(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)
(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
(h) I have not applied for inclusion of my
name in the electoral roll of any other
(i)My name has not already been included in this or any other constituency.
in which I was ordinarily resident earlier at the address mentioned below and if so, I request that the same may be deleted from that electoral roll, or transposed, as may be
(j) I have not been issued an EPIC in I
ndia/ have been issued an EPIC which is
enclosed with this application for cancellation.