Note :Fields marked with asterisk (*) are mandatory

Form 001

*
*

I request that a Duplicate Photo identity Card be issued to me as my original card is lost/destroyed/mutilated due to correction in my elector's detailsor due to change of address I want to get a fresh card with my new address.I am return my EIC to you along with fee for issue of duplicate EPIC My name is included in the electoral roll for the above constituency.Particulars in support of my calim for issue of duplicate EPIC are given below.

*
*
*
*
*
*
*
*
*
*
*


Reason for applying for a Duplicate Card


*
*
Captcha