Form 6

Assembly Constituency:

District:

Part*:

Select Relation Type and Enter Sr No of Relative to Fetch Address/Relation details (Autofill),If Sr No of relative is not known then click on the [ Search Relative ] link given below

Relation Type:

Sr No of Relative:* :

[ Search Relative ]

Applicant Relative and Address Details

Relation*:

FatherMotherHusbandOthers

Name*:

Phonetic :

Devnagari:

Surname*:

Phonetic:

Devnagari:

Section*:

Area Type:

Village/Town*:

Post Office*:

Pin Code*:

Tehsil/Taluka*:

State:

House No*:

Phonetic :

Devnagari:

Extra HNo:

(Extra House No if any)

Phonetic:

Devnagari:

Locality/Area:

Applicant's Personal Details

Name*:

Phonetic:

Devnagari:

Surname*:

Phonetic:

Devnagari:

Gender*:

MaleFemaleOthers

Date of Birth*:

(If Not known,enter Age)

Age *:

Years Month(s)

Year of Birth*:

Age as on Date*:

Resident*:

Since Birth (If Resident Since Date is not known;Enter Resident Since Years and Months)

Resident Since*:

Year(s) Month(s) (If Resident Since Date is entered then need not to enter Resident Since Years and Months)

Birth State:

Birth District:

Birth Village/Town:

Applicant's Other Details

Photo*:

Email:

Mobile No:

Place*:

How did you know about this Site?*

Details of family member(s) already included in the current electoral roll

Family Relations:

FatherMotherHusbandOthers

Type the characters you see in the Picture:

Picture:

Type Characters*

(Case Sensitive)

Public Grievance Redress

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Assembly Elections 2012

Election machinery

ECI Handbooks

Online Application for Inclusion of Name in Electoral Roll [ FORM 6 ]