Application for Inclusion of name in the Electoral Roll (Form - 6)

I. Applicant's Details:
Ac No to which registration is sought*:
First Name*
Surname*
Date of Birth :
Age *(as on 01-01-2018):
Sex *: Male Female Other
Place Of Birth :
Village/Town*:
State*:
District*:
Father's/Mother's/Husband's First Name*:
Father's/Mother's/Husband's Last Name*:
Relation*:
II. Particulars of place of present ordinary Residence (Full Address):
House No/Door No:
Street/Area/Locality/Mohalla/Road:
Village/Town*:
Post Office:
Tehsil/Taluka/Mandal/Thana:
State*:
District*:
Pin Code:
III. Details of member(s) of applicants's family : Do you have relative(s) currently enrolled in the Electoral Roll of Meghalaya? Yes No
IV. Declaration :
I hereby declare that to the best of my knowledge and belief that:
(i) I am a citizen of India;

(ii) I am ordinarily resident at the address given in para II above since
Birth Specify Date

(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;
E-mail ID:
Mobile No:
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