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Claim for inclusion of name in the electoral roll for a Teachers' Constituency

    The Electoral Registration Officer

         Sir, I request that my name be included in the electoral roll for the above Teacher's Constituency. Particulars in support of my claim for inclusion in the electoral roll are given below:

Applicant's Details

Address Details(Place of ordinary residence):

Disability (if any):- (Tick appropriate box) (optional Filed)

Whether registered as an elector for any assembly constituency, if yes, then mention the following

Aadhaar Details:- (Pleas tick appropriate option):

  Aadhaar Number
  Iam not able to furnish my Aadhaar Number because I don't have Aadhaar Number

During the last six years I have been engaged in teaching for a total period of more than three years

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Your Photograph*(Image size should be below 100KB)
Your Certificate (Image Format Only)*(Image size should be below 200KB)