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

    The Electoral Registration Officer

         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:

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

Address Details(Place of ordinary residence):

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

Aadhaar Details:- (Pleas tick appropriate option):

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

* I am a graduate of the

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;