Note: Fields marked with asterisk (*) are mandatory

Form 6A

[See rules 8B]
Application for inclusion of name in electoral roll by an overseas elector
To
The Electoral Registration Officer
Sir,
I request that my name be included in the electoral roll for the Constituency in which my place of residence, as per the particulars furnished below in 1(h), is located:
I. Particulars in support of my claim for inclusion in the electoral roll are given below:

(In English)
(In Regional)
(In English)
(In Regional)
(In English)
(In Regional)

Place of Birth Details


(In English)
(In Regional)
(In English)
(In Regional)
(In English)
(In Regional)

Place of present ordinary Residence in India (Full address as given in the passport)


Passport Details


Details of Visa of the Country of current residence


II. Description of Absence from Place Ordinary Residence in India

Reason of being absent from the place of ordinary residence




III. Full residential address in the country outside India where currently residing


IV. Full Official address in the country outside India currently residing (address of the place of employment or the education institution where studying)


V. Upload Supporting Document


VI. Declaration

I hereby declare that to the best of my knowledge and belief: -
(a) All information given in this application is true.
(b) I am a citizen of India by birth / domicile / naturalisation.
(c) I have not acquired citizenship of any other country.
(d) But for being absent from the place of my ordinary residence in India owing to the reason given in 2(a) above, I would have been ordinarily resident at the address given in my Indian Passport, which has been reproduced at 1(h) above.
(e) I undertake to immediately inform the Electoral Registration Officer through the Indian Mission in the Country of my current residence if I renounce my Indian Citizenship or if I acquire the citizenship of any other country.
(f) I undertake to immediately inform th e Electoral Registration Officer through the Indian Mission in the country of my current residence of any change in my residential address in the country of my residence for the records of the Electoral Registration Officer. I understand that any notice sent to me at the address, which is my residential a ddress in the country of my current residence according to the records of th e Electoral Registration Officer, shall be considered as due service of noti ce to me under the Representation of the People Act, 1950 and the rules made thereunder, and that it is my responsibility to keep the Electoral Regist ration Officer informed of my latest residential address in the country of my current residence.
(g) If I return to India and become ordinar ily resident in India, I shall immediately inform the Electoral Registra tion Officer of the concerned Assembly/Parliamentary Constituency.
(h) I have not applied for inclusion of my name in the electoral roll of any other constituency.
(i)My name has not already been included in this or any other constituency.
Or
My name may have been included in the electoral roll
(j) I have not been issued an EPIC in I ndia/ have been issued an EPIC which is enclosed with this application for cancellation.


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 Representation of the People Act, 1950 (43 of 1950).