FORM 4 [See rule 8] Letter of Request To Place _____________ Date _____________ The Occupant of ------------------------------ Sir/Madam, The preparation of the electoral roll for the Assembly Constituency in which you are residing has been taken in hand. It will greatly facilitate my work if you will kindly complete the statement below after reading the attached instructions and hand it over to my assistant who will call for it. STATEMENT Name and particulars of adult citizens ordinarily residing in the above premises Name of citizen Particulars as to father Age on 1st [or Mother] or husband January, 2000 1. 2. 3. 4. 5. 6. 7. etc. Signature __________________ Date _____________________ . 1. Inserted by SRO-1l2 dated 9-6-1994.
