Postal Ballot Form No.

Application for Postal Ballot Your Phone No ... .I..T.~..Q..Y:..1..'jV

To,

The Returning Officer b

TQ...~.0.
.................. ..~N.a...~ ~.~.f:S.ti6. Demkhong

A. Personal Information
1. Name: N..A:1Y.t.qAY.. ..2t:rN.q~o 4. Name of Spouse: l]\?:H...t b..~N.p..C!..P
2. VPIC No.: .. J.! ..q..Q.9...0..Q.Q.3..~ ..Y:.... 5. VPIC No. of Spouse: ...JD ...9::.l..6,.o.o ..o..?'3.Q
Male C. Occupation Details
3.Sex
Female 1. Civil Servant 0'
B. Civil Registry Details 2. Diplomat D
1. Dzongkhag: p.Y...~..~..IS.tf..A . 3. Member of Armed Force D
2. Gewog: TQ..et ~Af.\/.4 . 4. Student D
3. Village: ().A::-w.AK,"tf-A . 5. Trainee D
4. House No.: Tt:l..:7'...LQ.~ ..6.1? . 6. Spouse D
D. Current Postal Address 7. Any other D Please specify: .
....6..e../?.MTMe.Jr. ...rI.. .. ./!t...Q.TO.c.oL E. Competent Witness

.M.LN..J.S.Ti:Y.. of:..&~l4.N.ft.EA1e.l Name: (;,.~ ..~.~ J)~.~N. .

f4Y.:It.~'I..9.N.4.. TI....~~. 2. VPIC No.: ~..~ 'i.J ~ ..IT.r..~ .
..T.H.l.M ..R...tf:Y ..:....................................
3. Address: ~!~ ~ .
..............................................................................
.. ~ . A-'~
'1 .

F. Declaration
I hereby affirm that the above information is t[\ ~

SIGNATURE/RIGHTTIIUMB IMJl.RESSION ....~ Date ( tlJ,rr / 0 ~ /3-O'l({)

SIGNATURE/RKiIIT THUMBlMPRESSTUN ~/Ii)~ Date (~ / IGl ~ /1rrtlr")

OF THE COMPETENTWITNESS ~ ..

For Official Use Only

Received by: Date ( DO / MIV! / YYYY )

Entered in the Postal Ballot Application register by: .

Signature and Seal (R. 0): Date ( DO / M"Vl / Y'iYY )

Note:
1. "Competent Witness" means a Bhutanese citizen known to the postal voter who is a registered voter in any constituency.
2. VPIC number is same as Citizenship Identity Card Number.