"FORM 8"
[See rules 13(3) and 26]

 Application for correction to particular entered in electoral roll

To
The Electoral Registration Offer,

Assembly/ Parliament£ Constituency

Sir,

I request that entry related to my self appearing in electoral roll for the above constituency is not correct and it should be corrected. Correct Particulars in support of my request are given below:
I. Applicant's details  Name  Surname (if any)
                          
Part number of electrol roll: Serial number in that part:
Age as on 1st January................# Years:
 		 Years:
 		 Sex:
 
Date of Birth, if known Day:
 		 Month:
 		 Year:
 

*Father's

Mother's Name

Husband's

Name Surname (if any)


II. Particulars of place of ordinary residence (Full address)
House / Door number:                    
Street / Area / Locality/ Mohalla /Road:         
Town / Village                     
Post Office                     Pin Code 
Tehsil / Taluka / Mandal/ Thana                
District:                                       
III. Details of Electors' Photo Identity Card(if issued, in this or some other Constituency)
Electors' photo Identity card number:            
Name of Constituency                          
IV. Details of entries to be corrected
* My name/ *Age/ *Father's/Mother's/Husband's name /*Sex/*Address/*Electors' Photo identity Card Number may be corrected in items of information provided in this Form above.

Place
Date:                             Signature or thumb impression of the elector

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 section31 of the Representation of the people Act, 1950(43 of 1950)

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.

....................................................................(Perforation)......................................................................
 
Receipt for application

Recevied the application in Form 8 of **Shri / Shrimati / Kumari
**Address

Date                               Signature of the officer receiving the application on                                                                                   behalf of the Electoral Registration Officer                                                                                             (Address)
**To be filled by the applicant.

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 electrol 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:                                                 
Date                        Signature of                                        (Seal of the Electoral
                                   Electoral Registration Officer                                Registration Officer)

£During continuous updating after final publication of electoral roll.
* Strike out the inappropriate alternative.