FORM 7 [See rules 13 (2) and 26] Application for objecting inclusion or seeking deletion of name in electoral roll To The Electoral Registration Officer, ....... Assembly constituency. Sir, @ I object to the proposed inclusion of the name of the undermentioned person in the electoral roll for the above constituency. Particulars in support of my objection are given below: or @ I submit that the entry relating to *myself / *the person named below is required to be deleted for the reasons stated hereunder: I. @ Details of person inclusion of whose name is objected to:@ Details of person whose entry is to be deleted: 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: #II. Details of objector Name Surname (if any) Sex (male/female): Part number of electoral roll in which objector's name is included: His/her serial number in that part: * Father's/ Mother's/ Name Husband's Name Surname (if any) III. Particulars of place of ordinary residence of @objector /@person seeking deletion.(Full address): House / Door number : New. _______________ Old. _______________ Street/Area/Locality/Mohalla/Road : Town/Village : Post Office : Pin Code : Tehsil/Taluka/Mandal/Thana : District : @ First alternative will be relevant during preparation/revision of electoral roll. Second alternative will be relevant during continuous updating after final publication of electoral roll. Strike out the inappropriate alternative. * Strike out the inappropriate alternative. # Part-II not to be filled where applicant seeks deletion of entry relating to himself. P.T.O. -----------------------------------------------------------(Perforation)--------------------------------------------------------------- Receipt for application Received the application in Form 7 of **Thiru/Thirumathi/Selvi .................. **Address....................................... Date ........ Signature of the officer receiving the application on behalf of the Electoral Registration Officer (Address) ................ ** To be filled in by the applicant. IV. Reason(s) for *objection / *deletion : V. 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 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). * Strike out the inappropriate alternative. Details of action taken (To be filled by Electoral Registration Officer of the constituency) The application of Thiru/Thirumathi/Selvi ...................... *objecting to inclusion / *seeking deletion of name of Thiru/Thirumathi/Selvi ............ in the electoral roll in Form 7 has been accepted* / rejected* Detailed reasons for *acceptance [under or in pursuance of rule 18*/20*/26(4) £ ] or rejection [under or in pursuance of rule 17*/20*/26(4) £] : Place : Signature of (Seal of the Electoral Date : Electoral Registration Officer Registration Officer) * Strike out the inappropriate alternative. £ During continuous updating after final publication of electoral roll.
