Male Female Yes No 0 0 0 0 0 0 0 0 Application for correction to particulars entered in electoral roll [See Rules 13(3) and 26] FORM 8 To The Electoral Registration Officer, £ Assembly/Parliamentary Constituency Sir, I request that entry relating to myself appearing in the electoral roll for the above constituency is not correct and it should be corrected. Correct particulars in support of my request are given below: Surname (if any) Name I. Applicant 's details Part number of electoral roll Serial number in that part Age as on # Years Months Sex 1st January Date of Birth, if known Name Surname (if any) * Father's / Mother's / Husband's Name 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 Elector's Photo Identity Card (if issued, in this or some other Constituency) Elector's Photo Identity Card number Name of the Constituency IV. Details of entries to be corrected: * My name/ *Age/ *Father's/ Mother's/ Husband's name/ *Sex/ Address/ * Elector's 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 section 31 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. Published on National Portal of India (india.gov.in) Photo Identity Card number may be corrected in terms of information provided in this Form above. Place (Perforation) Details of action taken (To be filled by Electoral Registration Officer of the constituency) for correction of Km The application of Shri/ Smt./ entry in the electoral roll in Form 8 has been accepted*/ rejected*. Detailed reasons for * acceptance [under or in pursuance of rule 18*/20*/ 26(4)]£ *rejection [under or in pursuance of rule 17*/20*/ 26(4)£ ] Place Date Signature of (Seal of the Electoral Electoral Registration Officer Registration Officer) * Strike out the inappropriate alternative. £ During continuous updating after final publication of electoral roll. Published on National Portal of India (india.gov.in) Receipt for application Received 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 ** To be filled in by the applicant. (Address)
