FORM -18

(See Rule 31)

CLAIM FOR INCLUSION OF NAME IN THE ELECTORAL ROLL FOR A GRADUATES
CONSTITUENCY

To
The Electoral Registration officer,
South Graduates Constituency

Sir,
I request that my name be registered in the electoral roll for the South Graduates Constituency.
The Particulars are:
Name (in full) ………………………………………………………………………… Sex: Male / Female
Father's /Mother's /Husband's name (in full)……………………………………………………………...
Qualification ………………………………………………………………………………………………….
Occupation ……………………………………………………………………………...............................
House address (Place of ordinary residence)
House No ………………………………………………………………………………..............................
Street / Mohalla ...……………………………………………………………………….............................
Town / Village ………………………………………………………………………..................................
Post Office ……………………………………………….. PIN
Police Station / Tehsil / Taluka / Mouza
District …………………………………………………………………………………………………………
Age ……………………………………………………………………………………….............................
2 * I am a graduate of the…………………………………………………………… University having
passed the Degree / Diploma Examination in the year………………………..............................
OR
* I am in possession of a Diploma Certificate in ……................................................................
which is a qualification equivalent to that of a graduate of University in India having passed
the examination for the diploma certificate in the year ………………………………………….....
3 In Support of my claim as being a Graduate/in possession of the above Diploma/ Certificate
I submit herewith ………………………………………………………………………………………..
4 ** My name has not been included in the electoral roll for this or any other graduates
constituency.
OR
** My name has been included in the electoral roll for the ................................. graduates
constituency under the address given below and I request that it be deleted from that roll :
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
5 I declare that I am a citizen of India and that all the particulars given above are true to
the best of my knowledge and belief.

Place ………………………….. ………..………………………………….

Date .................................... . Signature of claimant
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.

* Strike out the paragraph not applicable

** Strike off the inappropriate alternative
 (To be filled in only by the Persons who are serving in Government / Government Undertaking)

THIRD SCHEDULE
Certificate issued to a Graduate Employee by the Gazetted head of office
regarding his educational qualification:
Certified on the basis of entries in Government records in my custody that Sri / Srimathi / Kumari

……………………………………......................................... (here give name in full) son / daughter /

wife of …………………………………. who is employed in this office as …………………………….
has passed ………………………………………(here mention the particulars of the Degree / Diploma
examination ) from ………………………………………………………………(here mention the name of
the University / Board / Institute) in the year………………………………………………………………...
Date .................................................
Place :
Seal : Signature of Head of Office
(To be signed by Gazetted Officer)

INFORMATION OF ACTION TAKEN

The application in Form 18 of Shri / Smt / Kum ………………………………………………………………

Address …………………………………………………………………………………………….. has been
(a) Accepted and the name of Shri / Smt. / Kum ………………………………………….. has been
Registered at SL No.……………………………. In Part No ………………………………………...
(b) Rejected for the reason ………………………………………………………………………………

Electoral Registration Officer

Date: …………………………………… (Address) ……………………………………..
…………………………………………………

RECEIPT FOR APPLICATION

Received the Application Form 18 from Shri / Smt. / Kum* ………………………………………….........
Address…………………………………………………………………………………………………………
…………………………………………………………………………………………………………………..

Electoral Registration Officer

Date: …………………… (Address)………………………………...
…………………………………………….
* To be filled by the applicant
 Varaprasad S

Additional form for reference

Please fill this if you are posting it to our office

address. No need of this form if you are directly
handing over your form to Tahashildar / Asst.
Commissioner / Deputy Commissioner

Name :

Phone no. (Mobile) :

Address:

E-Mail ID:
 G MADHUSUDANA
Ex – MLC (BJP)

BJP CANDIDATE
MLC ELECTION 2010 - SOUTH GRADUATES CONSTITUENCY

Namaskar,

1. If you are a Graduate / Diploma holder who has completed the Graduation /
Diploma on or before 01/11/2006, you are eligible to vote for this MLC election of
South Graduates Constituency which is expected to be held at the month of June
this year (2010)

2. The other 2 important Criteria is that you must have completed your Graduation /
Diploma from any University of India / Board of Technical Education & You must
be an ordinary resident of Mysore / Mandya / Hassan or Chamarajanagar Districts.
(i.e you must have an ID proof for your residential Address while voting)

3. Any graduate who has the above eligibility can register his name (if not registered
earlier or if your name is missing from the voters list) by filling up 2 FORM 18
forms (The above 2 pages) and submitting it to Tahashildar / Asst. Commissioner /
Deputy Commissioner of your area of residence along with 2 “Self Attested”
photocopies of your Final year Marks card / Degree certificate / Convocation
Certificate of your Graduation or Diploma. You have to produce your original
Certificate during the time of submission.

OR

You can post 2 filled Form 18 forms with your signature and 2 “Self Attested”
Photocopies of your Certificate to the below given office address.

4. Please follow the same procedure for filling the form as given in the sample copy
which is available in the next download link.

5. Please take a print out of blank FORM 18 and hand fill the form. Don’t edit pdf form
and take printout.

6. Take printout of only First 2 Pages if you are handing it over to Tahashildar /
Asst. Commissioner / Deputy Commissioner office OR take print out of First 3
Pages if you are posting it to our office address.
7. For any other queries regarding election or filling of the form please feel free to
contact the below given Contact Nos.

8. Forward it to your friends and relatives and help them to Enroll.

Office Address: 195, Ahobila Math, Near Jagan Mohana Palace, Ramavilasa Road, Mysore – 570024
Residential Address: “Kesari”, 2241, 5th Cross, Basaveshwara Road, Mysore – 570004

Contact Information
Phone Nos.: 0821-2437189, 0821-2447241, 94480-67437
E-Mail ID: g.madhusudana@yahoo.com