30/03/2017 FORM6

ApplicationforinclusionofnameinelectoralrollApplicationID:052514346

To,

TheElectoralRegistrationOfficer

*AssemblyConstituency:Serilingampally
Sir,

Irequestthatmynamebeincludedintheelectoralrollfortheabove
Constituency.Particularsinsupportofmyclaimforinclusioninthe
electoralrollaregivenbelow:

I.Applicant'sDetails:

Name: RAVI :

Surname(ifany): YALALA :
Dateofbirthifyouknow: Day:30 Month:08 Year:1978 Gender:M

Ageason1stJanuary
Year:37 Months:4
2016:

PlaceofbirthPlaceofbirth

Village/Town: JAMSHEDPUR

District: SINGHBHUM State: JHARKHAND

RelationDetails

RelationType
F
Father's/Mother's/Husband's:

Name: SRINIVASRARAO :

Surname(ifany): YALALA :

II.ParticularsofplaceofpresentordinaryResidence(Fulladdress)

House/Doornumber: PLOTNOB.102

Street/Area/Locality //
IRWORAILVIHARPHASE3 : 3
/Mohalla/Road:

Town/Village: SERILINGAMPALLY /:

Tehsil/Taluka/Mandal/
Thana:
Serilingampally /:

District: RANGAREDDY PostOffice: SERILINGAMPALLY

Pincode: 500019

III.Detailsofmember(s)ofapplicant'sfamilyalreadyincludedinthecurrentelectoralrolloftheConstitutency:

RPartnumberofthe
Relationshipwith Serialnumberinthe Elector'sPhotoIdentity
Name: rollofthe
applicant: Part: CardNumber:
Constitutency:
1. 0 0
2. 0 0
MobileNo:0 Remarks:

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