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    Parvati 8

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    sajid
    The document is a voter application form requesting correction of entries in the existing electoral roll. It provides personal details of the applicant such as name, EPIC number, date of birth, mobile number and requests correction of the date of birth and mobile number in the electoral roll.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Parvati 8

    Uploaded by

    sajid
    29 views1 page
    The document is a voter application form requesting correction of entries in the existing electoral roll. It provides personal details of the applicant such as name, EPIC number, date of birth, mobile number and requests correction of the date of birth and mobile number in the electoral roll.

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    © © All Rights Reserved

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    The document is a voter application form requesting correction of entries in the existing electoral roll. It provides personal details of the applicant such as name, EPIC number, date of birth, mobile number and requests correction of the date of birth and mobile number in the electoral roll.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    29 views1 page

    Parvati 8

    Uploaded by

    sajid
    The document is a voter application form requesting correction of entries in the existing electoral roll. It provides personal details of the applicant such as name, EPIC number, date of birth, mobile number and requests correction of the date of birth and mobile number in the electoral roll.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    4/17/23, 8:08 PM form8

    form8
                                                                  FORM-8

                                                 ELECTION COMMISSION OF INDIA


                                                                                                                           [See Rules 13(3) and 26]

    Voter Application Form for shifitng of Residence/Correction of Entries in Existing Electoral Roll/
    Replacement of EPIC/Marking of PwD
    To, The Electoral Registration Officer,
    Karnataka Bidar
     Assembly / Parliamentary Consitituency
    I request that entry relating to myself appearing in the electoral roll the above Constituency
    is not correct and it should be corrected.
    Name Parvati ಪಾರ್ವತಿ
    Surname(if any)
    EPIC No. (If issued) WHI6971824
    Aadhaar Number
    Mobile No. of Self (id available) 8867380487 Relative ☐
    Email id of Self(If available) Relative ☐
    (II) I submit application for (Tick any one of the following)
    1. ☐ Shifting of Residence (or)
    2. ☑ Correction of Entries in Existing Electoral Roll (or)
    3. ☐ Issue of Replacement EPIC without correction (or)
    4. ☐ Request for Marking as Person with Disablity (or)
    2. Application for Correction of Entries in Existing Electoral Roll
    Please correct my following details in Electoral Roll/EPIC:
                               1. ☐  Name                                 2. ☐  Gender                                 3. ☑  DoB/Age                                
    4. ☐  Relation Type                                
                               5. ☐  Relation Name                   6. ☐  Address                                7. ☑  Mobile Number                      
    8. ☑  Photo                                
    The correct particulars in entry to be corrected are as under:-
    Date of birth 01/06/1960
    Mobile Number 9900862593

    DECLARATION

    I HEREBY DECLARE that to the best of my knwoledge and belief that I am a citizen of India and I am aware
    that making a statement or declaration which is false and which I know or believe to be false or do not believe to
    be true, is punishable under Section 31 of Representation of the People Act, 1950 (43 of 1950) with imprisonment
    for a term which may extend to one year or with fine or with both.
    Place Bidar
    Date 17/04/2023

    about:blank 1/1

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