Chief Electoral Officer’s Office of Andhra Pradesh: E-REGISTRATION(Form-6)

Application for inclusion of name in electoral roll ApplicationID:0734535

To,

The Electoral Registration Officer

*Assembly Constituency: Medak

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:

Name:

KUMAR

పేరు:

కుమార్

Surname(if any):

SUPLA

ఇంటి పేరు:

సుప్ల

Date of birth if you know:

Day:09

Month:02

Year:1984

Gender: M

Age as on 1st January 2013:

Year:28

Months:10

Village/ Town:

PET

District:

MEDAK

State:

ANDHRA PRADESH

Relation Type Father’s/Mother’s/Husband’s:

F

Name:

VENKAT

పేరు:

వెంకటే

Surname(if any):

SUPLA

ఇంటి పేరు:

సుప్ల

House/Door number:

9-5-4/2/45

Street /Area /Locality /Mohalla /Road:

SIVA ENCLAVE

వీది /ఏరియా/లొకాలిటి:

శివ ఎన్క్లేవ్

Town/ Village:

VPET

పట్టణం/గ్రామం:

పేట

Tehsil/ Taluka/Mandal/ Thana:

PET

తాలూక /మండలం:

పేట

District:

MEDAK

Post Office:

PET

Pin code:

506791