4/9/2014

FORM-6

Application for inclusion of name in electoral roll

ApplicationID:14096428

To,
The Electoral Registration Officer
*Assembly Constituency: Visakhapatnam East
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:

NEMALI SANTOSH GANESH

Surname(if any):

NEMALI

Date of birth if you know:

Day:02

Age as on 1st January 2014: Year:24

Month:12

Year:1989

Gender:

:
M

Months:0

Place of birth Place of birth

Village/ Town:

VISAKHAPATNAM

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4/9/2014

District:

FORM-6

VISAKHAPATNAM

State:

ANDHRA PRADESH

Relation Details
Relation Type
F
Father's/Mother's/Husband's:
Name:

NEMALI VENKATA RAMANA

Surname(if any):

NEMALI

II. Particulars of place of present ordinary Residence(Full address)

House/Door number:

D.NO: 50-78-10/31,GOLLAVEEDHI,

Street /Area /Locality

/Mohalla /Road:

SEETAMMAPETA

/ /
:

Town/ Village:

VISAKHAPATNAM

/ :

Tehsil/ Taluka/Mandal/
Thana:

Visakhapatnam Urban

District:

VISAKHAPATNAM

/:

Post Office:

AKKAYAPALEM

Pin code:

530016

III. Details of member(s) of applicant's family already included in the current electoral roll of the Constitutency:

Name:
http://ceoaperms.ap.gov.in/Eregistration/Postal/userdetails.aspx

Relationship with
applicant:

RPart number of the

roll of the
Constitutency:

Serial number in the

Part:

Elector's Photo Identity Card

Number:

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4/9/2014

FORM-6

applicant:

Constitutency:

Part:

1.

2.

Mobile No: 8886280741

Remarks:

Number:

Email-Id: nemaliganesh@gmail.com
Print

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