Election Department FORM 8A [See rules 13(4) and 26] Application for transposition of entry in electoral roll To The Electoral Registration Officer, ............Assembly/£Parliamentary Constituency Sir, I request that the entry in the electoral roll for the above mentioned constituency relating to * Myself/*person named below should be transposed to the relevant part of the roll in this constituency. Particulars of the entry to be transposed are given below: - I. Details of person whose entry is to be transposed Name Surname (if any) Part Number of electoral roll in which his/her name is included: His/her serial number in that part: Elector's Photo Identity Card (if issued) Number: * Father's Mother's Name Husband's Name Surname (if any) II Particulars of present 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. Period of continuous residence at the above address on the date of application Years: Months: IV. Part number to which the entry has to be transposed (if known): @ V. Details of Applicant Name Surname (if any) Part number of electoral roll in which his/her name is included His/her serial number in that part: Elector's Photo Identity Card (if issued) Number: £ In case of Union territories having no Legislative Assembly and the State of Jammu and Kashmir. * Strike out the inappropriate alternative. @ Part V not to be filled where applicant seeks transposition of entry relating to himself. ....................(Perforation)................... Receipt for application Received the application in Form 8A of ** Shri/Shrimati/Kumari............ **Address................................... Date.......... Signature of the officer receiving the application on behalf of the Electoral Registration Officer (Address)............... ................... **To be filled in by the applicant. VI. Declaration: I hereby declare that the facts and particulars mentioned above are true to be best of my knowledge and belief. Place: Date: Signature or thumb impression of the applicant 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) Details of action taken (To be filled by Electoral Registration Officer of the constituency) The application of Shri/Smt./Km......................... for transposition of entry relating to himself/herself/Shri/Smt./Km............... in the electoral roll in Form 8A has been accepted */rejected *. Detailed reasons for acceptance or rejection [under rule 26(4) ] * : Place: Signature of (Seal of the Electoral Date: Electoral Registration Officer Registration Officer) * Strike out the inappropriate alternative.
