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  • 1. VOTER REGISTRATION byYou are NOT REGISTERED until you SIGN and SUBMIT your VoterRegistration FormEASY 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 a1. PRINT this form. Make sure you print pages 3 and 4 (Form 6) STUDENT while filling your online registration, you will find a on one page in back to back print format. This is your Voter copy of STUDENT DECLARATION FORM on last page. Registration Form - the official application required by the Election Commission to register you as a voter. 4. SIGN and SUBMIT the completed form to the2. FILL additional fields, if applicable. Check Electoral Registration Officer (ERO) of your Assembly If anybody from your house is already registered on Constituency (AC). You will find your ERO’s address below. electoral rolls, fill in their details on Page 5. If you are already a registered voter from a different While submitting the Voter Registration form, do not forget to constituency, fill in those details on Page 4. This will help ask for Receipt of Application. Election Commission to cancel your previous voter registration. Check out www.jaagore.com to join the Jaago Re! movement! If you have already been issued a Voter ID card, mention your card number and date of issue on Page 4.3. ATTACH additional documents. To register for voting, you will also need to submit: a. Address Proof document b. Age Proof document (for first time voters) c. Student Declaration Form (if you are a student residing outside your native city)Either of the above documents should be an officialGovernment issued document, which will also act as yourproof of citizenship. SUBMIT YOUR FORM TO: Electoral Registration Officer (ERO) of Assembly Constituency 116-Bidhannagar Sanjay Kumar Das Sub Divisional Officer, Bidhannagar Mayukhbhavan, Saltlake Kolkata-700091 Ph:033-23595270
  • 2. GENERAL INSTRUCTIONSDOCUMENTS REQUIRED TO REGISTER 5 MYTHS ON VOTING1. 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 1. Landline phone bill You should have a valid IDENTITY PROOF. Voter ID card is 2. Mobile telephone bill only one of the valid proofs 3. Water bill 4. Electricity bill 2. I can vote only from the place of my birth / permanent residence 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 you2. AGE Proof document name. It needs to have only the address of the place where you If you are a first time voter, you will also need to submit an age are staying. You can use address proof document on the name proof document. You can submit the proof of Date of Birth from of your parents, relatives, friends etc. with whom you are any government agency authorized document like: staying. 1. Birth certificate 2. Passport 4. As a voter, I can vote in 2 kinds of elections – State Assembly 3. PAN Card Elections & General Elections 4. Driving Licence As a registered voter you can vote in more than 2 elections! 5. State board exam certificate etc. Besides General and Assembly elections, you can also vote in your Local Body Elections or Municipal Corporation Elections,3. For STUDENTS only as called in cities. If you are a student residing outside your native city in a hostel / mess, you might not have any of the above mentioned address 5. Registering to Vote is a cumbersome process proof documents. In this case, you can get a Student Earlier perhaps, but not any more! With Jaago Re! Declaration Form (Page 5 of this form) signed by your college not only can you fill and submit your registration form dean/principal/registrar and submit it along with your voter easily, you can also get to know when your name gets on the registration form. voter list. And all of this from the convenience of your home!DISCLAIMERWhile all efforts have been made to make all data on the website ( www.jaagore.com ) or this Registration Form as error free aspossible, users are requested to refer to the officially published error free copies of the Constitution of India, Acts, Rules and Ordersmade there under and to the latest editions of the various Handbooks, Compendia and Reports published by the Election Commissionof India (ECI), for their authentic version. Tata Tea Ltd. will be responsible for any loss to any person causedby any shortcoming, defect or inaccuracy in the above data. We also do not assure that any particular person will be on the electoralrolls of ECI.
  • 3. FORM 6 [See rules 13(1) and 26] Application for inclusion of name in electoral rollTo The Electoral Registration Officer, 116-Bidhannagar 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 forinclusion in the electoral roll are given below:I. Applicants Name Surname (if any) Details Satyajit RoutrayAge as on 1st January 2012# Years: 25 Months: 8 Sex (Male/Female): MaleDate of birth, if known: Day: 16 Month: 05 Year: 1986Place of Village/Town kolkatabirth: District: State: West BengalFathers/Mothers/Husbands Name Surname (if any) Jogendra RoutrayII. Particulars of place of ordinary residence (Full address):House/Door Number: Police Abasan, A1/702Street/Area/Locality/Mohalla/Road: AF-block, SaltlakeTown/Village: KolkataPost Office: Pincode:700064Tehsil/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 applicationReceived the application in Form 6 of ** Shri/ Shrimati/Kumari Satyajit Routray**Address: police Abasan, A1/702, AF-block, Saltlake, Kolkata, 700064,Date: Signature of the officer receiving the application on behalf of the Electoral Registration Officer (Address)...........................................................**To be filled in by the applicant.
  • 4. III.Details of member(s) of applicants family already included in the current electoral roll of the Constituency : Name Relationship Part number of Serial Electors with applicant the roll of the number in Photo Identity Constituency that Part Card Number1.2.IV. DeclarationI 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 since01-01-2003(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 samemay 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 the electorNote — Any person who makes a statement or declaration which is false and which he either knows or believes to be falseor 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 ofname 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 ofrule 17*/20* / 26(4)£] :Place : Signature of (Seal of the ElectoralDate : Electoral Registration Officer Registration Officer)£ During continuous updating after final publication of electoral roll.* Strike out the inappropriate alternative
  • 5. SPACE FOR PASTING DECLARATION BY STUDENTS LIVING IN ONE RECENT PASSPORT SIZE HOSTELS/MESSES/ELSEWHERE PHOTOGRAPH (3.5x (TO BE ATTACHED WITH FORM 6) 3.5 CM) SHOWING FRONTAL VIEW OF FULL FACE WITHIN THIS BOX I. I, ................................................................................................(NAME IN BLOCK LETTERS), son/daughter of .............................................................................................................................resident of ............................. ...................................................................................(complete postal address of native place), hereby declare that :---- (a) I am a bonafide student of ____________________________________________________(name of the institution) and pursuing ________________________________(details of the course) from ________(month)_________(year) to _________(month)________(year); *(b) I am presently residing at - (i)______________________________________________________(if residing in hostel/mess,mention Room No./Block No./ Block Name, etc. of the hostel/mess). OR * (ii)_______________________________________________________________(if residing elsewhere outside the hostel/mess, mention complete postal address of the place of stay outside the hostel/mess). (c) * I want to be registered in the electoral roll/retain my registration in the electoral roll of my native place at my above-mentioned residential address with my parents/guardian. OR *I want to be registered in the electoral roll of the constituency where I am presently residing.II. I am aware that registration in the electoral roll of more than one constituency or more than once in a constituency is not permitted under the election law and am also aware of the penal provisions of Sec. 31 of the R.P.Act, 1950, which reads as follows: - "If any person makes in connection with (a) the preparation, revision or correction of an electoral roll, or (b) the inclusion or exclusion of any entry in or from an electoral roll, a statement or declaration in writing which is false and which he either knows or believes to be false or does not believe to be true, he shall be punishable with imprisonment for a term which may extend to one year, or with fine, or with both". Place : (signature of the student) Date : It is certified that the information given in the declaration at (a) above and the photograph have been verified from the records of the institution and are found to be correct. Place/Date: Signature and seal of the Head Master/Principal/Registrar/Director/Dean * Strike out the inapplicable alternatives. Note- The onus of delivery of the declaration to the ERO concerned will lie on the applicant.