ELECTION COMMISSION OF INDIA
FORM-6A
(See Rule-8B of Registration of Electors Rules, 1960)
Acknowledgement No.
(To be filled by office)
(To be filled by office)
Application for Inclusion of Name in Electoral Roll by an Overseas Elector
To, The Electoral Registration Officer,
I request that my name may be included in the electoral roll for the Constituency in which my
place of
residence is located as mentioned in (j) below:
PASTE ONE RECENT PASSPORT SIZE PHOTOGRAPH (3.5 CM X 3.5 CM) SHOWING FRONTAL VIEW OF FULL FACE WITHIN
THIS BOX
(a) Name *
(b) Last Name *
(c) Name of relative *
(d) Last Name of relative *
(e) Date of Birth (dd/mm/yyyy)
/
/
(f) Place of Birth
Village/Town
District
State
(g) Gender (Put a tick mark in proper box)
(h) Email id#
(i) Mobile No.#
(j) Address in India as mentioned in original passport
House No.
Street/Area/Locality
Town/Village
District
Pin Code
Place
Date
Date
Signature
Application received on (DD/MM/YYYY)
The application in Form 6A of Shri/Shrimati/Kumari has
been :- (a) Accepted and the name has been registered in the electoral roll of (constituency)
at S.No. Part No.
(b) Rejected for the reason:-
Date:
Name/Signature of ERO/AERO
✂
✂
Acknowledgement/Receipt
Acknowledgement Number
Date
Received the application for inclusion in name of self from Shri / Smt. / Ms.
[ Applicant can refer the Acknowledgement No. to check the status of application]
Name/Signature of ERO/AERO
✅
Form Submitted Successfully