VOTER REGISTRATION by

 
You are NOT REGISTERED until you SIGN and SUBMIT your Voter
Registration Form
 
EASY INSTRUCTIONS to complete your voter registration:   To view the complete list of VALID address proof and age
    proof documents, refer to Page 3. If you have opted as a
STUDENT while filling your online registration, you will find a
1 PRINT this form . Make sure you print pages 3 and 4 (Form 6) copy of STUDENT DECLARATION FORM on last page.
  on one page in back to back print format. This is your Voter    
Registration Form - the official application required by the
Election Commission to register you as a voter. 4. SIGN and SUBMIT the completed form to the
      Electoral Registration Officer (ERO) of your Assembly
Constituency (AC). You will find your ERO’s address below.
2. FILL additional fields , if applicable. Check
If anybody from your house is already registered on    
electoral rolls, fill in their details on Page 5.   While submitting the Voter Registration form, do not forget to
If you are already a registered voter from a different ask for Receipt of Application.
constituency, fill in those details on Page 4. This will help    
Election Commission to cancel your previous voter
registration. 5. CONFIRM your form submission to Jaago re!
If you have already been issued a Voter ID card, mention     One Billion Votes either by:
your card number and date of issue on Page 4. Sending an sms “VOTE confirm” to 56767 from your mobile
    phone as registered with www.jaagore.com
Updating your profile at www.jaagore.com
3. ATTACH additional documents . To register    
  for voting, you will also need to submit: Once you confirm, we will continuously track and confirm your
voter status to you by SMS and email!
a. Address Proof document    
b. Age Proof document (for first time voters) Check out www.jaagore.com to know more on what you can
c. Student Declaration Form (if you are a student residing do with Jaago Re! One Billion Votes movement.
outside your native city)  

   
  Either of the above documents should be an official
Government issued document, which will also act as your
proof of citizenship.
 
 
SUBMIT YOUR FORM TO:

Electoral Registration Officer (ERO) of Assembly Constituency

166 - Andheri East

Shri AA Pawar
Tahsildar (Encroachment/ Removal)
Ismail Yusuf College Compound, Mess in Barracks
Hindu Friends Society Road, Jogeshwari (E)
Mumbai-400060
Ph:022-2837868/ 26591220

 
 
 
GENERAL INSTRUCTIONS
DOCUMENTS REQUIRED TO REGISTER 5 MYTHS ON VOTING
   
1. ADDRESS Proof document 1. I am registering to get my voter ID card
  This document is required for the BLO (Booth Level Officer) to   When you register to vote, you are registering only to get your
come and verify your residence status. It is therefore not name included in the electoral rolls (also called voter list) and
essential for the address proof document to have your name. It NOT to get a voter ID card. To get a voter ID card, you have to
needs to have only the address of the place where you are register separately.
staying Remember, on election day, only 2 things are mandatory for
  Any one of the following documents is acceptable for address you to be allowed to vote:
proof:   Your name should be present on voter list
You should have a valid IDENTITY PROOF. Voter ID card is
1. Landline phone bill only one of the valid proofs.
2. Mobile telephone bill   
3. Water bill 2. I can vote only from the place of my birth / permanent residence
4. Electricity bill
5. Property tax receipt   As a citizen of India greater than 18 years of age, you are
6. Bank statement eligible to vote from any place in India, provided you have been
7. Passport an ORDINARY RESIDENT i.e. you have been staying at your
8. Ration card current address for at least 6 months or more.
9. House Lease/Rental agreement   
10. LPG receipt 3. I do not have a valid ADDRESS PROOF document to register for
11. Driving license voting
12. Identity cards given by the employer     It is not essential for the address proof document to have your
name. It needs to have only the address of the place where you
   are staying. You can use address proof document on the name
2. AGE Proof document of your parents, relatives, friends etc. with whom you are
staying.
  If you are a first time voter, you will also need to submit an age
proof document. You can submit the proof of Date of Birth from    
any government agency authorized document like: 4. As a voter, I can vote in 2 kinds of elections – State Assembly
Elections & General Elections
1. Birth certificate   As a registered voter you can vote in more than 2 elections!
2. Passport Besides General and Assembly elections, you can also vote in
3. PAN Card your Local Body Elections or Municipal Corporation Elections,
4. Driving Licence as called in cities.
5. State board exam certificate etc.   
5. Registering to Vote is a cumbersome process
     Earlier perhaps, but not any more! With Jaago re! One Billion
3. For STUDENTS only Votes , not only can you fill and submit your registration form
  If you are a student residing outside your native city in a hostel / easily, you can also get to know when your name gets on the
mess, you might not have any of the above mentioned address voter list.
proof documents. In this case, you can get a Student   And all of this from the convenience of your home!
Declaration Form (Page 5 of this form) signed by your college
dean/principal/registrar and submit it along with your voter
registration form.
 
 
DISCLAIMER
While all efforts have been made to make all data on the website ( www.jaagore.com ) or this Registration Form as error free as
possible, users are requested to refer to the officially published error free copies of the Constitution of India, Acts, Rules and Orders
made there under and to the latest editions of the various Handbooks, Compendia and Reports published by the Election Commission
of India (ECI), for their authentic version. Neither Janaagraha nor Tata Tea Ltd. will be responsible for any loss to any person caused
by any shortcoming, defect or inaccuracy in the above data. We also do not assure that any particular person will be on the electoral
rolls of ECI.
 
 
 FORM 6
[See rules 13(1) and 26]

Application for inclusion of name in electoral roll

 To
The Electoral Registration Officer,

 166 - Andheri East  Assembly/Parliamentary£ Constituency.

 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 Surname (if any)
 I. Applicant's
   details Sagar Kulkarni

Age as on 1st January 2008 # Years :  28 Months :  1 Sex (male/female) : Male

Date of birth, if known : Day :  09 Month :  12 Year :  1979

Place of Village/Town :  Mumbai

birth : District :   State :  Maharashtra
Name Surname (if any)
Father's / Mother's / Husband's /
Guardian's Name  Anil  Kulkarni

II.  Particulars of place of ordinary residence (Full address):

House / Door number : P & T Staff Mitra Mandal,, D2/111

Street/Area/Locality/Mohalla/Road : Tarun Bharat, Chakala

Town / Village : Mumbai

Post Office :   Pincode :  400099

Tehsil/Taluka/Mandal/Thana :    

District : 

£ In case of Union territories having no Legislative Assembly and the State of Jammu and Kashmir.
# Please give the year i.e. 2003, 2004, etc.
* Strike out the inappropriate alternative.
 
 
 
 
 
 
P.T.O.
.................................................................................(Perforation)...................................................................................
Receipt for application
 
Received the application in Form 6 of ** Shri/ Shrimati/Kumari  Sagar Anil Kulkarni
**Address :   P & T Staff Mitra Mandal, D2/111 Tarun Bharat Chakala, Mumbai 400099
 
Signature of the officer receiving the application on
Date :  
behalf of the Electoral Registration Officer
  (Address) .........................................................
 
**To be filled in by the applicant.
 
 III. Details of member(s) of applicant's family already included in the current electoral roll of the Constituency :

Name Relationship Part number of Serial Elector's

with applicant the roll of the number in Photo Identity
Constituency that Part Card Number
1.        
2.        

IV. Declaration

I hereby declare that to the best of my knowledge and belief:-

(i) I am a citizen of India; (ii) I am ordinarily resident at the address given in para II above since 15-06-1983
(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;
 
Or
 
*My name may have been included in the electoral roll for ................................................................. 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.
Full Address (Earlier Place of ordinary residence) :

Electors photo identity card (if issued) number;

 
......................... date of issue .............................

Place : Date : Signature or thumb impression of claimant

Note — Any person who makes a statement or declaration which is false and which he either knows or believes to be false or
does not believe to be true, is punishable under section 31 of the Representation of the People Act, 1950 (43 of 1950).
* Strike out the inappropriate alternative.
 
Details of action taken
(To be filled by Electoral Registration Officer of the constituency)
The application of
Shri/Smt./Km...................................................................................................................................................................... for inclusion of
name in the electoral roll in Form 6 has been accepted* / rejected*.
Detailed reasons for *acceptance [under or in pursuance of rule 18*/20* /26(4)]£ or *rejection [under or in pursuance of
rule 17*/20* / 26(4)£] :

Place : Signature of (Seal of the Electoral

Date : Electoral Registration Officer Registration Officer)
 
£ During continuous updating after final publication of electoral roll.
* Strike out the inappropriate alternative.