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    PARTHA GHOSH
    Samiran Ghosh has applied for inclusion of his name in the electoral roll for the first time. He is 18 years old and resides at House No. n0109, Debagram Chatterjee Para in Debagram village, Nadia district of West Bengal. His father's name is Nimai Ghosh. He declares that he is a citizen of India born in Debagram village, and has lived there since 2002. He also declares that he has not applied to be included in any other constituency's electoral roll and his name is not already included in any roll.

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    PARTHA GHOSH
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    Samiran Ghosh has applied for inclusion of his name in the electoral roll for the first time. He is 18 years old and resides at House No. n0109, Debagram Chatterjee Para in Debagram village, Nadia district of West Bengal. His father's name is Nimai Ghosh. He declares that he is a citizen of India born in Debagram village, and has lived there since 2002. He also declares that he has not applied to be included in any other constituency's electoral roll and his name is not already included in any roll.

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    Samiran Ghosh has applied for inclusion of his name in the electoral roll for the first time. He is 18 years old and resides at House No. n0109, Debagram Chatterjee Para in Debagram village, Nadia district of West Bengal. His father's name is Nimai Ghosh. He declares that he is a citizen of India born in Debagram village, and has lived there since 2002. He also declares that he has not applied to be included in any other constituency's electoral roll and his name is not already included in any roll.

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    77 views2 pages

    @ViewBag Title PDF

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    PARTHA GHOSH
    Samiran Ghosh has applied for inclusion of his name in the electoral roll for the first time. He is 18 years old and resides at House No. n0109, Debagram Chatterjee Para in Debagram village, Nadia district of West Bengal. His father's name is Nimai Ghosh. He declares that he is a citizen of India born in Debagram village, and has lived there since 2002. He also declares that he has not applied to be included in any other constituency's electoral roll and his name is not already included in any roll.

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    12/20/2020 @ViewBag.

    Title

    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,West Bengal Kaliganj 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 SAMIRAN সিমরন
    (b)Surname(if any) GHOSH ঘাষ
    (c) Name and surname of Relative of
    NIMAI GHOSH িনমাই ঘাষ
    Applicant [see item (d)]
    (d) Type of Relation Father ☑ Mother ☐ Husband ☐ Wife ☐
    (e) Age [as on 1st January of current calendar year
    2021]
    (f) Date of Birth (in DD/MM/YYYY format)(if known) 03/12/2002
    (g) Gender of Applicant (Tick appropriate box) Male ☑ Female ☐ Third Gender ☐
    (h)Current address where applicant is
    House No. n0109 এন0109
    ordinarily resident
    Street/Area/Locality DEBAGRAM CHATTERJEE PARA দব াম চ াটাজ পারা
    Town/Village DEBAGRAM দব াম
    Post Office DEBAGRAM দব াম Pin Code 741137
    District NADIA State/UT West Bengal
    (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.
    9883714432
    (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 DEBAGRAM District NADIA State West Bengal
    (ii) I am ordinarily resident at the address given at (h) above since 03/12/2002 .
    (iii)I have not applied for the inclusion of my name in the electoral roll for any other constituency.

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    12/20/2020 @ViewBag.Title

    *(iv)My name has not already been included in the electoral roll for this or any other assembly / parliamentary constituency
    Applicant Place DEBAGRAM
    Applicant Date 20/12/2020

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