Government of West BengalHome(C & E) Department

Election Wing21, NS Road, Kolkata-700001

No.601-Home(Elec)R10E-l/2011

The Chief Electoral Officer

West Bengal

The Foreign Secretary

Ministry of External Affairs

Government of India

South Block

New Delhi

I am to refer to the Election Commission of India's communication, bearing

No 3/1/2010/SDR dated 14 February 2011 on the above subject addressed to you, a copy of

which is also endorsed to this end.

As directed by the Commission, I am forwarding herewith a copy of

the Notification under Rule SA of the Registration of Electors Rules, 1960 made

by me, pertaining to the State of West Bengal. Also enclosed herewith is a list containing

the addresses of all the EROs in this State for convenience of applicants.

~cl~-(Sunil Kumar Gupta)

Chief Electoral Officer

West Bengal

y forwarded to Shri Narendra N. Butolia, Under Secretary, Election Commission of

India for the Commission's kind information and necessary action.

- This has reference to the Commission's circular, bearing No 3/1/2010/SDR

dated 14 February 2011. All the actions as delineated in points a e of

the paragraph 3 of the Commission's said circular #l.~been taken.

Officer ¥:eJalr;;,u?tJ

I

/ and 'rex officio Special Secretary to the Go of West Bengal

Under Section-20A of the Representation of the People Act, 1950,

inserted vide Representation of the People (Amendment) Act, 20 I0, which

has come into effect w.e.f. lOdIFebruary, 20 II. every overseas elector, i.e.,

Indian citi7..en who is absenting from his place of ordinary residence in India

owing 10 employment, education or otherwlse, and has not acquired

citizenship of any other country and who,s oot iocluded in the electoral roll,

is entitled to have his/her name registered in the electoral roll of the

constituency in which hislher place of residence in India as mentioned in

his/her passport is located.

In terms of rule 8A of the Reg.stration of Electors Rules, 1960, every

overseas elector whose place of residence in India is located in the State of

West Bengal who has completed 18 years of age as on 01-01· 2011, and is

desirous of registering his/her name in the electoral roll, is invited hereby to

submit claim application in Fonn-6A for registration in the electoral roll of

the constituency in whicli his/her place of residence as shown in the passport

is located. Form-6A alonb'With guidelines for tIle applicants is given below.

The claim application in Form-6A may be either submitted in person directly

to the rCbrlstratiollofficer of the constituency concerned or sent to such

registration officer by post alongwith the documents mentioned 10 Fonn-6A

and the guidelines. When the claim app-Iocation is sent by post, it should be

accompamed by photocopies of the relevant pages of the passport duly

attested by the competent official of the Indian mission in the country

concerned.

Addresses of the registration officers of each of the 294 Assembly

constituencies in tbe State of West Bengal can be seen on the webslte

www.ceowestbengal.nic.in.

©GOVERNMENT OF TAMIL NAOU

">11

[Regd. No. TNfCCNf46712009-11.

[R. Dis. No. 19712009.

[price: Rs. 2.40 Paise.

TAMILNADU

GOVERNMENT GAZETTE

Under section-2OA of the Representation of the People Pd. 1950. inserted vKJe Representation of the People (Amendment)

Act, 2010, whic:h has come into efJectw.eJ. 10th February, 2011, every Ovef888Selector, i.e., nctian citizenv.flO is absenting from

his place of ordinaty residence ~ Irda owing k> emptJyment, edJcalioo or o1herwlse, and has not acqt.ired citizenship of any other

<::omtryandwho is rotinduded In the eEdotaI roI.isenltledtlo haw hisJherraneregistered in the eledoral roI ottheconstiluency

in wtlk:h hbIIher place of.residenco in 10018 as men~ in hIsIher passport is located.

In terms of rule SA of the Registration of 8e<:brs RUes. 1960, every 0YefSe3S eIedor Whose place of residence in India is

located in the Stale of Tami Nadu'AflO has completed 18y&afS of age as on 01-01· 2011. and isdesmJsotregistering ~

name in the eIeOOral roll, is invited hereby to submit claim application to Fonn-6A for reQis1rationin the electoral roI of the

constituency in wtich hfsIher place cI residence as shown in the passport is located. Form-6A aklng wiItl guidelines for the

appllcarits 1sowen below. The claim application in Form-6A may be either" SlbnJied in person direclt:f to the registration officer

of the constituency concerned Of sent to such registration otrlcer by post along with the doQJments rnenUoned in Fofm..6A and

the guidelines. When the claim application is sent by post. it shcn.*:tbe acmmpani9d by photocopies of the relevant pages of the

passport duly atte5'ed by the compet&nt officiaJ of the Indian mission ill the country amcemed.

PRAVEEN KUMAR,

Chief Electoral Offker and

Sectet81Y to Government.

(v) Pi" Code .

(vi) TahsiVTalukalMaoclclVThana

(iv) Date pf expiry of current Indian

Passport .•

(Copias of the relevant pages of the passport containing the particulars mentioned at Items

(a) to (i) above to be eocIosed-attested by the Indian Mission if sent by post and produced with the

original passport if presented in person bel'ofe the registration officer)

[Iv) Place of issue of VISa.• • .• .

(v) OateotexpiryofVISa • • • .....• • • .............• ..• • • • •

(Copies of the relevant pages of the passport containing tfle currenl valid v;sa

endol'SelTlent mentioned above to be enclosed--attested by the Indian Mission if sent by post and

produced with the original passport if presented in per.JOnbefore the reglstrallon officer)

2. Oesaiptlon of Absence from Place of Ordinary Residence in India:

(a) Reason of being absent from the pface of ordinary residence in India-

SPACE FOR PAST1NG

ONE RECENT PASSPORT

SIZE PHOTOGRAPH (3.5

eM X 3.5 CW) SHOWINGFRONTAl. VIEW Of A.J...L.

FN::E WITHIN THIS BOX

....... AssemblylParliamentary

Constituency.

(c) Surname.

(d) Date of Birth ....• • Oay ..• .. Month ....• ... year

(e) sex (MaleIFemale)

(i)Oistrict.._ .

(iii) Slate .• .• ....

(I)N.ame.

(ii) Middle Name ..........• • ..• • • • • • • ....• • • .• • .• ..• .•_.

(h) Place of Ordinary Residence in India (Fun Address as given in the Passport)

(i) HouseJDoor number ...

5. Dedaration:---' hereby declare that.k> the best of IcnowIodge and belief:-

(a) AD information given in this application is true

(b) lama citlzanoflndiabybirthldomicile/naturalisatioo

(c) I have not acquired citizenship of any other COtJntr'y

Cd) But tor being absent from the place of my' ordinary residence in India owing to the reason giYen

in 2 (a) above, I "WOuldhave been ordinarily resident at the address given In my Indfan Passportwhich has been reproduced at 1 (h) above.

(e) i undertake 10immediately inform the Electoral RegistratiOn Officer through the Indian Mission

in the Country of my current residence if I renounce my Indian Citizerlship or If I acquire thecitizenship of any other country.

(f) I undertake 10immediately inform the Electoral RegistratiOn Officer through the Indian Mission

in the country of my current residence of any change in my residential address in the country

of my residence for the records of the Electoral Registration Officer. I understand that any

notice sent to me at the address, which is my residential address In the oounb'y of rrrt current

residence according to the records of the Electoral Registration 0fI0er. shall be mnsidered as

due seMce 01 notice to me under the Representation of the People Act. 1950 and the nAes

made thereunder. and that it is my responsibility 10 keep the .Electoral Registration 0fIicet"

informed of my latest residential address in the comtJy at my ament residence.

(g) I. return k>India ad become on:hriy residenI in lntia. I shall ~ inform the EJe12:lIai

RegIsCra\k)nOfflcer of the concerned A$$emblylPaJiamentary Constituency.

(h) I have not applied for inclusion of my name In the eiectoral roll d any other ConsUfuency

(i) My name has not already been Included in this or any OIher Constituency

0,

My name may have ~n included in the Elecloral

Rollof ConslituerlCY In State in which I was

ordinarily resident earlier at the address mentloned below and. if so. I request that the same

may be deleted from that electoral roll or transposed. as may be appropriate.

Full address (Earlier place o( ordinary residence) •

Signature.....• • .• .• • .• • .• • • .

fItace .....................• • ..• • • ..• ~.

Oat.

PART-B

(For use In the offlce of Electoral Registration OfficeT)

Application received on ..• • ....• • .• .• • • • • ..• • • .• • • .• ...• ...• • ..• • ..• • .....([){)b&1fYYYY}

The application • .• Fonn GAof SM'StvimatilKumari .

has been:-

Documenttl to be attached

-4. Paste one receI1tpassport size coloo'ed photograph ¥lith a Iigtrt background (preferabtywhlte) showing IhefuQ taceofthe-5. AI in all the ClOIoom in Form-6A. Writs your name and other paticuIars as given in the valid Indian Passport.

6. If appIi;a;tion is sent by post. it should be acoompanied by phokK:opy of the relevant pages of the passport containing

Ille photograph and all other partlculars of the applicant and the page containing the valid visa entlorsemenl These

photo-copies should be got duly attested by the competent official in the Indian Mission. Applications without the

attested phokK:opias of these documeflts will be liable to be SLmmariy reiected •

7. If the appIic:;atiofIis submitted in person befurethe ERO. the application should be ac:companiild by a pt1oto-copy of the

relevant pages at the passport as mentioned above. The original passport should a150 be produced along ¥lith the

application forverification by the registration officer. The passportwil be returned immediately afterverificaool\.

Voting

8. It may be noted that after your enrolment, you wil be able to castYOle in election In the Constmency, if you are physIcaJly

present in the poDing station along with Y'J'K original passport on the day at poB.

(a) Accepted and the name has been registered in the electoral roDof .....• .

.. .. (Constituency) alS.Na ..............• ..... .Part No .

(b) Raiec:ted lor the reason. ....• ......• .• ....• • ..• • • • • ..• .• • • • ...• • .• • •

PART-e

Acknowledgement fw Application

(When presented in person 10the Registration Offteef)

Received the application in Form 6A of

Signatureofthe~ng Officer .• ...

Address ...

Note;-The Pfincipal rules were pobIi:shed in the Gazette of India, Extraordinary. vide notfication runbets S.O. 2750(E),

dated the1tth November, 1960 and last amended vide number S.0.1219(E). dated the 15th May. 2009.

GUIDEUNE5 FOR FIWNG UP THE APPUCATfON FORM-6A

General instructions

Who can file Form-6A

1. Evely citizen of India Slaying in a foreign country, who has not acqUired citiz:enship of a foreign oountry. and has

completed 18 years of age 830n 1st January of the year, can make an application in Fonn-6A for being ragisterod in the

roUforthe Constituency pertaining to the locality in which his place of residence in India as mentioned In the passport is

located. The application in Form-6A can be presented to the Registration Oflicer ooncemed.

2. The appI~ shoukl have COfl'l)Ieted eighteen years r::I age as on 1st January of the year. For exanpIe. if the application

is for inclusion d name in the eiedoral roBwith reference tJ 01-01-2011 as the qualifying da~. the appficant should h3118

completed 18 years of age as on Ot.o1· 1011.

Where to submit the application in Form-6A

3. The application shOuld be submitted directly to the Electoral Registration Officer (ERO) of the Constituency within which

the place of ordinary residence of !he appIic:ant as given in the vakf passport faIs. The ApplIcation in Form-6A can be

presen1ed i'l person to the ERO Of sent by pOStaddr&ssed to the ERO concerned.

(The particulars and postal address of the ERO$ of allhe oonsUtuon~ of India can be seen on the website of EJection

Commiss600 of India (http://eci.nic-in)J . .

LAC No.1 Name of LAC I Elecloral Reglslratlon Officer Poslal Address LAC No. Name of LAC Elecloral Regislrallon OffIcer Poslal Address

010 the Circle Officer, Ratabari Revenue 010 the Deputy Commissioner, Karbi

Ratabari (SC) ICircle Officer, R. K. Nagar Circle, P.O.- Ratabari Dist- Karimganj Pin- 19 Diphu (ST) Election Officer, Diphu Anglong, P.O.- Diphu Dist- Karbi Anglong

788735 Pin-782460

010 the Circle Officer, Patharkandi 010 the Sub Divisional Officer (C),

2 IPatharkandi ICircle Officer, Patharkandl Revenue Circle IRevenue Circle, P.O.- Patharkandi, Dist- 20 Baithaiangso (ST) Extra Assistant Commissioner, Hamren Hamren, P.O.- Hamren Dist.- Karl Anglong

IKarimganj Pin- 788724 Pin-782486

010 the Deputy Commissioner, Karimganj, 010 the Circle Officer,Mankachar Rev.

3 IKarimganj North IElection Officer, Karimganj Ip.o.- Karimganj Dist- Karimganj Pin- 21 Mankachar Circle Officer, Mankachar Rev.Circle Circle, P.O.- Mankachar Dist- Dhubri Pln-

788710 783131

010 the Circle Officer, Nilambazar 010 the Circle Officer, South Salmara Rev.

4 IKarimganj South ICircle Officer, Nllambazar Revenue Circle 1 Revenue Circle, P.O.- Karimganj Dist- 22 Salmara South Circle Officer, South Salmara Rev. Circle Circle, P.O.- South Salmara Dist- Dhubri

Karimganj Pln- 788710 Pin- 783127

010 the Circle Officer, Badarpur Rev. 010 the Assistant Settlement Officer,

5 IBadarpur ICircle Officer, Badarpur Revenue Circle ICircle, P.O.- Badarpur Dist- Karimganj Pin- 23 Dhubri Assistant Settlement Officer, Dhubri Dhubri, P.O.- Dhubri Dist- Dhubri Pin-

788806 783301

010 the Circle Officer,Hailakandi Rev.010 the Deputy Commissioner, Dhubri,

6 IHailakandi ICircle Officer, Hailakandi Revenue Circle IClrcle, P.O.- Hailakandi Dist- Hailakandi 24 Gauripur Election Officer, DhubriP.O.- Dhubri Dist- Dhubri Pin- 783301

Pin- 788152

010 the Assistant Settlement Officer, 010 the Assistant Settlement Officer,

Katlicherra IAssistant Settiement Officer, Katlicherra IKatlichera, P.O - Katlichera, Dist- 25 Golakganj Assistant Settlement Officer, Golokganj Golokganj, P.O - GolakganJ, Dist- Dhubri

Hailekandi Pin- 788161 Pin-783334

010 the Circle Officer,Algapur Rev. Circle,010 the Circie Officer, Bilashlpara Rev.

8 IAlgapur ICircle Officer, Aigapur Revenue CircleIp.o._ Aigapur Dist- Hailakandi Pin- 788150

26 Bilasipara West Circle Officer, Bilashipara Revenue Circle Circie, P.O.- Bilashipara Dist- Dhubri Pin-

783348

9 ISilchar IElection Officer, Slichar1010 the Deputy Commissioner, Cachar,

I I 27 IBilasipara East ICircie Officer, Chapor Rev. Circle, Bilashipara1010 the Circle Officer, Chapor Rev. Clrcie,

P.O.- Slichar Dlst- Cachar Pin- 788001 P.O.- Chapor Dist- Dhubri Pin- 783371

1010 the Circle Officer,Sonai Rev. Circie,

I IIGOSSaigaOn IElection Officer, Gossaigaon

010 the Sub Divisional Officer (C),

10 ISonal ICircie Officer, Sonai Revenue Circle 28 !GOSSaigaon, P.O.- Gossaigaon Dist.-P.O.- Sonai Dist- Cachar Pin- 788001

Kokrajhar Pin- 783360

1010 the Circle Officer,Sllchar Rev. Circie,010 the Circle Officer, Gossalgaon Rev.

11 IDholai (SC) ICircle Officer, Silchar Revenue Circle 29 Kokrajhar West (ST) Circle Officer, Gossaigaon Rev. Circle Circle, P.O.- Gossaigaon Dist.- KokrajharP.O.- Dholai Dist- Cachar Pin- 788114

Pin-783360

010 the Circle Officer,Udharbond Rev. 010 the Deputy Commissioner, Kokrajhar,

12 IUdharbond ICircie Officer, Udharbond Revenue Circle ICircle, P.O.- Udharbond Dist- Cachar Pin- 30 Kokrajhar East (ST) Election Officer, Kokrajhar P.O.- Kokrajhar Dist- Kokrajhar Pin-

788030 783370

010 the Sub Divisional Officer (C),0/0 the Circle Officer, Sidli Rev. Circie,

13 ILakhipur ISub Divisional Officer (C), Lakhipur ILakhipur, P.O.- Lakhipur Dist.- Cachar Pin- 31 Sidli (ST) Circle Officer, Sidli Revenue CircleP.O.- Sidli Dist.- Bongaigaon Pin-783373

788103

1010 the Deputy Commissioner, Cachar,0/0 the Deputy Commissioner,

14 IBarkhola IAdditional Deputy Commissioner-ill, Cachar, Silchar 32 Bongaigaon Election Officer, Bongaigaon Bongaigaon, P.O.- Bongaigaon Dist-P.O.- Slichar Dist- Cachar Pin- 788001

Bongaigaon Pin- 783380

0/0 the Circle Officer,Katigorah Rev.010 the Sub Divisional Officer (C), Bijni,

15 IKatigorah ICircle Officer, Katigorah Revenue Circle IClrcle, P.O.- Katigorah Dist- Cachar Pin- 33 Bijni Election Officer, BijniP.O.- Bijni Dist.- Chirang Pin- 783390

788805

0/0 the Deputy Commissioner, Dima 010 the Sub Divisional Officer (C), North

16 IHalftong (ST) IElection Officer, Hafiong IHasao Dist., P.O.- Hafiong Dist- Dima 34 Abhayapuri North Election Officer, North Salmara, Abhayapuri Salmara, P.O.- Abhayapuri Dist.-

Hasao Pin- 788819 Bongaigaon Pin- 783384

0/0 the Sub Divisional Officer (C), 010 the Sub Divisional Officer (C), North

17 IBokajan (ST) IElection Officer, Bokajan IBokajan, P.O.- Bokajan Dist.- Kari Anglong 35 Abhayapuri South (SC) Extra Assistant Commissioner, North Salmara Salmara, P.O.- Abhayapuri Dist.-

Pin- 782480 Bongaigaon Pin- 783384

1010 the Block Dev. Officer, Howraghal 0/0 the Circle Officer, Dudhnoi Rev.

18 IHowraghat (ST)Isr. Block Development Officer, Howraghal Development D BI k PO- H h t D' 1- K rb'

36 Dudhnoi (ST) Circle Officer, Dudhnoi Rev. Circle Circle, P.O.- Dudhnoi Dist.- Goalpara PinBlock ev. oc.' .. owrag a, IS a I

Anglong Pln- 782481 783124

LAC No.1 Name of LAC I Electoral Registration Officer I Postal Address LAC No. Name of LAC Electoral Registration Officer Postal Address

37 IGoalpara East IElection Officer, Goalpara1010 the Deputy Commissioner, Goalpara,

55 Hajo Circle Officer, Hajo Revenue Circle010 the Circle Officer, Hajo Rev. Circle,

P.O.- Goalpara Dist- Goalpara Pin- 783101 P.O.- Hajo Dist- Kamrup Pin- 781102

010 the Circle Officer, Goalpara Rev. 010 the Circle Officer, Kamalpur Rev.

38 IGoalpara West ICircle Officer, Balijana, Goalpara Revenue Circle ICircle, Goalpara Dist- Goalpara Pin- 56 Kamalpur Circle Officer, Kamalpur Revenue Circle Circle, P.O.- Kamalpur Dist- Kamrup Pin-

783101 781380

010 the Block Dev. Officer, Lakhipur Dev.010 the Circle Officer, Rangia Rev. Circle,

39 IJaleswar I Block Development Officer, Lakhipur IBlock, P.O.- Lakhipur, Dist- Goalpara Pin- 57 Rangia Circle Officer, Rangia Revenue CircleP.O.- Rangia Dist- Kamrup Pin- 781354

783129

010 the Circle Officer, Bamagar Rev. 010 the Circle Officer, Tamulpur Rev.

40 ISorbhog ICircle Officer, Sorbhog Revenue Circle ICircle, P.O.- Bamagar Dist- Barpeta Pin- 58 Tamulpur Circle Officer, Tamulpur Revenue Circle Circle, P.O.- Tamulpur Dist- Baksa Pin-

781317 781367

010 the Circle Officer, Sarupeta Rev.010 the Circle Officer, Nalbari Rev. Circle,

41 IBhabanipur ICircle Officer, Sarupeta Revenue Circle I Circle, P.O.- Sarupeta Dist- Barpeta Pin- 59 Nalbari Circle Officer, Nalbari Revenue CircleP.O.- Nalbari Dist- Nalbari Pin-781335

781316

010 the Circle Officer, Bajali Rev. Circle, 010 the Circle Officer, Barkhetri Rev.

42 IPatacharkuchi ICircle Officer, Bajall Rev. Circle, Patacharkuchi IP.O.- Patacharkuchi Dist- Barpeta Pin- 60 Barkhetri Circle Officer, Barkhetri Revenue Circie, Mukalmua Circle, P.O.- Mukelmua Dist- Nalbari Pin-

781326 781126

1010 the Circle Officer, Barpeta Rev. Circle,010 the Circle Officer, Paschim Nalbari

43 IBarpeta ICircle Officer, Barpeta Revenue Circle 61 Dharmapur Circle Officer, Paschim Nalbari Revenue Circle, Chamata Rev. Circle, P.O.- Chamata Dist- NalbariP.O.- Barpeta Dist- Barpeta Pin- 781301

Pin-781306

010 the Circle Officer, Kalgachia Rev.010 the Circle Officer, Barama Rev. Circle,

44 IJania ICircie Officer, Kalgachia Revenue Circle ICircle, P.O.- Kalgachia Dist- Barpeta Pin- 62 Barama (ST) Circle Officer, Barama Revenue CircleP.O.- Barama Dist- Baksa Pin- 781346

781319---

45 IBaghbor IElection Officer, Barpeta1010 the Deputy Commissioner, Barpeta,

63 Chapeguri (ST) Circle Officer, Baska Revenue Circle, Musaipur010 the Circle Officer, Baska Rev. Circle,

P.O.- Barpeta Dist- Barpeta Pin- 781301 P.O.- Musalpur Dist- Baska Pin- 781372

010 the Circle Officer, Sarthebari Rev. 010 the Circle Officer, Harisinga Rev.

46 ISarukhetri ICircle Officer, Sarthebari Revenue Circle ICircle, P.O.- Sarthebari Dist- Barpeta Pin- 64 Panery Circle Officer, Harisinga Revenue Circle, Tangla Circle, P.O.- Tangla Dist- Udalguri Pin-

781307 784521

,DID the Circle Officer, Chenga Rev. Circle,010 the Circle Officer, Kalaigaon Rev.

47 IChenga ICircle Officer, Chenga Revenue Circle 65 Kalaigaon Circle Officer, Kalaigaon Revenue Circle Circle, P.O.- Kalalgaon Dist- Darrang Pin-P.O.- Chenga Dist- Barpeta Pin- 781305

784525

1010 the Circie Officer, Boko Rev. Circle,010 the Circle Officer, Sipajhar Rev

48 IBoko (SC) ICircle Officer, Boko Revenue Circle 66 Sipajhar Circle Officer, Sipajhar Revenue Circle Circle, P.O.- SipaJhar Dist- Darrang Pln-P.O.- Boko Dist- Kamrup Pin- 781123

784145

010 the Circle Officer, Chaygaon Rev. 010 the Circle Officer, Mangaldoi Rev.

49 IChaygaon ICircle Officer, Chaygaon Revenue Circle ICircle, P.O.- Chaygaon Dist- Kamrup Pin- 67 Mangaldoi (SC) Circle Officer, Mangaldoi Revenue Circle Circle, P.O.-Mangaldol Dist- Darrang Pin-

781124 764125

010 the Circle Officer, Palashbari Rev. 010 the Circle Officer, Dalgaon Rev.

50 IPalasbari ICircle Officer, Palashbari Revenue Circle ICircle, P.O.- Palashbari Dist- Kamrup Pin- 68 Dalgaon Circie Officer, Dalgaon Revenue Circle Circle, P.O.- Dalgaon Dist- Darrang Pin-

781128 784116

010 the Circle Officer, North Huwahati 010 the Circle Officer, Udalguri Rev.

51 IJalukbari ICircle Officer, North Guwahati Revenue Circle IRev. Circle, P.O.- Jalukbari Dist- Kamrup 69 Udalguri (ST) Circle Officer, Udalguri Revenue Circle Circle, P.O.- Udalguri Dist- Udalguri Pin-

(M) Pin-781013 784509

52 IDispur ICircle Officer, Dispur Revenue Circle1010 the Circle Officer, Dispur Rev. Circle,

70 Mazbat Circle Officer, Mazbat Revenue Circle010 the Circle Officer, Mazbat Rev. Circle,

P.O.- Dispur Dist- Kamrup (M) Pin- 781006 P.O.- Mazbat Dist- Udalguri Pin- 784507

010 the Circle Officer, Guwahati Rev. 010 the Circle Officer, Dhekiajuli Rev.

53 IGauhati East ICircle Officer, Guwahati Revenue Circle ICircle, P.O.- Guwahati Dist- Kamrup (M) 71 Dhekiajuli Circle Officer, Dhekiajuli Revenue Circle Circle, P.O.- Dhekiajuli Dist- Sonitpur Pin

Pin-781001 764110

010 the Deputy Commissioner, Kamrup 010 the Block Dev. Officer, Dhekiajuli Dev.

54 IGauhati West ISub Divisional Officer (S), Kamrup (M) i(M), PO.- Guwahati Dist- Kamrup (M) Pin- 72 Borchalla Block Development Officer, Dhekiajuli Block, P.O.- Dhekiajull Dis\.- Sonltpur Pin

781001 764110

LAC No.1 Name of LAC I Electoral Registration OffIcer I Postal Address I I LAC No.1 Name of LAC I Electoral Registration Officer Postal Address

73 ITezpur ICircle Officer. Tezpur Revenue Circle1010 the Circle Officer, Tezpur Rev. Circle,

91 Hojai Circle Officer, Hojai Revenue Circle010 the Circle Officer, Hojai Rev. Circle,

P.O.- Tezpur Dist- Sonitpur Pin-784001 P.O.- Hojai Dist- Nagaon Pin- 782435

010 the Circle Officer, Charaiduar Rev.010 the Circle Officer, Lanka Rev. Circle,

74 IRangapara ICircie Officer, Charaiduar Revenue Circle ICircle, P.O.- Rangapara Dist- Sonitpur Pin 92 Lumding Circle Officer, Lanka Revenue CircleP.O.- Lumding Dist- Nagaon Pin- 782447

784505

10/0 the Circle Officer, Naduar Rev. Circle,0/0 the Circle Officer, Bokakhat Rev.

75 ISootea ICircle Officer, Naduar Revenue Circle 93 Bokakhat Circle Officer, Bokakhat Revenue Circle Circle, P.O.- Bokakhat Disl- Goiaghat Pin-P.O.- Sootea Dist- Sonitpur Pin- 784175

785612

0/0 the Circle Officer, Biswanath Rev. 010 the Sub Divisional Officer (C),

76 I Biswanath ICircle Officer, Biswanath Revenue Circie ICircie, P.O.- Biswanath Dist- Sonitpur Pin- 94 Sarupathar Eiection Officer, Dhansiri, Sarupathar Dhansiri, P.O.- Sarupathar Dist.-Golaghat

784177 Pin-785601

0/0 the Sub Divisional Officer (C), 0/0 the Circle Officer, Golaghat Rev.

77 IBihall IElection Officer, Biswanath IBiswanath Chariali, P.O.- Biswanath Dist.- 95 Golaghat Circle Officer, Golaghat Revenue Circle Circle, P.O.- Golaghat Dist- Golaghat Pln-

Sonitpur Pin- 784177 785621

0/0 the Sub Divisional Officer (C), 010 the Circle Officer, Khumtai Rev.

78 IGohpur IElection Officer, Gohpur IGohpur, P.O.- Gohpur Dist.- Sonitpur Pin- 96 Khumtai Circle Officer, Khumtai Revenue Circle Circle, P.O.- Khumtai Dist- Golaghat Pin-

784168 785619

1010 the Circle Officer, Mayong Rev. Circle,010 the Circle Officer, Jomat West Rev.

79 IJagiroad (SC) ICircle Officer, Mayong Revenue CircleP.O.- Jagiroed Dist- Morigaon Pin-782410

97 Dergaon (SC) Circle Officer, Jorhat West Circle, Jorhat Circle, P.O.- Dergaon Dist- Jomat Pin-

785614

0/0 the Deputy Commissioner, Morigaon,010 the Deputy Commissioner, Jomat,

80 IMorigaon IElection Officer, Morigaon IP.O.- Mongaon Dist- Morigaon Pin- 98 Jomat Election Officer, JomatP.O.- Jomat Dist- Jomat Pin- 785001

782105

010 the Circle Officer, Leharighat Rev.010 the Sub Divisional Officer (C), Majuli,

81 ILahanghat ICircle Officer, Laharighat Revenue Circle ICircle, P.O.- Laharighat Dist- Morigaon Pin 99 Majuli (ST) Election Officer, MajuliP.O.- Majuli Dist.-Jorhal Pin- 785110

782127

82 IRaha (SC) ICircle Officer, Raha Revenue Circle1010 the Circle Officer, Raha Rev. Circle,

100 Titabor Circle Officer, Tltabor Revenue Circle010 the Circie Officer, Titabor Rev. Circle,

P.O.- Raha Dist- Nagaon Pin- 782103 P.O.- Titabor Dist- Jorhal Pin- 785630

83 IDhing ICircie Officer, Dhing Revenue Circle1010 the Circle Officer, Dhing Rev. Circle,

101 Moriani Circle Officer, Mariani Revenue Circle010 the Circle Officer, Mariani Rev. Circle,

P.O.- Dhing Dist- Nagaon Pin- 782123 P.O.- Mariani Dlst- Jorhat Pin- 785634

84 IBatadraba ISub Divisional Officer (S), Nagaon1010 the Deputy Commissioner, Nagaon,

102 Teok Circle Officer, Teok Revenue Circle010 the Circle Officer,Teok Rev. Circle,

P.O.- Nagaon Dist- Nagaon Pin-782001 P.O.- Teok Dist- Jorhat Pin- 785112

85 IRupahihat ICircle Officer, Rupahl Revenue Circle1010 the Circle Officer, Rupahi Rev. Circle,

103 Amguri Circle Officer, Amguri Revenue Circle, Amguri010 the Circie Officer, Amguri Rev. Circle,

P.O.- Rupahi Dist- Nagaon Pin- 782125 P.O.- Amguri Dist- Sivsagar Pin- 785680

86 INowgong ICircle Officer, Nagaon Revenue Circle1010 the Circie Officer, Nagaon Rev. Circle,

104 Nazira Election Officer, Nazira010 the Sub Divisional Officer (C), Nazira,

P.O.- Nagaon Dlst- Nagaon Pin- 782001 P.O.- Nazira Dist.-Sivsagar Pin- 785685

,0/0 the Circle Officer, Kampur Rev. Circle,010 the Circle Officer, Mahmara Rev.

87 IBarhampur ICircle Officer, Kampur Revenue Circle 105 Mahmara Circle Officer, Mahmara Revenue Circie Circle, P.O.- Mahmara Dist- Sivsagar Pin-P.O.- Kampur Dist- Nagaon Pin- 782426

785670

010 the Circle Officer, Samaguri Rev.010 the Circle Officer, Sonari Rev. Circle,

88 ISamaguri ICircie Officer, Samagun Revenue Circle ICircle, P.O.- Samaguri Dist- Nagaon Pin- 106 Sonari Circle Officer, Sonari Revenue CircleP.O.- Sonari Dist- Sivsagar Pin- 785690

782140

010 the Sub Divisional Officer (C), II I IThowra ICircle Officer, Demow Revenue Circle

10/0 the Circle Officer, Demow Rev. Circle,89 IKaliabor IElection Officer, Kaliabor IKaliabor, P.O.- Kaliabor Dist.- Nagaon Pin- 107

P.O.- Demow Dist- Sivsagar Pin- 785662782137

010 the Circle Officer, Dabaka Rev. Circle'l

I I ISibsagar ISub Divisional Officer (S), Sivsagar1010 the Deputy Commissioner, Sivsagar,

90 IJamunamukh ICircle Officer, Dabaka Revenue Circle Ip.o.- Jamunamukh Dlst· Nagaon Pin- 108

782428P.O.- Sivsagar Dist- Sivsagar Pin- 785640

LAC No. Name of LAC Electoral Registration Officer Postal Address

010 the Circle Officer, Bihpuria Rev.

109 Bihpuria Circle Officer, Bihpuria Revenue Circle Circle, P.O.- Bihpuria Dist- North

Lakhimpur Pin- 784161

010 the Circle Officer, Naobaicha Rev.

110 Naobaicha Circle Officer, Naoboicha Revenue Circle Circle, P.O.- Bihpuria Dist- North

Lakhlmpur Pin- 787023

010 the Deputy Commissioner, North

111 Lakhimpur Election Officer, Lakhimpur Lakhimpur, P.O.- Lakhimpur Dist- North

Lakhimpur Pin- 787001

010 the Sub Divisionai Officer (C),

112 Dhakuakhana (ST) Election Officer, Dhakuakhana Dhakuakhana, P.O.- Dhakuakhana Dist.-

Lakhimpur Pin- 787055

010 the Sub Divisional Officer (C),

113 Dhemaji (ST) Election Officer, Dhemaji Dhemaji, P.O.- Dhemaji Dist.-Lakhimpur

Pin-787057

114 Jonai (ST) Election Officer, Jonai010 the Sub Divisional Officer (C), Jonai,

P.O.- Jonai Dist.-Lakhimpur Pin- 787060

115 Moran Circle Officer, Moran Revenue Circle010 the Circle Officer, Moran Rev. Circle,

P.O.- Moran Dist- Dibrugarh Pin- 785670

010 the Circle Officer, Dibrugarh East Rev.

116 Dibrugarh Circle Officer, Dibnugarh East Revenue Circle Circle, P.O.- Dibnugarh Dist- Dibnugarh Pin

786001

010 the Circle Officer, Dibnugarh West

117 Lahowal Circle Officer, Dibnugarh West Revenue Circle Rev. Circle, P.O.-Lahowal Dist- Dibnugarh

Pln-786010

010 the Circle Officer, Tengakhat Rev.

118 Duliajan Circle Officer, Tengakhat Revenue Circle, Tengakhat Circle, P.O.-Tengakhat Dist- Dibnugarh Pin

786103

010 the Circle Officer, Tingkhong Rev.

119 Tingkhong Circle Officer, Tingkhong Revenue Circle Circle, P.O.-Tingkhong Dist- Dibnugarh Pin

786612

010 the Circle Officer, Naharkatia Rev.

120 Naharkatia Circle Officer, Naharkatia Revenue Circle Circle, P.O.-Naharkatia Dist- Dibnugarh Pin

786610

121 Chabua Circle Officer, Chabua Revenue Circle010 the Circle Officer, Chabua Rev. Circle,

P.O.-Chabua Dist- Dibrugarh Pin-786184

010 the Circle Officer, Tinsukia Rev.

122 Tinsukia Circle Officer, Tinsukia Revenue Circle Circle, P.O.-Tinsukia Dist- Tinsukia Pin·

786125

123 Digboi Extra Assistant Commissioner, Tinsukia010 the Deputy Commissioner, Tinsukia,

P.O.- Tinsukia Dist- Tinsukia Pin- 786125

010 the Sub Divisional Officer (C),

124 Margherita Election Officer, Margherita Margherita, P.O.- Margherita Dist.-Tinsukia

Pin- 786181

010 the Circle Officer, Doom Dooma Rev.

125 Doomdooma Circle Officer, Doom Dooma Revenue Circle Circle, P.O.-Doom Dooma Dist- Tinsukia

Pin- 786151

126 Sadiya Election Officer, Sadiya010 the Sub Divisional Officer (C), Sadiya,

P.O.- Sadiya Dist.-Tinsukia Pin- 786155

GOVERNMENT OF ASSAM

ELECTION DEPARTMENT: DISPUR

No.ELE.127/2010/24: Linder Section - 20A of the Representation of the People Act.. 1950

inserted vide Representation of the People (Amendment) Act. 20 IO. 1\ h ich has come into

effect lV.e.f. loth February. 20 II. every overseas elector. i.e .. Indian citizen who is ab enting

from his place of ordinary residence in India owing to employment. education or othem ise

and has not acquired citizenship of any other COUl1lr~and who is not included in the electoral

roll. is entitled to have his/her name registered in the electoral roll of the constituency in

which his/her place of residence in India as mentioned in his/her passport is located.

In terms of rule SA of the Registration of Electors Rules. 1960. every overseas elector

Ilhose place of residence in India is located in the tate of Assam \\ho has completed 18

years of age as on 01.01.2011. and is desirous of registering his/her name in the electoral roll.

is invited hereby to submit claim application in Form-6A for registration in the electoral roll

of the constituency in l\ohich his/her place of residence as shown in the passport is located.

Form-6A alongwith guidelines for the applicant is gi\en below. The claim application in

Form-6A may be either submitted in person directl) to the registration officer of the

constituency concerned or sent to such registration 0fficer by po t along\\ ith the documents

mentioned in Form-6A and the guidelines. When the claim application is sent by post. it

should be accompanied b~ photocopies of the relelant page of the passport duly attested b)

the competent official of the Indian mission in the coumry concerned.

Addresses of the registration officers of each of the 126 A sam Legislative Assembly

constituencie in the State of Assam can be seen on the website: ceoassam.nic.in

~(Hemanta~A.S)

Chief Electoral Officer. Assam.

Election D~parlment. Dispur.

IJ.;r 11/ "vJ 11:"

t

under Secuon· 20A of the Representation of the People Act. 1950. t'tSertecl

vde Representationof the People (Amerldment) Act. 2010. which has oome into

effect w.eJ. 10· February, 2011, every overseas eJec~. ,e., £ndian citizen who is

absentmg from hIs place of Ofdinary residence ,n India owing to employment,

education or otherwise, and has not: acquired citizenshIp of any other country and

~'ho is not included in the electoral roll, Is ent~i!ed to have hislher name registered

n the eleclora! roll of the oonstituenclf in which hiSl11er place of residence in India

as ment.oned ,n I'1s!her passport is located.

lrl terms of rule SA of the Registration of Electors Rules, 1960. every

oyerse3S eteclor whose place of reside'1ce in India is Iocaled in !.he Stale of Kera,a

.• • •.,,0 has completed 18 yea~ of age as on 01.Q1-2011. and is desrous if

~egistenng hishler r-,ame in the elea-oral ro'i. is invited he;eby 10 submit daim

application In Form-6A for registratIOn in lhe electoral fO,l of the constituency in

which t1islher place of residence as shown in the passport is localed. Form-6A

alongwilh guidelines for the applicants is given below. Tne claim application in

Form· 6A may be eIther submilted in person directly to the registration officer of the

oonsliluency ooncerned or sent to such registration officer by post a10ngwilhthe

documents mentioned in Form· 6A and the guidelines. When the claim application is

sent by post. it should be accompanied by photocopies of the relevan1 pages of the

passport duiy attested by It:e oompetent official of the Indian mission '0 the COlintry

concerned.

Addresses of the registration offICers of each of the 1(.0 Assembly

c:orosUtuenclesin the Stale of Kerala can be seen on the website

WNW.cco.kerala.gov.in.

The Chi~r Ele<:tOroil!Offker. Kera!a,

"J'hiruvdnanthapUtillll

lhe SeO"l!tary

\finislry of External i\ffai["l.

Govrmml'nf IIf Incli"

::;Oulb Block

'\h. Delhi

<.:opy of the notifiC'iltion published und~r Rule SA of the R~gistr<nion of

Ele<tors Rules. 1960 with Iislof ilddl'f'ss of Electoral Rtgistr.ttion OHice~ in the "fittf' is

enclosed bert\\ilh for infonuatiUIl otnd 1lf'C:essary ac:tion.

_1Im.m.g.. · m· .g...g.gmg~~_No Name of District: 1 KASARAGOD

Taluk OfftCe Kasaragod,Near Mallikarjuna Temple,Kasaragod P.O.Kasaragod Dist.

671121

04994 230021

Postal Address ;

PIN CODE;

PHONE NUMBER;

TALUK OFFICE, THAlASSERY,(MINI CIVil STATION), KANNUR DISTRICT, KERALA

670101

0490 2343813

Postal Address :

PIN COO£:

PHONE NUMBER:

NO Name of LACs ;

MANJESHWAR

KASARAGOD

UDMA

13 THAlASSERY

14 KUTHUPARAMBA

15 MATIANNUR

16 PERAVOOR

Postal Address ;

PIN CODE:

PHONE NUMBER:

NO Nar!!f of LACs :

KANHANGAD

TRIKARIPUR

Taluk Office Hosdurg,Kanhangad P.O,Kasaragod Dist.

671315

04672 204042

Postal Addres5 :

PIN CODE:

PHONE NUMBER:

NO Name of LACs:

Postal Address :

PIN CODe:

PHONE NUMBER:

NO Nilr!!f of LACs:

TAlUK OFFICE, TAUPARAMBA, KANNUR DISTRICT, KERALA

670141

0460 2203142

Postal Address:

PIN CODE:

PHONE NUMBER:

NO Name of LACs :

19 KAlPElTA

Taluk Office, Vythiri, Vythiri (POl, Wayanad.

673576

04936255229

PAVYANNUR

TAUPARAMBA

IRIKKUR

Postal Address:

PIN CODE:

PHONE NUMBER:

Taluk Office, Sultan Bathery, Sultan Bathery (PO), Wayanad

673592

04936220296

TALUK OFFICE, KANNUR, KANNUR DISTRICT, KERALA

670002

04972704969

PIN CODE:

PHONE NUMBER:

NO Nar!!f of LACs:

7 KAlUASSERI

10 AZHIKODE

11 KANNUR

12 DHARMADAM

_1I!!!m.g, ..;m. ,e·..m· 'mi!' '!!!!!lm!~_No Name of Taluk: 9 BAOAKARA

1IIIIII~~~'m· · ~~-36 WANDOQR

PHONE NUMBER:

NO Name of LACs :20 VADAKARA

21 KUITIADI

22 NADAPURAM33 KONDQnY

34 ERANAD

37 MANJERI

40 MALAPPURAM

23 QUILANDY

24 PERAMBRA

25 BALUSSERI41 VENGARA

42 VALLIKKUNNU

43 TIRURANGADI

26 ELATHUR

27 KOZHIKOOE NORTH

28 KOZHIKODE SOUTH

29 BEYPORE

30 KUNNAMANGALAM

31 KODUVAllY

32 THIRUVAMBADY

PHONENUMBER: 04942422238

NO Name of lACs;

44 TANUR

45 TIRUR

46 KOTTAKKAl

Postal Address :

P'INCOOE:

PHONE NUMBER:

Taluk Office Nilambur,Chandakunnu P O,Nilambur,Malappuram District

679342

04931221471

PIN CODE: 679322

PHONENUMBER: 04933227230

NO Name of LACs:

38 PERINTHAlMANNA

39 MANKAOA

PINCODE: 678101

PHONENUMBER: 04923224740

NO Hame of lACs :

58 CHITTUR

59 NENMARA

PHONE NUMBER;

NO Name of LACs :

49 THRITHALA

50 PAnAMBI

51 SHORNUR

52 OTTAPALAM

PIN CODE:

PHONE NUMBER:

NO Name of LACs:

61 (HELAKKARA

62 KUNNAMKULAM

Postal Address:

PIN CODE:

PHONE NUMBER:

Taluk Office Palakkad,Palakkad Civil 5tati on Post

678001

0491· 2505770

Postal Address:

PIN CODE:

PHONE NUMBER:

66 OllUR

67 THRISSUR

68 NATIlKA

53 KONGAD

5S MALAMPUZHA

56 PALAKKAD

_~~~: .•' !!!lll!!!D~_No Name of Taluk : 29 KOCHI

PostalAddress; KoehiTalukOffice,Fortkoehl,Ernakulam

No Name of Taluk: 2S MUKUNDAPURAM

Postal Address: Taluk Office Mukundapuram IrinjaJakuda PO

NO Name of LACs:

70 IRINJALAKKUDA

71 PUTHUKKAD

72 CHALAKKUDY

79 VYPEN

80 KOCHI

PHONE NUMBER:

NO Name of LACs:

Postal Address:

PIN CODE:

PHONE NUMBER:

NO Name of LACs :

81 THRIPUNITHURA

82 ERANAKULAM

83 THRIKKAKARA

63 GURUVAVOOR

64 MANALUR

6S WAOAKKANCHERY

Taluk Office Kodungaltur Kodungallur P 0

680664

04802802336

Postal Address :

PIN COO£:

PHONE NUMBER:

NO Name of LACs:

_EElmig· ..g. ggl.l!lmm!!!!mm1iJ~.85 PIRAVOM

86 MUVATIUPUZHA

_Eltm~~:g· .g.~~.92 PEERUMADE

No Name of Taluk : 35 THODUPUZHA

Postal Address: TAHASILDAR ,lAlUK OFFICE,THODUPUZHA. Pin 685584

PIN CODE; 685584

PHONE NUMBER: 04862222503

NO Name of LACs :

No Name of Taluk : 40 CHANGANASSERY

Postal Address: Taluk Office, Changanacherry

PINCODE: 686101

PHONENUMBER: 04812420037

NO Name of LACs;

99 CHANGANAS5ERY

No Name of Taluk : 36 OEVIKULAM

Postal Address; Tahsildar, Taluk Office, Devikulam

PIN COOE: 685613

PHONENUMBER: 4829263963

NO Name of LACs:

No Name of Taluk : 41 KOTTAYAM

Postal Address: Mini Civil Station, Taluk Office, Kottavam

PINCODE: 686001

PHONENUMBER: 048U568007

NO Name of LACs :

Postal Address :

PIN COOE:

PHONENUMBER:

96 ffiUMANOOR

97 KOTIAYAM

98 PUTHUPPAllY

PHONE NUMBER:

NO Name of LACs:

Postal Address:

PIN CODE:

PHONE NUMBER:

NO Name of LACs:

No NameofTaluk: 44 CHERTl1ALA

Postal Address: Taluk Office, Cherthala, Cherthala.P.O

PIN COOE: 688524

PHONE NUMBER:

NO Name of LACs :

102 AROOR

103 CHERTHALA

Ta/uk Office, Mavelikara,Mavelikar.a.P.O

690101

04792302216

Taluk Office, AmbalappuzhaAlappuzha P.O

688001

04772253771PHONE NUMBER:

NO Name of LACs:

Taluk Office,Revenue Tower,

689101

04692601303

No NameofTaluk: 46 KUTTANAOU

Postal Address: Taluk Office, Kutt anad1hekkekar.a.P.O, Moncompu

PIN CODE: 688503

Taluk Office,Ranni p.o,Pathanamthitla

689672

04735227442

No Name of Taluk: 41 KARTHIKAPPAllY

Postal Address: Taluk Office, Karthikapally, Haripad.P.O

PIN CODE: 690514

PHONE NUMBER:

NO Name of LACs :

107 HARfPAD

108 KAVAMKULAM

Taluk Office,Mini Civil Station ,Pathanamthitta

689645

04692222221

Postal Address :

PlNCOOE:

PHONE NUMBER:

123 KUNDARA

124 KOLLAM

125 ERAVIPURAM

126 CHATHANNOOR

Postal Address :

PIN CODE:

PHONE NUMBER:

NO NarneofLACs:

Taluk Office,Mini Civilstation Building,Punalur (PO)

691305

04752222605

Postal Address:

PIN CODE:

PHONE NUMBER:

NO Name of LACs:No Name of Taluk: 56 KOITARAKKARA

Postal Address: Taluk Office,Thrikkannamanal,Kottarakkara (PO)

PIN CODE: 691506

PHONE NUMBER: 04742454623

NO Name of LACs :

127 VARKALA

128 ATIINGAl

129 CHIRAYINKEEZHU

Taluk Office Chirayinkeezhu, Attingal

695101

04722622406

Taluk Office,Minl Civil Station BUilding,Sasthamootta(PO)

690521

04762830345

Postal Address:

PIN CODE:

PHONE NUMBER:

NO Name of LACs:Postal Address :

PIN CODE:

PHONE NUMBER:

130 NEDUMANGAD

131 VAMANAPURAM

136 ARUVIKKARA

Taluk Office, Revenue Tower Nedumangadu

695541

04722802424

PIN CODE:

PHQNE NUMBER:

NO Name of LACs :

132 KAZHAKKQOTTAM

133 VATIIYOORKAVU

134 THfRUVANANTHAPURAM

"FORM6A

(See rule 8(B)

District--------

State in India

Space for pasting

one recent passport

size photograph

(3.5 x 3.5 eM)

showing frontal

view of full face

within this box

The Electoral Registration Officer,

_________ Assembly/ Parliamentary Constituency

I request that my name be included in the electoral roll for the constituency in which my place of

residence as per the particulars furnished below in item (h) is located.

(a) Name .

(b) Middle Name .

(c) Surname .

(d) Date of Birth Day Month Year

(e) Sex (male/Female)

(t) Place of Birth

(i) ViIlagelTown

(ii) District

(iii) State

(g) Father'slMother's/Husband's detail

(i) Name .

(ii) Middle Name .

(iii) Surname .

(h) Place of Ordinary Residence in India (Full Address as given in the Passport)

(i) HouselDoor number .

(ii) Street ArealLocality/Mohalla/Road .

(iii) TownlVillage .

(iv) Post office .

(v) Pin Code .

(vi) TahsillTalukalMandal!fhana .

(vi) District

(i) Passport Details-

(i) Passport Number

(ii) Place ofIssue of current Indian Passport .

(iii) Date of Issue of current Indian Passport .

(iv) Date of expiry of current India passport .

[Copies of the relevant page of the passport containing the particulars mentioned at item

(a) to (i) above to be enclosed - attested by the Indian Mission if sent by post and

produced with the original passport ifpresented in person before the registration officer]

U) Details of Visa of the Country of current residence

(i) Visa Number

(ii) Type of Visa (Single Entry/Multiple Entry/

Tourist/Work Visa etc) .

(iii) Date of issue of Visa .

(iv) Place of issue of Visa .

(v) Date of expiry of Visa .

(vi) Name of the Issuing Authority .

[Copies of the relevant pages of the passport containing the current valid visa

endorsementmentioned above to be enclosed - attested by the Indian Mission if sent bypost and produced with the original passport if presented in person before theregistrationofficer]

2. Description of Absence from Place of Ordinary Residence in India-

(a) Reason of being absent from the place of ordinary residence in India- (i) employment/

(ii) education/(iii) other (Give Description)

(b) Date from which absenting from ordinary residence in

India (DDIMMNYYY)

3, Full residential address in the country outside India where currently

residing .

4, Full Official address in the country outside India currently residing (address of the place of

employment or the education institution where studying) .

5, Declaration - I hereby declare that to the best of knowledge and belief

(a) all information given in this application is true

(b) I am a citizen of India by birth/domicile/naturalization

(c) I have not acquired citizenship of ay other country

(d) But for being absent from the place of my ordinary residence in India owing to the reason

given in 2(a) above. I would have been ordinarily resident at the address given in my Indian

Passport which has been reproduced at leg) above.

(e) I undertake to immediately inform the Electoral Registration Office through the Indian

Mission in the Country of my current residence if I renounce my Indian Citizenship or if I

acquire the citizenship of any other country.

(f) I undertake to immediately inform the Electoral Registration Officer through the Indian Mission in

the country of my current residence of any change in my residential address in the country of my

residence for the records of the Electoral Registration Officer. I understand that any notice sent to

me at the address, which is my residential address in the country of my current residence according

to the records of the Electoral Registration Officer, shall be considered as due service of notice to

me under the Representation of the People Act, 1950 and the rules made thereunder, and that it is

my responsibility to keep the Electoral Registration Officer informed of my latest residential

address in the country of my current residence.

(g) If! return to India and become ordinarily resident in India, I shall immediately inform the Electoral

Registration Officer of the concerned Assembly/ Parliamentary Constituency.

My name may have been included in the electoral roll of 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, or transposed, as

may be appropriate.

Elector Photo Identity Card (if issued) number .

Date of issue .

G) I have not been issued an EPIC in India have been issued an EPIC which is enclosed with this

application for cancellation.

Signature .

Place .

Date .

PART-B

(For use in the office of Electoral Registration Officer)

Application received on (DD/MM/YYYY)

The application in Form 6A ofShriiShrimati/Kumari has been :-

(a) Accepted and the name has been registered in the electoral roll of .

(constituency) at S1.No Part No .

(b) Rej ected for the reason .

PART-C

Acknowledgement for Application

(When presented in person to registration officer)

Received the application in Form 6A of

Shri/Shrimati/Kumari .

Address .

Signature ofthe Verifying Officer _

Address _

Note: The principal rules where published in the Gazette of India, Extraordinary, vide notification

number S.O. 2750 (E) dated the 11th November, 1960 and last amended vide number S.O. 1219 (E)

dated the 15th May, 2009.

1. Every citizen of India staying in a foreign country, who has not acquired citizenship of a foreign

country, and has completed 18 years of age as on 1st January of the year, can make an application

in Form 6A for being registered in the roll for the constituency pertaining to the locality in which

his place of residence in India as mentioned in the passport is located. The application in Form 6A

can be presented to the registration officer concerned.

2. The applicant should have completed eighteen years of age as on 1st January of the year for

example, if the application is for inclusion of name in the electoral roll with reference to

01-01-2011 as the qualifying date, the applicant should have completed 18 years of age as on

01-01-2011.

3. The application should be submitted directly to the Electoral Registration officer (ERa) of the

constituency within which the place of ordinary residence of the applicant as given in the valid passport

falls. The Application in Form 6A can be presented in person to the ERa or sent by post addressed to the

ERa concerned.

[The particulars and postal address of the EROs of all the constituencies of India can be seen on the

website of Election Commission ofIndia (http://eci.nic.in)]

4. Paste one recent passport size coloured photograph with a light background (preferably white)

showing the full face of the applicant.

5. Fill in all the columns in Form-6A. Write your name and other particulars as given in the valid

Indian Passport.

6. If the application is sent by post, it should be accompanied by photo-copy of the relevant pages of

the passport containing the photograph and all other particulars of the applicant and the page containing the

valid visa endorsement. These photo-copies should be got duly attested by the competent official in the

Indian Mission. Applications without the attested photo-copies of these documents will be liable to be

summarily rejected.

7. If the application is submitted in person before the ERa, the application should be accompanied by

a photo-copy of the relevant pages of the passport as mentioned above. The original passport should also be

produce alongwith the application for verification by the registration officer. The passport will be returned

immediately after verification.

8. It may be noted that after your enrolment, you will be able to cast vote in election in the

constituency, if you are physically present in the polling station alongwith your original passport on the dayof pol!.