ELECTION COMMISSION OF INDIA Form ID

APPLICATION FOR DUPLICATE / REPLACEMENT / WALLET FRIENDLY ECI-EPIC-

ELECTOR’S PHOTO IDENTITY CARD (EPIC) DUE TO (tick the appropriate 001C
box)
Defect(s) Loss / destruction / mutilation of image
Epic not being wallet friendly
State/ UT :
AC (No. & Name):
To
The Electoral Registration Officer …………………………...…………………… Constituency.

Sir / Madam
I am / was an elector of the constituency mentioned above and I was issued with Elector’s Photo Identity
Card but (tick the appropriate box)
image in card is incorrect spelling of my name is incorrect
spelling of my relation's name is incorrect relation type is incorrect
gender is incorrect age is incorrect
address is incorrect address needs change due to shifting
card has been lost card has got destroyed
image in card is mutilated. Wallet friendly card is required in lieu of old card
I request that a corrected / duplicate/ wallet friendly EPIC may be issued to me

Applicant’s Current Details

in Tamil
Applicant’s name in English
in Tamil
Father’s/Mother’s/
Husband’s name in English
Place of Ordinary Residence (full Address) :
House/Door NoÆ New : Old : Street / Road /Locality/Mohalla :

Flat / Building Name : Municipality/Ward No. :

Block/Gram Panchayat : Town/Village :

District : Post office :

Police Station: Pin Code :

Electors Photo Identity Card NO : Date of Birth

(DD/MM/YYYY)
Applicant’s details as in card
in Tamil
Applicant’s name
in English

Father’s/Mother’s/ in Tamil
Husband’s name in English
Place of Ordinary Residence (full Address) :
House/Door No. : Street / Road / Locality / Mohalla :

Flat Name / Building Name : Municipality/Ward No.

Block/Gram Panchayat : Town/Village :

District : Post office :

Police Station: Pin Code :

Electors Photo Identity Card NO Age

Applicant’s/Elector’s Photograph
I am submitting two copies of my recent passport-size photograph along with my signature/left thumb
impression across one photograph.
Affix one passport size
Two passport size photographs are pasted in the space (3.5 cm x 3.5 cm)
Affix one passport provided-one signed across and the other unsigned-at colored photo here
size (3.5 cm x 3.5 my own cost for preparation of Photo-Electoral Roll & (This photo should be
cm) coloured photo Electors Photo Identity Card. An attested photocopy of signed across, i.e. part
here (Do not put a photo-bearing identification document is also of the signature on the
your signature on enclosed. photo and part of the
this photo ) Form )
In support of Photograph-Passport, Driving License, PAN Card, and Service ID Cards issued to
employees by State/Central Electors Photo Identity Card./PSU/Public Electors Photo Identity Card.Co.,
Passbook with photograph issued by Public Sector Bank/Post Office, Students Identity Card issued by
Recognized Educational Institution., Pension Document, Railway Identification Card, Freedom Fighter
ID Card, Arms License, Elector’s Photo-Identity Card (Electors Photo Identity Card) issued, if any
[Note: Please enclose attested photocopy of any of the above photo-bearing documents for verification of
the photograph. In case the document is self-attested, then show the original at the time of submission of
the Form in person.
Declaration
I hereby declare that the facts and particulars mentioned above are true to the best of my knowledge and
belief. Also I am aware that I am liable for penal action for giving incorrect information in this
application.
Place :
Date :
……………………………………………………….
Applicant / Elector’s signature or left thumb impression
Note:
1. If name is not there in electoral roll or /and shifted from outside the Assembly Constituency, then
claim has to be given in Form 6 for inclusion of name in the roll; if shifted within the constituency then
application has to be given in Form 8A.
2. For correction of name in Tamil or in case of wrong image, Form 8 has to be given
3. In case of request for replacement / duplicate Electors Photo Identity Card due to change of address,
lost / misplaced / mutilated Electors Photo Identity Card or for wallet friendly Electors Photo Identity
Card in lieu of old card, the amount prescribed has to be remitted by the applicant.
For Office Use **
CERTIFIED that I, _____________________, s/o__________________, ________________
(designation of verifying/attesting officer) have verified the authenticity of the applicant’s photograph
with original passport/driving licence/arms licence/others (specify name of document and get one
photocopy if not already attached) or on the basis of the statement of Shri/Smt.__________________
(name of the person) supporting the authenticity of the photograph, whose name is included in the
electoral roll. The application for Duplicate / Corrected / Wallet friendly EPIC is accepted / rejected.

Signature of ERO
Acknowledgement of **Corrected / Duplicate / Wallet-friendly EPIC (by the Elector)
Received **Corrected / Duplicate / Wallet friendly EPIC No and Date :
Elector’s signature / left thumb impression :
ERO / AERO signature with date and designation :
** Strike out the inappropriate alternative