Details of action taken (to be filled by electoral registration Officer of the constituency) |
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| Revision identity | Constituency number and name | |||||
| The application of Shri /Smt./Km……………………… for inclusion of name in the electoral roll in Form 6 has been accepted/rejected. | ||||||
| Accepted: | ||||||
| a) | Under rule
18/rule 20 and name of the elector is included in the electoral roll of the Constituency finally published on …………. After Intensive/Summary/Special revision |
Serial number allotted | In part number | |||
| Or b) | Under sub-rule (4) of rule 26 and name of the elector is included in the electoral roll of the constituency | |||||
| Rejected : | ||||||
| Rejected, under rule 17/rule 20/26(4) | ||||||
| Detailed reasons for acceptance [under rule 18/20/26 (4)] or rejection [under rule 17/20/26(40) | ||||||
Place:
Date:
| Seal of the Electoral Registration Officer |
Signature of Electoral Registration Officer
For use of registration Officer or other Officer designated by him
| Details of acknowledgement
particulars indicated in Form 9 ( To be filled by Officer receiving the application ) |
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| Details of acknowledgement receipt issued to the applicant. | |||||
| Receipt number | Signature
of Officer Receiving the application |
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| Date of receipt: | |||||
| Remarks, if any, of the Officer receiving the application: | |||||
| Application received by: | |||||
| Name of Officer: | |||||
| Designation: | |||||
| Personal identity number: (as allotted by the District Election Officer/Electoral Registration Officer for the purpose of revision of rolls) |
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| Designated
location identity (where the Application has been received) |
Serial No. of the Form in the list (Form 9) | Date of the list (Form 9) |
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Place:
Date:
Signature of Officer
Receiving the application
Electoral Registration officer /Assistant Electoral Registration Officer/designated Officer/Supporting Staff of designated Officer.