[See rules 13(1) and 26]
As a first time voter
due to shifting from another constituency
Particulars in support of my claim for inclusion in the electoral roll are given below:-
I hereby declare that to the best of knowledge and belief -
(i) I am a citizen of India and place of my birth is
(ii) I am ordinarily resident at the address given at (h) above since
(iii)I have not applied for the inclusion of my name in the electoral roll for any other constituency.
(iv)My name has not already been included in the electoral roll for this or any other assembly/ parliamentary constituency
My name may have been included in the electoral roll for Constituency in State 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.