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    Application For Certified Copy of Electoral Roll

    Uploaded by

    Heera Kardong
    This document contains an application form for obtaining a certified copy of an electoral roll from the Election Department. The form requests applicant details like name, gender, address, and contact information. It also requests details about the voter entry being sought like polling station number, part number, and year of the electoral roll. Applicants must provide identity documents like an Aadhaar or PAN card number and may attach additional supporting documents.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Application For Certified Copy of Electoral Roll

    Uploaded by

    Heera Kardong
    4K views2 pages
    This document contains an application form for obtaining a certified copy of an electoral roll from the Election Department. The form requests applicant details like name, gender, address, and contact information. It also requests details about the voter entry being sought like polling station number, part number, and year of the electoral roll. Applicants must provide identity documents like an Aadhaar or PAN card number and may attach additional supporting documents.

    Original Title

    APPLICATION FOR CERTIFIED COPY OF ELECTORAL ROLL

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    This document contains an application form for obtaining a certified copy of an electoral roll from the Election Department. The form requests applicant details like name, gender, address, and contact information. It also requests details about the voter entry being sought like polling station number, part number, and year of the electoral roll. Applicants must provide identity documents like an Aadhaar or PAN card number and may attach additional supporting documents.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    4K views2 pages

    Application For Certified Copy of Electoral Roll

    Uploaded by

    Heera Kardong
    This document contains an application form for obtaining a certified copy of an electoral roll from the Election Department. The form requests applicant details like name, gender, address, and contact information. It also requests details about the voter entry being sought like polling station number, part number, and year of the electoral roll. Applicants must provide identity documents like an Aadhaar or PAN card number and may attach additional supporting documents.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    Department: Election

    APPLICATION FOR CERTIFIED COPY OF ELECTORAL ROLL


    ( ৰ ৰ )
    (*Marked Fields are mandatory)
    (*চিহ্নযু ক্ত তথ্যববোৰ বোধ্যতোমূ লক)

    Applicant’s Details (আবেদনকাৰীৰ বেৱৰণ)

    *Applicant’s Name (আববদনকোৰীৰ নোম) ………………………………………..


    *Applicant’s Gender ( ৰৰ ) Male Female
    *Mobile Number (মবোইল নম্বৰ ) ………………………………………..
    Date Of Birth ( ৰ ৰ ) ………………………………………..
    Father’s Name ( ৰ ) ………………………………………..
    Aadhar card Number ( ৰ ৰ) ………………………………………..
    Pan Number ( ৰ) ………………………………………..
    Mail Id ( ) ………………………………………..

    Address Details ( ৰ ৰ )
    *State (ৰোজ্য) ………………………….
    *District(চজ্লো) ………………………….
    *Sub-Division (মহকুমো) …………………………..
    *Circle Office(ৰোজ্হ িক্র) ………………………….
    House No ………………………….
    Mouza ( ) …………………………..
    *Village/Town(গোওঁ/টোউন) …………………………..
    *Police Station(থ্োনো) …………………………..
    *Post Office(ডোকঘৰ) …………………………..
    * Pin Code(পিন নং) …………………………..

    Signature of the applicant


    (আববদনকোৰীৰ িোক্ষৰ)
    Department: Election

    APPLICATION FOR CERTIFIED COPY OF ELECTORAL ROLL


    ( ৰ ৰ )
    (*Marked Fields are mandatory)
    (*চিহ্নযু ক্ত তথ্যববোৰ বোধ্যতোমূ লক)

    Other Details ( ৰ )

    Name of LAC (LACৰ ) …………………………..

    LAC No (LAC নং) …………………………..

    Name of Polling Station …………………………..


    Polling Station No …………………………..
    Part Number …………………………..
    GP or Ward …………………………..
    Year of Electoral Roll …………………………..

    Voter List Serial


    Voter’s Name Voter Gender Voter Age
    No. Name of Father/Mother/Husband

    Supporting Documents (সংলগ্ন নচথ্)

    1. Any other documents(Voter ID Card, Voter slip/ Previous Voter List etc.).

    Signature of the applicant


    (আববদনকোৰীৰ িোক্ষৰ)
    ……………~………………

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