Application for inclusion of name in electoral roll

ApplicationID:09810507

To,
The Electoral Registration Officer
*Assembly Constituency: Jangoan
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:

I. Applicant's Details:
Name:

RAJESHWAR

Day:26 Month:11 Year:1979 Gender:

Surname(if any): DOOSAKANTI

Date of birth if
you know:
Age as on 1st
January 2013:

Year:33 Months:1

Place of birth Place of birth

Village/ Town:

LADNOOR

District:

WARANAGAL

Relation Details
Relation Type

State:

ANDHARAPRADESH

Father's/Mother's/Husband's:
Name:

SHANKARAIAH

Surname(if any): DOOSAKANTI

II. Particulars of place of present ordinary Residence(Full address)

House/Door
number:

2-1

Street /Area
/Locality
1ST WARD
/Mohalla /Road:

//:

Town/ Village:

LADNOOR

/
:

Tehsil/
Taluka/Mandal/
Thana:

MADDUR

/:

District:

WARANGAL

Post
Office:

LADNOOR

1st

Pin code: 506224

III. Details of member(s) of applicant's family already included in the current

electoral roll of the Constitutency:
Name:

Relationship
with
applicant:

RPart number
Serial
of the roll of the number in
Constitutency: the Part:

1. SHANKARAIH

FATHER

2.

Mobile No: 9347381798

Remarks:

Email-Id: rajeshward1@gmail.com

Elector's Photo
Identity Card
Number: