Voters Form

VOTER REGISTRATION by  

You are NOT REGISTERED until you SIGN and SUBMIT your Voter Registration Form   EASY INSTRUCTIONS to complete your voter registration:     1 PRINT this form . . Make sure you print pages 3 and 4 (Form 6) on one page in back to back print format. This is your Voter Registration Form the official application required by the Election Commission to register you as a voter.     2. FILL additional fields , if applicable. Check If anybody from your house is already registered on   electoral rolls, fill in their details on Page 4. If you are already a registered voter from a different constituency, fill in those details on Page 4. This will help Election Commission to cancel your previous voter registration. 3. ATTACH additional documents .   To register for voting, you will also need to submit:      a. Address Proof document      b. Age Proof document (for first time voters)  

Either of the above 2 documents should be an official Government issued document, which will also act as your proof of citizenship. To view the complete list of VALID address proof and age proof documents, refer to Page 2.     4. SIGN and SUBMIT   the completed form to the Electoral Registration Officer (ERO) of your Assembly Constituency (AC). You will find your ERO’s address below. You can also view the location of your ERO on your City map below!     5. CONFIRM   your form submission to Jaago re! One Billion Votes either by: Messaging (by SMS) “VOTE submit” to 56767 Updating your profile at www.jaagore.com Once you confirm, we will continuously track and confirm your voter status to you by SMS and email!  

  Map:  

     

SUBMIT YOUR FORM TO:

Electoral Registration Officer (ERO) of Assembly Constituency   - kalyan-dombivli

GENERAL INSTRUCTIONS DOCUMENTS REQUIRED TO REGISTER 1. ADDRESS Proof document   This document is required for the BLO (Booth Level Officer) to come and verify your residence status. It is therefore not essential for the address proof document to have your name. It needs to have only the address of the place where you are staying   Any one of the following documents is acceptable for address proof: 1. Landline phone bill 2. Mobile telephone bill 3. Water bill 4. Electricity bill 5. Property tax receipt 6. Bank statement 7. Passport 8. Ration card 9. House Lease/Rental agreement 10. LPG receipt 11. Driving license 12. Identity cards given by the employer

5 MYTHS ON VOTING 1. I am registering to get my voter ID card   When you register to vote, you are registering only to get your name included in the electoral rolls (also called voter list) and NOT to get a voter ID card. To get a voter ID card, you have to register separately. Remember, on election day, only 2 things are mandatory for you to be allowed to vote:   Your name should be present on voter list You should have a valid IDENTITY PROOF. Voter ID card is only one of the valid proofs.    2. I can vote only from the place of my birth / permanent residence   As a citizen of India greater than 18 years of age, you are eligible to vote from any place in India, provided you have been an ORDINARY RESIDENT i.e. you have been staying at your current address for at least 6 months or more.    3. I do not have a valid ADDRESS PROOF document to register for voting

    It is not essential for the address proof document to have your name. It needs to have only the address of the place where you are staying. You can use address proof document on the name    of your parents, relatives, friends etc. with whom you are AGE Proof document 2. staying.   If you are a first time voter, you will also need to submit an age     proof document. You can submit the proof of Date of Birth from any government agency authorized document like: 4. As a voter, I can vote in 2 kinds of elections – State Assembly Elections & General Elections

1. Birth certificate 2. Passport 3. PAN Card 4. Driving Licence 5. State board exam certificate etc.    3. For STUDENTS only   If you are a student residing outside your native city in a hostel / mess, you might not have any of the above mentioned address proof documents. In this case, you can get a Student Declaration Form (Page 5 of this form) signed by your college dean/principal/registrar and submit it along with your voter registration form.  

  As a registered voter you can vote in more than 2 elections! Besides General and Assembly elections, you can also vote in your Local Body Elections or Municipal Corporation Elections, as called in cities).    5. Registering to Vote is a cumbersome process   Earlier perhaps, but not any more! With Jaago re! One Billion Votes, not only can you fill and submit your registration form easily, you can also get to know when your name gets on the voter list. And all of this from the convenience of your home!

  DISCLAIMER

While all efforts have been made to make all data on the website ( www.jaagore.com ) or this Registration Form as error free as possible, users are requested to refer to the officially published error free copies of the Constitution of India, Acts, Rules and Orders made there under and to the latest editions of the various Handbooks, Compendia and Reports published by the Election Commission of India (ECI), for their authentic version. Neither Janaagraha nor Tata Tea Ltd. will be responsible for any loss to any person caused by any shortcoming, defect or inaccuracy in the above data. We also do not assure that any particular person will be on the electoral rolls of ECI.    

FORM 6 [See rules 13(1) and 26]

Application for inclusion of name in electoral roll  To The Electoral Registration Officer,   - kalyan-dombivli  Assembly/Parliamentary£ Constituency.  Sir,       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:  I. Applicant's

   details

Name

Surname (if any)

vijay

kulkarni

Age as on 1st January 2008 # Date of birth, if known :

Years :  59 Day :  06

Months :  1

Sex (male/female) : Male

Month :  12

Year :  1948

Village/Town :  

Place of birth :

District :  

Father's / Mother's / Husband's Name

State :   Name

Surname (if any)

 pandurang

 kulkarni

II.  Particulars of place of ordinary residence (Full address): House / Door number : pramila sa, 2nd floor Street/Area/Locality/Mohalla/Road : nandivli road, near lewa bhavan, ramnagar, Town / Village :  Post Office :  

Pincode :  421201

Tehsil/Taluka/Mandal/Thana :  dombivli east

 

District : 

£ In case of Union territories having no Legislative Assembly and the State of Jammu and Kashmir. # Please give the year i.e. 2003, 2004, etc. * Strike out the inappropriate alternative.            

P.T.O. .................................................................................(Perforation)................................................................................... Receipt for application

Received the application in Form 6 of ** Shri/ Shrimati/Kumari  vijay pandurang kulkarni **Address :   pramila sa 2nd floor nandivli road near lewa bhavan, ramnagar, , dombivli east thane 421201   Signature of the officer receiving the application on Date :   behalf of the Electoral Registration Officer   (Address) .........................................................   **To be filled in by the applicant.  

III. Details of member(s) of applicant's family already included in the current electoral roll of the Constituency : Name

Relationship with applicant

Part number of the roll of the Constituency

Serial number in that Part

Elector's Photo Identity Card Number

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 15-09-1978 (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. Full Address (Earlier Place of ordinary residence) :

Electors photo identity card (if issued) number; ......................... date of issue .............................

 

Place :

Date :

Signature or thumb impression of claimant

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). * Strike out the inappropriate alternative.  

Details of action taken (To be filled by Electoral Registration Officer of the constituency) The application of Shri/Smt./Km...................................................................................................................................................................... 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)£] :

  Place : Signature of Date : Electoral Registration Officer   £ During continuous updating after final publication of electoral roll. * Strike out the inappropriate alternative.  

(Seal of the Electoral Registration Officer)