
    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 Chapra District SARAN State Bihar
    (ii) I am ordinarily resident at the address given at (h) above since 01/01/2018 .
    (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 Pachrukhi
    Applicant Date 11/10/2020

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