FORM 8 (SEE rule13 (3) and 26) Application for objection to particulars entered in electoral roll To The Electoral Registration Officer, ....... Assembly/e Parliamentary Constituency. Sir, I request that the entry relating to myself appearing in the electoral roll for the above mentioned Constituency is not correct and it should be corrected. Correct particulars in support of my request are given below: I. Details of applicant 1. Title $ 2. First and middle name 3. Last name 4. Part number of electoral roll: 5. serial number in that part: 6. Age on 1st January .............# 7. Year: 8. Month: 9. Sex (Male/Female): Date of Birth if know: 10. Day: 11. Month: 12. Year: Place of Birth: 13. Village /Town: 14. District: 15. State: II. (a) Details of relation of person whose entry is to be transposed (Father/mother/ husband) 16. Title $ 17. First and middle name 18. Last name (b) Relationship with the applicant Father/Mother/Husband: III. Particulars of place of ordinary residence (Full address): 19. House/ Door number: 20. Street/Mohalla/Road/Gali: 21. Area/ Locality: 22. Town/Village: 23. Post Office: 24. Pin Code: 25. Police Station: 26. Tehsil/Taluka @: 27. Block/Mandal (for Village)@: 28. District: e In case of Union territories having no Legislative Assembly and the State of Jammu and Kashmir $ Sh./Smt/Km./Dr. etc. # Please give the year i.e. 1999,2000 etc. @ May not be applicable in Metropolitan Areas VI. Details of Elector's Photo Identity Cards (if issued, in this or some other Constituency) 29. Elector's photo Identity Card number: 30. Date of Issue: 31. Constituency (Assembly/ Parliamentary e Constituency) number: Name: V. Details of entries to be corrected 32. *My name/*age/*Father's/ Mother's/Husband's name/ *Relation/*sex/*Address/*Electors' Photo Identity Card number may be corrected in terms of information provided in this Form above. 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 11 (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 11) Date of the list (Form 11) 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. ........................ for correction of entry in the electoral roll in Form 8 has been accepted*/ rejected* * Accepted: a)* Under rule 18*/rule 20* and entry of the electoral is corrected in the electoral roll of the Constituency finally published on .............................. after Intensive*/Summary*/Special* Revision Serial number of entry corrected 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.
