VOTER REGISTRATION by

You are NOT REGISTERED until you SIGN and SUBMIT your Voter Registration Form
EASY INSTRUCTIONS to complete your voter registration:
1. PRINT this form. Make sure you print pages 3 and 4 (Form 6) on one page in back to back print format. This is your Voter Registration Form - the official application required by the Election Commission to register you as a voter. 2. FILL additional fields, if applicable. Check If anybody from your house is already registered on electoral rolls, fill in their details on Page 5. If you are already a registered voter from a different constituency, fill in those details on Page 4. This will help Election Commission to cancel your previous voter registration. If you have already been issued a Voter ID card, mention your card number and date of issue on Page 4. 3. ATTACH additional documents. To register for voting, you will also need to submit: a. Address Proof document b. Age Proof document (for first time voters) c. Student Declaration Form (if you are a student residing outside your native city) Either of the above documents should be an official Government issued document, which will also act as your proof of citizenship. Check out www.jaagore.com to join the Jaago Re! movement! While submitting the Voter Registration form, do not forget to ask for Receipt of Application. 4. SIGN and SUBMIT the completed form to the Electoral Registration Officer (ERO) of your Assembly Constituency (AC). You will find your EROs address below. To view the complete list of VALID address proof and age proof documents, refer to Page 3. If you have opted as a STUDENT while filling your online registration, you will find a copy of STUDENT DECLARATION FORM on last page.

SUBMIT YOUR FORM TO: Assistant Electoral Registration Officer (AERO) of Assembly Constituency 165-Andheri West Smt.M.M.Ghevande Tahsildar Andheri, Tahsildar Andheri Office, Dadabhai Navroji Road, Near Bhavans College, Andheri (W), Mumbai-58 Ph: 26231368 Mob:9821343511

GENERAL INSTRUCTIONS
DOCUMENTS REQUIRED TO REGISTER 1. ADDRESS Proof document
This document is required for the BLO (Booth Level Officer) to come and verify your residence status. It is therefore not essential for the address proof document to have your name. It needs to have only the address of the place where you are staying. Any one of the following documents is acceptable for address proof: Your name should be present on voter list 1. Landline phone bill 2. Mobile telephone bill 3. Water bill 4. Electricity bill 5. Property tax receipt 6. Bank statement 7. Passport 8. Ration card 9. House Lease/Rental agreement 10. LPG receipt 11. Driving license 12. Identity cards given by the employer 3. I do not have a valid ADDRESS PROOF document to register for Voting It is not essential for the address proof document to have your name. It needs to have only the address of the place where you 2. AGE Proof document If you are a first time voter, you will also need to submit an age proof document. You can submit the proof of Date of Birth from any government agency authorized document like: 1. Birth certificate 2. Passport 3. PAN Card 4. Driving Licence 5. State board exam certificate etc. 4. As a voter, I can vote in 2 kinds of elections State Assembly Elections & General Elections As a registered voter you can vote in more than 2 elections! Besides General and Assembly elections, you can also vote in your Local Body Elections or Municipal Corporation Elections, 3. For STUDENTS only If you are a student residing outside your native city in a hostel / mess, you might not have any of the above mentioned address proof documents. In this case, you can get a Student Declaration Form (Page 5 of this form) signed by your college dean/principal/registrar and submit it along with your voter registration form. 5. Registering to Vote is a cumbersome process Earlier perhaps, but not any more! With Jaago Re! not only can you fill and submit your registration form easily, you can also get to know when your name gets on the voter list. And all of this from the convenience of your home! as called in cities. name. It needs to have only the address of the place where you are staying. You can use address proof document on the name of your parents, relatives, friends etc. with whom you are staying. 2. I can vote only from the place of my birth / permanent residence As a citizen of India greater than 18 years of age, you are eligible to vote from any place in India, provided you have been an ORDINARY RESIDENT i.e. you have been staying at your current address for at least 6 months or more. You should have a valid IDENTITY PROOF. Voter ID card is only one of the valid proofs

5 MYTHS ON VOTING
1. I am registering to get my voter ID card When you register to vote, you are registering only to get your name included in the electoral rolls (also called voter list) and NOT to get a voter ID card. To get a voter ID card, you have to register separately. Remember, on election day, only 2 things are mandatory for you to be allowed to vote:

DISCLAIMER While all efforts have been made to make all data on the website ( www.jaagore.com ) or this Registration Form as error free as possible, users are requested to refer to the officially published error free copies of the Constitution of India, Acts, Rules and Orders made there under and to the latest editions of the various Handbooks, Compendia and Reports published by the Election Commission of India (ECI), for their authentic version. Tata Tea Ltd. will be responsible for any loss to any person caused by any shortcoming, defect or inaccuracy in the above data. We also do not assure that any particular person will be on the electoral rolls of ECI.

FORM 6
[See rules 13(1) and 26]

Application for inclusion of name in electoral roll

To The Electoral Registration Officer, 165-Andheri West Assembly/Parliamentary Constituency., 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 Pratick Vinay Years: 19 Day: 04 Months: 10 Month: 03

Surname (if any) Tibrewala Sex (Male/Female): Male Year: 1992

Age as on 1st January 2012# Date of birth, if known: Place of birth:

Village/Town Mumbai District: Name Vinay State: Maharashtra Surname (if any) Tibrewala

Father's/Mother's/Husband's

II. Particulars of place of ordinary residence (Full address):

House/Door Number: 43/44, Tower-1, , Link Garden Bldg, Street/Area/Locality/Mohalla/Road: Off Link Road, , Andheri-west Town/Village: Mumbai Post Office: Tehsil/Taluka/Mandal/Thana: District: In case of Union territories having no Legislative Assembly and the State of Jammu and Kashmir. # Please give the year i.e. 2003, 2004, etc. * Strike out the inappropriate alternative. Pincode:400053

P.T.O. ..................................................................................(Perforation)...................................................................................
Receipt for application

Received the application in Form 6 of ** Shri/ Shrimati/Kumari Pratick Vinay Tibrewala **Address: 43/44, Tower-1, , Link Garden Bldg,, Off Link Road, , Andheri-west, Mumbai, 400053, Date: Signature of the officer receiving the application on behalf of the Electoral Registration Officer (Address)........................................................... **To be filled in by the applicant.

III.Details of member(s) of applicant's family already included in the current electoral roll of the Constituency : Name Relationship with applicant Part number of the roll of the Constituency Serial number in that Part Elector's Photo Identity Card Number

1. 2.

IV. Declaration
I hereby declare that to the best of my knowledge and belief:(i) I am a citizen of India; (ii) I am ordinarily resident at the address given in para II above since04-03-1992 (iii) I have not applied for the inclusion of my name in the electoral roll for any other constituency; (iv) *My name has not already been included in the electoral roll for this or any other assembly constituency; Or *My name may have been included in the electoral roll for ................................................................. Constituency in ................State in which I was ordinarily resident earlier at the address mentioned below and if so, I request that the same may be deleted from that electoral roll.

Full Address (Earlier Place of ordinary residence) :

Electors photo identity card (if issued) number; ......................... date of issue .............................

Place :

Date :

Signature or thumb impression of the elector

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 Shri/Smt./Km................................................................................................................................... for inclusion of name in the electoral roll in Form 6 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 : Date :

Signature of Electoral Registration Officer

(Seal of the Electoral Registration Officer)

During continuous updating after final publication of electoral roll. * Strike out the inappropriate alternative