FORM 6 got 6

[See rules 13(1) and 26] / [13 (1) kW 26MtJ fis ghf]

Application for inclusion of name in electoral roll / thfhs goa bga nrgjfhd zg
To / bgWe The Electoral Registration Officer / thfhs g mfh, Assembly Constituency / rlnguit bjhF. Sir/ Iah, I request that my name be included in the electoral roll for the above Constituency. Particulars in support of my claim for inclusion in the electoral roll are given below. nkFl bjhFfhd thfhs goa vdJ bgaiu nrJ bfhSgo nfL bfhnw. jfhd tuf nH bfhLfgLsd:
SPACE FOR PASTING ONE RECENT PASSPORT SIZE PHOTOGRAPH (3.5 CM X 3.5 CM) SHOWING FRONTAL VIEW OF FULL FACE WITHIN THIS BOX

Kf KGikahd Kw njhwij fhLw, fl L mss (3.5br. X 3.5 br.) rga ifgl xid flF xLtjfhd l

Applicants details / I. zgjhu tuf Name in English / bga My Name in Tamil / bga j

** Name / **bga

** Surname (if any)/ ** FLgbga (VnjDU)

Age as on 1st January ................. # rdt 1M njaW taJ

Years: MLf:

Months / khjf:

Sex (male/female/others) ghd (M/bg/ ju): Year /ML:

Date of birth, if known Day /eh: wj nj (bjUjh): Village/ Town / uhk / efu: Place of birth wj l District / khtl:

Month / khj:

State / khy:

* Fathers/ Mothers / Husbands ** Surname (if any)/ ** Name / ** bga Name in English **FLgbga (VnjDU) jfgdh/ jhah/ fzt bga My * Fathers/ Mothers / Husbands Name in Tamil * jfgdh/ jhah/fzt bga j Particulars of place of present ordinary residence (Full address): II. rhjhuzkhf FoUJ tU l tuf (KGikahd Kft): House/ Door number L / fj v New a: Old giHa:

Flat Name / Building Name mLFkho FoU / fol bga: Street/ Area/Locality/Mohalla/Road bjU / gF / l / rhiy: Town/ Village efu / uhk: Post Office mr mYtyf: Tehsil/ Taluka/Mandal/ Thana / tl / kly: District / khtl: # * Please give the year i.e. 2007, 2008, etc. # rahd tUlij Fl (mjhtJ 2007 , 2008 Kjait) Strike out the inappropriate alternative / bghUjkwitfis moJ l Pin Code / mr FpL
v:

** Name in English and Tamil will enable the entry of name to be made correctly in Electors Photo Identity Card (EPIC) ** thfhs ifgl milahs mil bga rahf l bgWtjF VJthf bgaiu jY MyY vGj.

III. Details of member(s) of applicants family already included in the current electoral roll of the Constituency j bjhF jnghija thfhs goa Kdnu l bgWs zgjhu FLgd tuf Relationship with applicant Name/ bga zg jhuUl cw Kiw Part number of the roll of the Constituency bjhFfhd thfhs goa mls ghf v Serial number in that Part ghf tir v Electors Photo Identity Card Number
thfhs ifgl milahs mil v

1. 2.

IV. Declaration I hereby declare that to the best of my knowledge and belief: (i) I am a citizen of India; (ii) I am ordinarily resident at the address given in para II above since..(date, month, year) (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 constituency; Or *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 IV. cWbkh eh f ewhf mjtifY kW ew tifY flthW cW TWnw:(i) eh xU a Fokf/ (ii) nkny FLs g II Kft ______________ (eh, khj, tUl) UJ eh rhjhuzkhf FoUJ tUnw; (iii) ntW vj bjhFfhd thfhs goaY v bgaiu nrJ bfhSgo eh zfiy; (iv)*j rlkw bjhF myJ ntbwj rlkw bjhFfhd thfhs goaY v bga Vbfdnt nrfgliy myJ *......................................... khy ..................................................................................... bjhFfhd thfhs goa eh K rhjhuzkhf FoUJtj fl Kft vDila bga nrfgoUfyh. mgoah mj thfhs goaUJ vDila bgaiu Lgo nfLbfhnw. Full Address (Earlier Place of ordinary residence) Electors Photo Identity Card number (if already issued) thfhs ifgl milahs mil K rhjhuzkhf FoUj l KG Kft : (tHUjh) v.......................................

Date of issue / tHfgl eh...................................... Place / l: Date / eh: Signature or thumb impression of the applicant zgjhu ifbahg/ if bgUu milahs Please give your mobile number / cf ifng/ E-mail I.D (optional)/ dr Kftia Fl (UgFglJ). 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). F: vtuhtJ bghahd myJ bghahdbjW jh mJs myJ ew myJ cikahdbjW

eghj mifia myJ cWbkhia bfhLjh mt 1950M Mo kf uJt rl (1950 43) 31tJ jofgljftuhth.
* Strike out the inappropriate alternative. * bghUjkwitfis moJ l

Details of action taken (To be filled by Electoral Registration Officer of the constituency)/ nk eltoif vLfgl tuf (bjhF thfhs g mfhah bragl ntoaJ) The application of Thiru/Tmt./Selvi............................. for inclusion of name in the electoral roll in Form 6 has been accepted*/rejected*. Detailed reasons: for *acceptance [under or in pursuance of rule 18*/20*/26(4)] or* rejection [under or in pursuance of rule 17/20*/26(4)]: U/Uk/br ....................................................................................................bgaiu thfhs goa nrgjfhd got 6 zg VWbfhsglJ* / uhffglJ* VWbfhsgLjYfhd [ 18*/20*/ 26(4) - ] myJ uhffgLjYfhd (f 17*/20*/26(4) - ) fhuzf:

Place / l : Date / eh:

Signature of Electoral Registration Officer thfhs g mfh ifbahg

(Seal of the Electoral Registration Officer) (thfhs g mfh Kiu)

During continuous updating after final publication of electoral roll / thfhs goa W btpoF d eilbgW bjhlUj nghJ. * Strike out the inappropriate alternative / * bghUjkwitfis moJ l

Remarks of Field Level Officers (e.g BLO, Designated Officer, Supervisory Officer) / fs mYty (thF rhto iy mYty, zfgl mYty, Ff

nkghit

mYty)-f

(This page should be thick enough so that it does not get mutilated/damaged in postal transit) / (jgh mDnghJ ahkUf gf fdkhd jh Uf ntL) Intimation of action taken (Section-II of the page is to be filled by Electoral Registration Officer of the constituency and to be posted to the applicant on the address as given by the applicant in Section-I) eltoif vLfgl tu (bjhF thfhs g mfhah -II uggL, -I- zgjhuuh bfhLfgl KftF mDgglntL) --------------------------------------------------First fold/ Kj ko-------------------------------------------------------------------------

Section-I /-I
Postage Stamp to be affixed by the Electoral Registration Authority at the time of dispatch mDif nghJ thfhs g mYtyfjh jgh iy xlgl ntL.

** The application in Form 6 of Thiru/Tmt./Selvi **U/ Uk/br got 6- mfgl zgkhdJ

** (Full address) House/Door number / (KG Kft) L/fj v : Street/Area/Locality/Mohalla/Road / bjU/gF/l/rhiy: Post Office / mr mYtyf: Tehsil/Taluka/Mandal/Thana / tl/kly: ** To be filled in by the applicant / zgjhuuh ugglntL.

Flat Name / Building Name / mLFkho FoU/fol bga: Town /Village / efu/uhk: Pin Code / mr FpL v. District / khtl:

-------------------------------------------------- Second Fold / ulh ko------------------------------------------------Section-II -II has been (a) accepted and the name of Thiru/Tmt./Selvi. has been registered at Serial No..in Part Noof Assembly Constitu ency. (b) rejected for the reason (m) VfgL, U/ Uk/ br .. bga, rlkw bjhF thfhs goa ghf v . tir v. . g bragLsJ. (M) ........ vw fhuzfhf uhffgLsJ. Date / eh: Electoral Registration Officer / thfhs g mfh.. (Address) /(Kft)

.. ..

Receipt for application / got bgW bfhljF xif Received the application in Form 6 of ** Thiru/Tmt./Selvi U/ Uk/br ** ..lUJ got 6 bgW bfhsglJ. ** Address/Kft..... Date/ eh: .
Signature of the officer receiving the application on behalf of the Electoral Registration Officer/ thfhs g mfh rh got bgW bfhl mfh ifbahg (Address) / (Kft) ..

** To be filled in by the applicant/zgjhuuh ugglntL.

GUIDELINES FOR FILLING UP THE APPLICATION FORM-6 General Instructions

Who can file Form-6 1. First time applicant on attaining age of 18 years or more on the first day of January of the year with reference to which the electoral roll is being revised. 2. Person shifting his / her place of ordinary residence outside the constituency in which he / she is already registered.

When Form-6 can be filed 1. The application can be filed after draft publication of electoral roll of the constituency. The application is to be filed within the specific day provided for the purpose. Due publicity is given about the above period when the revision programme is announced. 2. 3. Only one copy of the application is to be filed. Application for inclusion of name can be filed through out the year even when the revision programme is not going on. During non-revision period, application must be filed in duplicate.

Where to file Form-6 1. During revision period, the application can be filed at the designated locations where the draft electoral roll is displayed (mostly polling station locations) as well as the offices of the Electoral Registration Officer and Assistant Electoral Registration Officer of the constituency. 2. During other period of the year when revision programme is not going on, the application can be filed with the Electoral Registration Officer or other Offices as may be specified.

How to Fill the Form-6 1. The application should be addressed to the Electoral Registration Officer of the constituency in which you seek registration. The name of the constituency should be mentioned in the blank space. 2. Name (With Documentary Proof) The name as it should appear in the electoral roll and Electors Photo Identity Card (EPIC) should be furnished. The full name except the surname should be written in the first box and surname should be written in the second box. In case you do not have a surname, just write the given name. Caste should not be mentioned except where the caste name is used as part of the electors name or a surname. Honorific appellations l ike Thiru,Thirumathi, Selvi, Khan, Begum, Pandit etc. should not be mentioned.

Age (With Documentary Proof) The age of the applicant should be eighteen or more on 1st January of the year with reference to which the electoral roll is being revised. The age should be indicated in years and months. e.g. A person born on or upto 1/1/1991 will be eligible for inclusion in the electoral roll which is being revised with reference to 1/1/2009. Persons born on 2/1/1991 or thereafter upto 1/1/1992 shall be eligible for inclusion during the next revision with reference to 1/1/2010. 4. Sex Write your sex in full in the space provided e.g. Male / Female / Others. . Eunuchs have to choose from one of these options. Date of Birth (With Documentary Proof) Fill up the date of birth in figures in the space provided in dd/mm/yyyy. Proof of date of birth to be attached are as under: (i) Birth certificate issued by Municipal Authorities or district office of the Registrar of Births & Deaths or Baptism certificate; or (ii) Birth certificate from the school (Govt. / Recognised) last attended by the applicant or any other recognised educational institution; or (iii) If a person is class 10 or more pass, he should give a copy of the marksheet of class 10, if it contains date of birth as a proof of date of birth; or (iv) Marksheet of class 8 if it contains date of birth; or (v) Marksheet of class 5 if it contains date of birth; or (vi) A declaration in prescribed format given in Annexure-I (made available on demand by registration authorities) made by either of his parents if the person is not educated till class 10 (In those cases where parental declaration is given as proof of age, the applicant will have to be present himself for verification before BLO/ERO/AERO); or

3.

5.

A certificate of his age given by a sarpanch of the concerned Gram Panchayat or by a member of the concerned Municipal Corporation/Municipal Committee, that the person is not educated till class 10 and both the parents are not alive. (viii) Indian Passport (ix) PAN card (x) Driving License (xi) Aadhar Letter issued by UIDAI Note: Documentary proof of age will be required only in those cases, where age of the applicant is between 18 and 21 years. In all other cases declaration of his age by the applicant will be taken as proof of age. 6. Place of Birth In case born in India, please mention name of place like Village / Town, District, State. Relations Name: In case of unmarried female applicant, name of Father / Mother is to be mentioned. In case of married female applicant, name of Husband is to be mentioned. Strike out the inapplicable options in the column. Place of Ordinary Residence Fill up the full and complete postal address including PIN code where you are ordinarily residing and want to get registered, in the space provided. Proof of ordinary residence to be attached are as under: (i) Bank / Kisan / Post Office current Pass Book, or (ii) Applicants Ration Card / Passport / Driving License / Income Tax Return filed or Assessment Order, or (iii) Latest Water / Telephone / Electricity / Gas Connection Bill for that address, either in the name of the applicant or that of his / her immediate relation like parents etc., or (iv) Postal departments posts received / delivered in the applicants name at the given address. NOTE: In case of homeless persons, the BLO will visit the address given in From 6 at night to ascertain that the homeless person actually sleeps at the place which is given as his address in Form 6. If the BLO is able to verify that the homeless person actually sleeps at that place, no documentary proof of place of residence shall be necessary. BLO must visit for more than one night for such verification. 9. Details of family members already included in the Electoral Roll Please fill up name and other particulars of immediate family members i.e. Father / Mother / Brother / Sister / Spouse included in the current electoral roll of the constituency. Name of any other relation like uncle, aunt, cousin brother / sisters etc. not to be mentioned. 10. Declaration Please indicate date from which you are residing in the given address. In case the exact date is not known, fill-up month and year. If your name is already included in the electoral roll of any other constituency, please write legibly the full previous address with PIN code. If you already have been issued with a Photo Identity Card by the Election Commission, please mention the card number (printed on the front side) and date of issue (printed on the back side) of the card in the space provided. Please attach a self-attested photocopy of both sides of the card. Miscellaneous In many places the photograph of the elector is also printed in the electoral roll. You have the option to submit one recent coloured passport-size photograph alongwith the form. The photograph will be used to print your image in the electoral roll and issue of identity card, if required. Please also give your full name and address on the acknowledgement and intimation portions. Please give your mobile number and E-mail ID in the form, which is optional, as the same, if given, may be used by the Electoral Registration Officer for further communication with the applicant whenever required. The Booth Level Officer for the part may be contacted with regard to any Electoral Roll registration work.

(vii)

7.

8.

Call Centre (toll free) telephone No. : 1950 Election Commissions website: : www.eci.nic.in got Officers 6I utjfhd Chief Electoral website tfhoFf : www.elections.tn.gov.in

got 6I utjfhd tfhoFf

bghJthd miuf

got 6I ah jhf brayh

1. thfhs goa Uj eilbgW Mo rdt Kj nj mW 18 taJ iwtilJ / 18 taF nkgL Kj Kiwahf zgt. 2. jh K g brUF bjhFF btna jdJ rhjhuz Ulij kh UF eg.

got 6 vnghJ mfglyh

1. bjhF thfhs goa tiu btpoF wF zgij jhf brayh. nfhiffis jhf brtjbfd tiuaWfgl fhyfl zgij jhf bra ntL. thfhs goa Ujg mfgl nkFl fhymsitg ca ms sgu bragL. 2. zg xnu xU uia kLnk jhf bra ntL. 3. bgaiu nrgjfhd zgij ML KGtJ (Uj gf eilbgwhj fhy cgl) jhf brayh. Ujg eilbgwhj fhyf zgij Uufshf jhf bra ntL.

got 6I vnf jhf brtJ

1. Ujg eilbgW fhy zgij tiu thfhs goa ghitF itfgL zfgl miklf (bgUghY thFrhto miklf) kW thfhs g mfh kW cj thfhs g mfh mYtyfY jhf brayh. 2. thfhs goa Ujg eilbgwhj, Mo kw fhyf zgij thfhs g mfhlnkh, Fl kw mYtyffnyh jhf brayh.

got 6-I vgo utJ

1. f g branfhU bjhF thfhs g mfhF zgij KftlntL. fhahf cs l bjhF bga uggl ntL. 2. bga (Mtz rhWl) thfhs goaY thfhs ifgl milahs milY tuntoago bga uggl ntL. FLg bga jj KGbgaiu Kj flY FLgbgaiu ulhtJ flY vGj ntL. cfSF FLgbga yhlh bgaiu kL vGj ntL. thfhsUila bga gFahfnth FLgbga gFahfnth yhjgr rh bgaiu FlTlhJ. fut milbkhfshd U, Uk, br, fh, ngf, go nghwit FlglTlhJ. 3. taJ (Mtz rhWl) thfhs goa Uj bragL Mo rdt Kj njaW zgjhu 18 taJ iwtilJ myJ mjF nkgL Uf ntL. taJ MLf kW khjf Flgl ntL. v.fh. xU eg 01.01.1991 mnwh myJ mjF Kngh wUjh 01.01.2009-I mogilahf bfhL UjgL thfhs goa jdJ bgaiu nrf jFilat Mwh. 02.01.1991 mnwh myJ mijaLJ 01.01.1992 tius ilgl fhy wjtf 01.01.2010-I mogilahf bfhL bragL mLj Uj jkJ bgaiu nrJ bfhs jFilatf Mthf. 4. ghd cfSila ghdij mjbfd xJfgl l Fl (v.fh.) M/bg/ju. Ueifa t VnjD xiw Fl ntL. 5. wj nj (Mtz rhWl) wj njia mjbfd fhahf lgLs l ug (nj/khj/tUl). wj njfhd rhwhf tUtdtW VnjD xiw izf ntL: (i) efuh mikfsh myJ khtl w w gths mYtyfjh tHfgl w rhj myJ Phdehd rhj ; myJ (ii) zgjhu filahf gw (muR/mffgl) gah myJ ntW VjhtJ mffgl f Wtdjh tHfgl w rhj (iii) xU eg gjh tF myJ mjF nk nj bgwtuhUjh, wj njF rhwhf gjh tF kbg rhj efiy (m wj nj FlgoUjh) rkf; myJ (iv) vlh tF rhj (m wj nj FlgoUjh) ; myJ (v) Ijh tF rhj (m wj nj FlgoUjh) ; myJ

(vi) xU eg gjh tF tiu gouhjtuh UF gr, bgnwh xUtuh, iz 1 cs tiuaWfgl got (mfhflUJ nfLbgwyh) mfgL cWbkh (bgnwh cWbkhna taJ rhwhf mfgL nef, thF rhto iy mYty/ thfhs g mfh/ cj thfhs g mfh Kiy zgjhu rghfhf tuntL) ; myJ (vii) jdJ bgnwh UtU cUl yhj xU eg gjh tF tiu gouhjtuh UF gr, mtUila taJ FJ uhk grhaJ jiyt myJ rgjgl khefuh/efuh cWd mF xU rhj. (viii) a flL (ix) tUkhd t uju fzF v mil (x) XLe ck (xi) a jJt milahs mfhu mikdh tHfgl Mjh foj F: 18 Kj 21 tiuyhd taJila zgjhuf kLnk taJ Fj Mtz rhiw mf ntL. kw vyh nefY zgjhu mF cWbkhna mtuJ taJrhwhf VW bfhsgL. ah wJ Ujh wj lij (uhk/efu, khtl, khy) ja brJ

6. wj l Fl.

7. cwd bga Ukzkhfhj bg zgjhuuhf Ujh jij/jh bgaiu Fl ntL. Ukzkhd bg zgjhuuhf Ujh fzt bgaiu Fl ntL. bghUjhjtiw moJ l. 8. rhjhuz tl f bgaiu g bra nfhUw cfsJ rhjhuz tl KG Kftia mryf FpL vQl mjbfd fhahf lgLs l Fl ntL. rhjhuz tlfhd rhwhf tUtdtW xiw izf ntL. m. t/rh/mr mYtyf el fzF ifnaL; myJ M. zgjhu czbghU gL mil/flL/XLe ck/ tUkhd t jhf brj got myJ tUkhd t Miz; myJ . zgjhu bganyh myJ mtuJ bgnwh nghw beUa cwd bganyh cs Fo/bjhiyng/rhu/rika vth iz nghwt rga uJ; myJ <. bfhLJs Kft zgjhu bgaUF tJ nrj jgh Jiw jghf F: L yhj egfis bghWjtiu, got 6- bfhLfgLs KftF thF rhto iy mYty ubghG brW, oyhj mj eg ciknyna mj lij cwFtjF gagLJwhuh vW flth. oyhj mj eg ciknyna mj ljh cwFwh vW thF rhto iy mYtyuh fla Kojh, ml mj eg tgjfhd Mtz rhW VJ njitglhJ. rghfhf xWF nkgl u bghGJf thF rhto iy mYty bry ntL. 9. thfhs goa Vfdnt nrfgLs cwdf tuf bjhF jnghija thfhs goa nrfgLs beUa cws FLg cWdf (jh/jij/rnfhju/rnfhj/fzt/kid) bga kW w tufis ja brJ ug ntL. w cwdfshd khkh/mij/jgh/bgagh/xW l rnfhju/rnfhj nghnwhiu Fl TlhJ. 10. cW bkh bfhLJs Kft jhf vj njUJ tJ tUf vW ja brJ Fl. rahd nj bjahlh khjij tUlij Fl. jfSila bga Kng ntbwhU bjhF thfhs goa nrfgoUjh KGikahd giHa Kftia mryf FpL vQl ja brJ bjthf vGj. gtif iwa lf thfhs goa thfhs ifglK mlgoUwJ. gotJl cfSila rga (ghngh mss) tz ifgl xiw mgJ cf UgJ FglJ. thfhs goa cf cUtglij ml, njitglh milahs mil tHf mifgl gagLjgL. cfSila KG bgaiu Kftia xif kW eltoif vLfgl tu gFf Fl. cfSila ifng v kW dr Kftia got Fl (UgFglJ). njitgLnghJ zgjhuUl bjhl bfhtjF tiw thfhs g mfh gagLjyh. thfhs goa g bjhlghf ghf thFrhto iy mYtyiu bjhl bfhsyh.

miH ika (flzyh) bjhiyng v a njj Miza tiyjs jiyik njj mfh tiyjs

: 1950 : www.eci.nic.in : www.elections.tn.nic.in