FORM 7 SEE rule13 (2) Application for objection to inclusion of name in electoral roll To The Electoral Registration Officer, ....... Assembly/e Parliamentary Constituency. Sir, I object to the inclusion of the name of the under mentioned person in the electoral roll for the above Constituency. Particulars in support of my objection are given below: I. Details of Person objected to: 1. Title $ 2. First and middle name 3. Last name 4. Part number of electoral roll in which his/her name is included: 5. His / her serial number in that part: II. a) Details of objector 6. Title $ 7. First and middle name 8. Last name 9. Sex (Male/female): 10. Part number of electoral roll in which his/her name is included: 11. His/her serial number in that part: (b) Details of relation of objector (Father/mother/ husband) 12. Title $ 13. First and middle name 14. Last name (c) Relationship with objector: Father/Mother/Husband: III. Particulars of objector's place of ordinary residence (Full address): 15. House/ Door number: 16. Street/Mohalla/Road/Gali: 17. Area/ Locality: 18. Town/Village: 19. Post Office: 20. Pin Code: 21. Police Station: 22. Tehsil/Taluka @: 23. Block/Mandal (for Village)@: 24. District: $ Sh./Smt/Km./Dr. etc. e In case of Union territories having no Legislative Assembly and the State of Jammu and Kashmir @ May not be applicable in Metropolitan Areas VI. Details of objector's Photo Identity Cards (if issued, in this or some other Constituency) 25. Electors' photo Identity Card number: 26. Date of issue: 27. Constituency (Assembly/ Parliamentary e Constituency) Name: V. Reason(s) for objection: VI. Declaration I hereby declare that the facts and particulars mentioned above are true to the best of my knowledge and belief: Place: Date: Signature or thumb impression of applicant I am submitting the application to the Electoral Registration Officer through (i) Sh./Smt./ Km. (full name and address) or (ii) in person, / or (iii) by Post ................... Signature or thumb impression of 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 section31 of the Representation of the People Act, 1950. Signature or thumb impression of the Person submitting the application * Strike out the inappropriate alternative e In case of Union territories having no Legislative Assembly and the State of Jammu and Kashmir For use of registration officer or other officer designated by him Details of acknowledgement particulars indicated in Form 10 (To be filled by Officer receiving the application) Details of acknowledgement receipt issued to the applicant. Receipt number: Signature of officer receiving the application: Date of receipt: Remarks, if any, of the Officer receiving the application: Application received by: Name of Officer: Designation *: Personal identity number: (As allotted by the District Election Officer/Electoral Registration Officer for the purpose of revision of rolls) Designated location identity (where the application has been received) Serial number of the Form in the list (Form 10) Date of the list (Form 10) Place: Date: Signature of Officer receiving the application * Electoral Registration Officer/ Assistant Electoral Registration Officer/Designated Officer / Supporting Staff of Designated Officer Details of action taken (To be filled by electoral registration officer of the Constituency) Revision identity Constituency number and name The application of Shri/Smt./Km. ........................ objecting to inclusion of name of Shri/Smt./Km. ........................ in the electoral roll in Form 7 has been accepted*/ rejected* * Accepted: a)* Under rule 18*/rule 20* and name of the person objected to is deleted from the electoral roll of the Constituency finally published on .............................. after Intensive*/Summary*/Special* Revision Serial number of entry deleted In part number b)* Under sub - rule (4) of rule 26e and the name of the person objected to is deleted from the electoral roll of the constituency * Rejected: Rejected, under rule 17*/rule 20*/rule 26(4) * Detailed reason for *acceptance [Under rule 18*/ 20*/26(4)*] or rejection [under rule 17*/ 20*/ 26(4) *] Place: Date: Signature of Electoral Registration Officer e During Continuous updating * Strike out the inappropriate alternative.
