Application for inclusion of name in electoral roll ApplicationID:02347920

To,
The Electoral Registration Officer
*Assembly Constituency: Ramagundam
Sir,
I request that my name be included in the electoral roll for the above
Constituency. Particulars in support of my claim for inclusion in the
electoral roll are given below:
I. Applicant's Details:
Name: ANUSHA .a:
Surname(if any): CHEPYALA .a: `_
Date of birth if you know: Day:18 Month:07 Year:1992 Gender: F
Age as on 1st January 2014: Year:21 Months:5
Place of birth Place of birth
Village/ Town: RAMAGUNDAM
District: KARIMNAGAR State: ANDHRA PRADESH
Relation Details
Relation Type
Father's/Mother's/Husband's:
F
Name: RAMDAS .a: oc
Surname(if any): CHEPYALA .a: `_
II. Particulars of place of present ordinary Residence(Full address)
House/Door number: 4-6-426/4/B/2
Street /Area /Locality
/Mohalla /Road:
NTPC,ANNAPURNA COLONY
Dc /o/
's0:
__,,_y s
Town/ Village: RAMAGUNDAM /n : o:
Tehsil/ Taluka/Mandal/
Thana:
Ramagundam c /: o:
District: KARIMNAGAR Post Office: JYOTHI COLONY
Pin code: 505215
III. Details of member(s) of applicant's family already included in the current electoral roll of the Constitutency:
Name:
Relationship with
applicant:
RPart number of the
roll of the
Constitutency:
Serial number in the
Part:
Elector's Photo Identity Card
Number:
1. 0 0
2. 0 0
Mobile No: 9704752815 Remarks:
Email-Id: shanu.anusha6@gmail.com
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