FORM-3 [See rule 7] Statement as to Place of Ordinary Residence by a Person employed under the Government of India in a post outside the State. Full name_____________________________________________________________ Father's/'Mother's/Husband's name________________________________________ Age on 1st January ______________________________________________________ Description of post held outside India________________________________________________ I hereby declare that I am a permanent resident of the State and that but for my being employed under the Government of India in the above-mentioned post, I would have been ordinarily resident at (full postal address______________________________________________________ I further declare that my wife (name) ________________________________aged____years. Ordinarily resides with me and is a permanent resident of the State. This cancels any previous statement as to place of ordinary residence made by me. Signature __________________________ Place __________________________ Verified Signature ________________ Date __________________________ Designation of the Head of Office _________________ (FOR USE IN THE ELECTION OFFICE) Statement received on the _________________________________200 ____________ Registered in the electoral roll for the ________________________________________ Assembly Constituency (No________________ ) Service voters Part, at S. No________ [Electoral Registration Officer] Date_________________ 1. Inserted by SRO-1I2 dated 9-6-1994.
