FORM 18

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FORM-18(GRADUATES)

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

To,

The Electoral Registration Officer

Graduate Constituency *

District *

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

1. Applicant's Details:

Name of the Applicant*

పేరు*

Surname (if any)

ఇంటి పేరు

Name of Relative of Applicant*

పేరు*

Surname of Relative of Applicant

ఇంటి పేరు

Gender of Applicant*

Type of Relation*

Date of Birth*

Educational Qualification *

విద్య *

Occupation *

వృత్తి *

Disability (if any) (Tick appropriate box) (Optional Field)

Visual impairment

Speech & hearing disability

Locomotor disability

Other

Address Details(Place of ordinary residence):

House / Door Number*

Street / Area / Locality *

వీధి / ప్రాంతం *

Town / Village *

పట్టణం / గ్రామం *

Post Office*

తపాలా కార్యాలయము*

*Tehsil/ Taluka/ Mandal/ Thana:*

Pincode *

Details of Assembly Constituency & EPIC, If the Applicant's Name is Included:

District

Assembly Constituency

Epic No(ID Card No):

Polling Station No:

Sl.No in PS:

Know your Epic Number

Click Here

Aadhaar Details:- (Pleas tick appropriate option):

Aadhaar Number

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

Graduate

Diploma

* I am a graduate of the

university having passed the degree/diploma examination in the year

* I am in possession of a diploma/cerificate in

which is a qualification equivalent to that of a gratuate of a

univeristy in india having passed the examination for the diploma/certificate in the year

Upload Supporting Documents

Your Photograph*(Image size should be below 100KB)

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

My name has not been included in the electoral roll for this or any other Graduates constituency;

My name has been included in the electoral roll for the Constituency

and District

under the given address below and I request that it to be deleted from that roll.

Mobile No

Email ID:

I declare that I am a citizen of India and that all the particulars given above are true to the best of my knowledge and belief.

Note: Any person who makes a statement or declaration which is false and which he either knows or believes to be false or does not believe to be true is punishable under section 31 of the Represention of the People Act, 1950.

Note: All Star(*) Fields are Mandatory...Upload only JPEG images and Image size should be below 100KB...Use Firefox,Chrome and IE-11 for best view FORM-18(GRADUATES)