1

¦ÉÉ®úiÉ ÊxÉ´Éb÷hÉÚEò +ɪÉÉäMÉ

xɨÉÖxÉÉ-8+ {ÉÉäSÉ Gò¨ÉÉÆEò : ...................
[{ɽþÉ ¨ÉiÉnùÉ®ú xÉÉånùhÉÒ ÊxɪɨÉ, 1960 ¨ÉvÉÒ±É ÊxÉªÉ¨É 13 (4) ´É 26)] (EòɪÉÉDZɪÉÒxÉ ´ÉÉ{É®úɺÉÉ`öÒ)

¨ÉiÉnùÉ®ú ªÉÉnùÒiÉÒ±É xÉÉånùÒSÉä ºlÉÉxÉÉÆiÉ®ú Eò®úhªÉɺÉÉ`öÒ +VÉÇ (VªÉÉ |ÉEò®úhÉÒ BEòÉSÉ ¨ÉiÉnùÉ®úºÉÆPÉÉiÉ ÊxÉ´ÉɺɺlÉÉxÉ BEòÉ Ê`öEòÉhÉɽÚþxÉ <iÉ®ú
Ê`öEòÉhÉÒ ºlÉÉxÉÉÆiÉÊ®úiÉ ZÉɱÉä +ºÉ±ªÉɺÉ)
|ÉÊiÉ, ¨ÉiÉnùÉ®ú xÉÉånùhÉÒ +ÊvÉEòÉ®úÒ, ........................................................ Ê´ÉvÉÉxɺɦÉÉ/±ÉÉäEòºÉ¦ÉÉ ¨ÉiÉnùÉ®ú ºÉÆPÉ xÉVÉÒEòSªÉÉ EòɳýÉiÉÒ±É
ºÉ¨ÉÉä®úSªÉÉ ¤ÉÉVÉÚxÉä ºÉÆ{ÉÚhÉÇ SÉä½þ®úÉ
¨ÉÒ Ê´ÉxÉÆiÉÒ Eò®úiÉÉä EòÒ, ={É®úÉäCiÉ ¨ÉiÉnùÉ®ú ºÉÆPÉÉÆiÉMÉÇiÉ ¨ÉÉZÉä ºÉ´ÉǺÉÉvÉÉ®úhÉ ÊxÉ´ÉɺÉÉSÉä Ê`öEòÉhÉ ºlÉÉxÉÉÆiÉÊ®úiÉ ZÉɱÉä +ºÉ±ªÉɨÉÖ³äý ÊnùºÉä±É +ºÉä {ÉɺÉ{ÉÉä]Çõ ºÉÉ<ÇVÉ
ªÉÉ ¨ÉiÉnùÉ®ú ªÉÉnùÒiÉÒ±É ¨ÉÉZªÉÉ º´ÉiÉ:SªÉÉ xÉÉ´ÉÉSÉÒ xÉÉånù ºÉƤÉÆÊvÉiÉ ¦ÉÉMÉɨÉvªÉä ºlÉÉxÉÉÆiÉÊ®úiÉ Eò®úhªÉÉiÉ ªÉÉ´ÉÒ. UôɪÉÉÊSÉjÉ ÊSÉEò]õÊ´ÉhªÉɺÉÉ`öÒ
(3.5 ºÉåä.¨ÉÒ.× 3.5
ºÉå.¨ÉÒ.) VÉÉMÉÉ
+VÉÇnùÉ®úÉSÉÉ iÉ{ɶÉÒ±É
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(¤É) +Éb÷xÉÉ´É (+ºÉ±ªÉɺÉ)
(Eò) ¦ÉÉMÉ Gò. (b÷) +xÉÖGò¨ÉÉÆEò
(<) <Ç{ÉÒEò Gò. (Ênù±Éä +ºÉ±ªÉɺÉ)
(¡ò) <Ç-¨Éä±É (´ÉèEòα{ÉEò)
(½þ) ¨ÉÉä¤ÉÉ<Ç±É Gò. (´ÉèEòα{ÉEò)
(MÉ) ºlÉÉxÉÉÆiÉÊ®úiÉ ZÉɱÉ䱪ÉÉ ºÉ´ÉǺÉÉvÉÉ®úhÉ ÊxÉ´ÉɺÉÉSÉÉ ºÉvªÉÉSÉÉ {ÉkÉÉ : PÉ®ú Gò¨ÉÉÆEò
®úºiÉÉ/IÉäjÉ/´ÉºÉÊiɺlÉÉxÉ
¶É½þ®ú/MÉÉ´É
b÷ÉEò EòɪÉÉÇ±ÉªÉ Ê{ÉxÉ EòÉäb÷
ÊVɱ½þÉ ®úÉVªÉ/Eåòpù¶ÉÉʺÉiÉ |Énäù¶É
PÉÉä¹ÉhÉÉ--- ¨É±ÉÉ VÉÉhÉÒ´É +ɽäþ EòÒ, VÉä JÉÉä]äõ +ɽäþ +ºÉä ¨É±ÉÉ ¨ÉɽþÒþiÉ +ɽäþ ËEò´ÉÉ VÉä JÉÉä]äõ +ɽäþ +ºÉä ¨É±ÉÉ ´ÉÉ]õiÉä ËEò´ÉÉ VÉä JÉ®äú +ɽäþ +ºÉä ¨É±ÉÉ ´ÉÉ]õiÉ xÉɽþÒ
+ºÉä ÊxÉ´ÉänùxÉ ËEò´ÉÉ |ÉÊiÉYÉÉ{ÉxÉ Eäò±ªÉÉºÉ ¨ÉÒ ±ÉÉäEò|ÉÊiÉÊxÉÊvÉi´É +ÊvÉÊxɪɨÉ, 1950 (1950 SÉä 43) SªÉÉ Eò±É¨É 31 +x´ÉªÉä ʶÉIÉäºÉ {ÉÉjÉ `ö®äúxÉ.
Ê`öEòÉhÉ : .........................................
ÊnùxÉÉÆEò : .......................................... +VÉÇnùÉ®úÉSÉÒ º´ÉÉIÉ®úÒ : ...............................

IÉäjÉÒªÉ ºiÉ®úÉ´É®úÒ±É {Éb÷iÉɳýhÉÒ +ÊvÉEòÉ­ªÉÉSÉÉ ¶Éä®úÉ :

 2

ELECTION COMMISSION OF INDIA

FORM-8A Acknowledgement No. ...................

[See Rules 13(4) and (26) of Registration of Electors Rule-1960] (To be filled by office)

Application for Transposition of Entry in Electoral Roll (in case of Shifting from One Place
of Residence to Another Place of Residence within Same Constituency)

To, The Electoral Registration Officer, .................................................. Assembly/Parliamentary Constituency SPACE FOR
PASTING ONE
I request that entry in the electoral roll for the above mentioned Constituency relating RECENT PASSPORT
SIZE PHOTOGRAPH
to Myself should be transposed to the relevant part of the roll in this constituency because (3.5 CM×3.5 CM)
SHOWING FRONTAL
I have shifted my place of ordinary residence within the same constituency. VIEW OF FULL FACE
WITHIN THIS BOX
Particulars of the applicant

(a) Name

(b) Surname (if any)

(c) Part No. (d) Serial No.

(d) EPIC No. (if issued)

(e) E-mail id (optional)

(f) Mobile No. (optional)

(g) Current address of my ordinary residence where I have shifted House No.

Street/Area/Locality

Town/Village

Post Office Pin Code

District State/UT

DECLARATION – I hereby declare that the facts and particulars mentioned above are true to the best of my
knowledge and belief. I am aware that making a statement or declaration which is false and which I know or
believe to be false or do not believe to be true, is punishable under Section 31 of the Representation of the People
Act, 1950 (43 of 1950).

Place : .........................................
Signature of Applicant : ...........................
Date : ..........................................

Remarks of Field Level Verifying Officer :

 3

Eäò±É䱪ÉÉ EòɪÉÇ´ÉɽþÒSÉÉ iÉ{ɶÉÒ±É

(¨ÉiÉnùÉ®úºÉÆPÉÉSªÉÉ ¨ÉiÉnùÉ®ú xÉÉånùhÉÒ +ÊvÉEòÉ­ªÉÉxÉä ¦É®úɴɪÉÉSÉÉ)
¸ÉÒ./¸ÉÒ¨ÉiÉÒ/EÖò¨ÉÉ®úÒ ............................................... ªÉÉÆxÉÒ º´ÉiÉ:SªÉÉ/¸ÉÒ./¸ÉÒ¨ÉiÉÒ/EÖò¨ÉÉ®úÒ ............................................... ªÉÉÆSªÉÉ
¨ÉiÉnùÉ®ú ªÉÉnùÒiÉÒ±É ºlÉÉxÉÉÆiÉ®úhÉɺÉÉ`öÒ Eäò±Éä±ÉÉ xɨÉÖxÉÉ 8+ ¨ÉvÉÒ±É +VÉÇ º´ÉÒEòÉ®ú±ÉÉ/xÉÉEòÉ®ú±ÉÉ.
[ÊxÉªÉ¨É 26(4) JÉɱÉÒ ËEò´ÉÉ +xÉÖºÉÉ®] +VÉÇ º´ÉÒEòÉ®úhªÉɤÉɤÉiÉ ËEò´ÉÉ xÉÉEòÉ®úhªÉɤÉɤÉiÉ iÉ{ɶÉұɴÉÉ®ú EòÉ®úhÉä JÉɱÉÒ±É|ɨÉÉhÉä :-----

Ê`öEòÉhÉ :
ÊnùxÉÉÆEò : ¨ÉiÉnùÉ®ú xÉÉånùhÉÒ +ÊvÉEòÉ­ªÉÉSÉÒ ºÉ½þÒ ¨ÉiÉnùÉ®ú xÉÉånùhÉÒ +ÊvÉEòÉ­ªÉÉSÉÒ ¨ÉÉä½þ®ú

PÉäiɱÉ䱪ÉÉ ÊxÉhÉǪÉÉSÉÒ ºÉÚSÉxÉÉ (¨ÉiÉnùÉ®ú ºÉÆPÉÉSªÉÉ ¨ÉiÉnùÉ®ú xÉÉånùhÉÒ +ÊvÉEòÉ­ªÉÉxÉä ¦É®úÉ´Éä +ÉÊhÉ +VÉÇnùÉ®úÉxÉä Ênù±É䱪ÉÉ {ÉkªÉÉ´É®ú +VÉÇnùÉ®úÉºÉ ]õ{ÉɱÉÉxÉä {ÉÉ`ö´ÉÉ´Éä.)
¸ÉÒ./¸ÉÒ¨ÉiÉÒ/EÖò¨ÉÉ®úÒ .......................................................................... ªÉÉÆSÉÉ xɨÉÖxÉÉ 8+ ¨ÉvÉÒ±É +VÉÇþ ½äþ {ÉjÉ {ÉÉ`öÊ´ÉiÉÉxÉÉ
¨ÉiÉnùÉ®ú xÉÉånùhÉÒ
+VÉÇnùÉ®úÉSÉÉ ºÉ´ÉǺÉÉvÉÉ®úhÉ ÊxÉ´ÉɺÉÉSÉÉ ºÉvªÉÉSÉÉ {ÉkÉÉ PÉ®ú Gò¨ÉÉÆEò +ÊvÉEòÉ­ªÉÉxÉä
ÊSÉEò]õ´ÉɴɪÉÉSÉÉ
®úºiÉÉ/IÉäjÉ/´ÉºÉÊiɺlÉÉxÉ ]õ{ÉÉ±É ¨ÉÖpùÉÆEò
¶É½þ®ú/MÉÉ´É
b÷ÉEò EòɪÉÉÇ±ÉªÉ Ê{ÉxÉ EòÉäb÷
ÊVɱ½þÉ ®úÉVªÉ/Eåòpù¶ÉÉʺÉiÉ |Énäù¶É
(+) +VÉÇ º´ÉÒEòÉ®úhªÉÉiÉ +ɱÉÉ +ɽäþ +ÉÊhÉ ¸ÉÒ./¸ÉÒ¨ÉiÉÒ/EÖò¨ÉÉ®úÒ .................................................. ªÉÉÆSÉä xÉÉ´É ........................................
Ê´ÉvÉÉxɺɦÉÉ ¨ÉiÉnùÉ®úºÉÆPÉÉSªÉÉ ¦ÉÉMÉ Gò¨ÉÉÆEò ...................... ¨ÉvÉÚxÉ ´ÉMɳýhªÉÉiÉ +ɱÉä +ºÉÚxÉ ¦ÉÉMÉ Gò¨ÉÉÆEò .................... SªÉÉ +xÉÖGò¨ÉÉÆEò ............
´É®ú xÉÉånùÊ´ÉhªÉÉiÉ +ɱÉä +ɽäþ.
(¤É) ...................................................................................... ªÉÉ EòÉ®úhÉɺiÉ´É +VÉÇ xÉÉEòÉ®úhªÉÉiÉ +ɱÉÉ +ɽäþ.
ÊnùxÉÉÆEò : ¨ÉiÉnùÉ®ú xÉÉånùhÉÒ +ÊvÉEòÉ®úÒ
{ÉkÉÉ ...............................................

+VÉÉÇSÉÒ {ÉÉäSÉ {ÉÉ´ÉiÉÒ

{ÉÉäSÉ {ÉÉ´ÉiÉÒ Gò¨ÉÉÆEò ............................... ÊnùxÉÉÆEò ...............................
¸ÉÒ./¸ÉÒ¨ÉiÉÒ/EÖò¨ÉÉ®úÒ ..................................................................................... ªÉÉÆSÉÉ xɨÉÖxÉÉ 8+ ¨ÉvÉÒ±É +VÉÇ |ÉÉ{iÉ ZÉɱÉÉ +ɽäþ.
(+VÉÇnùÉ®úɱÉÉ iªÉÉSªÉÉ +VÉÉÇSÉÒ ºÉt:κlÉiÉÒ ªÉÉ {ÉÉäSÉ {ÉÉ´ÉiÉÒ Gò¨ÉÉÆEòÉSªÉÉ ºÉÆnù¦ÉÉÇxÉä iÉ{ÉɺÉiÉÉ ªÉä<DZÉ).

¨ÉiÉnùÉ®ú xÉÉånùhÉÒ +ÊvÉEòÉ®úÒ/ºÉ½þɪÉEò ¨ÉiÉnùÉ®ú xÉÉånùhÉÒ +ÊvÉEòÉ®úÒ/¨ÉiÉùnùÉxÉ Eåòpù ºiÉ®úÒªÉ +ÊvÉEòÉ®úÒ ªÉÉÆSÉä xÉÉ´É/ºÉ½þÒ
 4

Details of action taken

(To be filled by Electoral Registration Officer of the constituency)

The application of Shri / Smt. / Kumari ....................................................................... for transposition of entry relating to
himself/herself/Shri/Smt./ Kum. .................................................... in the electoral roll in Form 8A has been accepted/

rejected. Detailed reasons for acceptance or rejection [under or in pursuance of rule 26(4)] are given below :

Place :

Date : Signature of ERO Seal of the ERO

Intimation of decision taken (to be filled by Electoral Registration Officer of the constituency and to be posted to the
applicant on the address as given by the applicant)

The application in Form 8A of Shri / Shrimati / Kumari ............................................................................... Postage Stamp

to be affixed by
the Electoral
Current address where applicant is ordinarily residence House No.
Registration
Authority at the
Street / Area / Locality time of dispatch

Town/ Village

Post Office Pin Code

District State / UT

Has been (a) accepted and the name of Shri / Shrimati / Kumari ........................................................... has been deleted from
Part No. ................................ and registered at S. No. ................................................ in Part No. ..................................... of
AC No. ..........................................................................
(b) rejected for the reason ...........................................................................................................................................................................

Electoral Registration Officer

Date : ..........................................
Address ....................................................

Acknowledgement/Receipt

Acknowledgement Number ............................... Date : ....................................

Received the Application in form 8A of Shri/Smt./Ms. ..................................................................................................................................

(Applicant can refer the Acknowledgement No. to check the status of application).

Name/Signature of ERO/AERO/BLO
 5

xɨÉÖxÉÉ 8+ ±ÉÉ VÉÉäb÷ɴɪÉÉSÉä

+VÉÇ xɨÉÖxÉÉ 8+ SÉÉ +VÉÇ ¦É®úhªÉÉʴɹɪÉÒ ¨ÉÉMÉÇnù¶ÉÇEò ºÉÚÚSÉxÉÉ

xɨÉÖxÉÉ-8+ EòºÉÉ ¦É®úÉ´ÉÉ.

1. ºÉƤÉÆÊvÉiÉ xÉÉånùÒSªÉÉ ºlÉÉxÉÉSÉÒ +nù±ÉɤÉnù±É VªÉÉ ¨ÉiÉnùÉ®úºÉÆPÉÉiÉ Eò®úhÉä +ɴɶªÉEò +ɽäþ iªÉÉ ¨ÉiÉnùÉ®úºÉÆPÉÉSªÉÉ ¨ÉiÉnùÉ®ú xÉÉånùhÉÒ +ÊvÉEòÉ­ªÉɱÉÉ
=qäù¶ÉÚxÉ +VÉÇ Eò®úÉ´ÉÉ. Ê®úEòɨªÉÉ VÉÉMÉäiÉ ¨ÉiÉnùÉ®úºÉÆPÉÉSÉä xÉÉ´É xɨÉÚnù Eò®úÉ´Éä.
2. +VÉÉÇSªÉÉ ¤ÉÉ¤É (+) ´É (¤É) ¨ÉvªÉää, +VÉÇnùÉ®úÉxÉä, ¨ÉiÉnùÉ®ú ªÉÉnùÒiÉ VɺÉä nù¶ÉÇʴɱÉä +ɽäþ iªÉÉ|ɨÉÉhÉä iªÉÉSÉä xÉÉ´É Ê±É½þÉ´Éä. ¨ÉiÉnùÉ®ú ªÉÉnùÒiÉ +VÉÇnùÉ®úÉSªÉÉ
xÉÉ´ÉÉSÉÒ +ÉtÉIÉ®äú ¨ÉÖÊpùiÉ Eäò±Éä±ÉÒ +ºÉ±ªÉɺÉ, iÉÒ ºÉÆIÉä{ÉÉi¨ÉEò º´É°ü{ÉÉiÉ +ºÉ±ªÉÉºÉ ´É iªÉɱÉÉ iªÉÉSÉä xÉÉ´É Ê´ÉºiÉÉÊ®úiÉ º´É°ü{ÉÉiÉ ¨ÉÖÊpùiÉ
Eò®úÉ´Éä +¶ÉÒ iªÉÉSÉÒ <SUôÉ +ºÉä±É iÉ®ú, iªÉɱÉÉ iªÉÉSÉä ºÉÆ{ÉÚhÉÇ xÉÉ´É Ê´ÉºiÉÉÊ®úiÉ º´É°ü{ÉÉiÉ Ê±ÉʽþiÉÉ ªÉä<±Ç É. {Éʽþ±ªÉÉ SÉÉèEò]õÒiÉ +Éb÷xÉÉ´ÉÉ´ªÉÊiÉÊ®úCiÉ
ºÉÆ{ÉÚhÉÇ xÉÉ´É Ê±É½þÉ´Éä +ÉÊhÉ nÖùºÉ­ªÉÉ SÉÉèEò]õÒiÉ +Éb÷xÉÉ´É Ê±É½þÉ´Éä. +VÉÇnùÉ®úÉºÉ +Éb÷xÉÉ´É xɺÉä±É iÉ®ú, Eäò´É³ý Ênù±Éä±Éä xÉÉ´É Ê±É½þÉ´Éä. ¨ÉiÉnùÉ®úÉSªÉÉ
xÉÉ´ÉÉSÉÉ +lÉ´ÉÉ +Éb÷xÉÉ´ÉÉSÉÉ ¦ÉÉMÉ ¨½þhÉÚxÉ VÉÉiÉÒSÉä xÉÉ´É ´ÉÉ{É®ú±Éä VÉÉiÉ +ºÉ±ªÉÉºÉ iÉä ´ÉMɳýiÉÉ, VÉÉiÉ xɨÉÚnù Eò°ü xɪÉä. ¸ÉÒ., ¸ÉÒ¨ÉiÉÒ, EÖò¨ÉÉ®úÒ,
JÉÉxÉ, ¤ÉäMɨÉ, {ÉÆb÷ÒiÉ, <iªÉÉnùÒºÉÉ®úJÉÒ ºÉx¨ÉÉxÉnù¶ÉÇEò +ʦÉvÉÉxÉä xɨÉÚnù Eò°ü xɪÉä.
3. ¤ÉÉ¤É (Eò) ´É (b÷) : VªÉÉ ¨ÉiÉnùÉ®ú ªÉÉnùÒ¨ÉvªÉä ªÉÉ{ÉÚ´ÉÔSÉ xÉÉ´É xÉÉånù±Éä±Éä +ºÉä±É iªÉÉ ¨ÉiÉnùÉ®ú ªÉÉnùÒSªÉÉ ¦ÉÉMÉÉSÉä xÉÉ´É ´É +xÉÖGò¨ÉÉÆEò +ÉÊhÉ
¨ÉiÉnùÉ®ú UôɪÉÉÊSÉjÉ +Éä³ýJÉ{ÉjÉ Gò¨ÉÉÆEò (¨ÉiÉnùÉ®ú ªÉÉnùÒiÉ ¨ÉÖÊpùiÉ Eäò±ªÉÉ|ɨÉÉhÉä) {ÉÚhÉÇ{ÉhÉä ʱɽþÉ´ÉÉ.
4. +VÉÉÇSªÉÉ ¤ÉÉ¤É (MÉ) ¨ÉvªÉä, VªÉÉ Ê`öEòÉhÉÒ, ¨ÉiÉnùÉ®ú ºÉÆPÉÉiÉÒ±É +VÉÇnùÉ®úÉSªÉÉ/ºÉƤÉÆÊvÉiÉ ´ªÉCiÉÒSªÉÉ ºÉ´ÉǺÉÉvÉÉ®úhÉ ÊxÉ´ÉɺɺlÉÉxÉ ¤Énù±É±Éä±Éä +ɽäþ
ËEò´ÉÉ xÉ´ÉÒxÉ Ê`öEòÉhÉÉSÉÉ ºÉÆ{ÉÚhÉÇ {ÉkÉÉ EÞò{ɪÉÉ xɨÉÚnù Eò®úÉ´ÉÉ. EÞò{ɪÉÉ +{ÉÚhÉÇ {ÉkÉÉ Ê±É½Úþ xɪÉä EòÉ®úhÉ iɺÉä Eäò±ªÉÉºÉ VªÉÉ Ê`öEòÉhÉÒ xÉÉånù ¤Énù±É
Eò®úhªÉÉSÉÒ +ɴɶªÉEòiÉÉ +ɽäþ iªÉÉ ¨ÉiÉnùÉ®ú ªÉÉnùÒiÉÒ±É ºÉƤÉÆÊvÉiÉ ¦ÉÉMÉÉºÉ {ÉkÉÉ VÉÉäb÷hÉä ¶ÉCªÉ ½þÉähÉÉ®ú xÉɽþÒ.
5. ºÉÚSÉxÉäSªÉÉ ¦ÉÉMÉÉiÉnäùJÉÒ±É ºÉÆ{ÉÚhÉÇ xÉÉ´É ´É {ÉkÉÉ Ê±É½þÉ´ÉÉ. +VÉÇnùÉ®úÉxÉä, iªÉÉSÉÉ §É¨ÉhÉv´ÉxÉÒ Gò¨ÉÉÆEò ´É <Ç-¨Éä±É +ɪÉb÷Ò tÉ´ÉÉ. iÉÉä näùhÉä ´ÉèEòα{ÉEò
+ºÉä±É, VÉ®ú iÉÉä näùhªÉÉiÉ +ɱªÉÉºÉ ¨ÉiÉnùÉ®ú xÉÉånùhÉÒ +ÊvÉEòÉ®úÒ +ɴɶªÉEò +ºÉ±ªÉÉºÉ +VÉÇnùÉ®úɶÉÒ {ÉÖføÒ±É ºÉÆ{ÉEÇò ºÉÉvÉhªÉɺÉÉ`öÒ iªÉÉSÉÉ ´ÉÉ{É®ú
Eò°ü ¶ÉEäò±É.
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+VÉÇnùÉ®úÉºÉ xÉ´ÉÒxÉ {ÉkÉÉ +ºÉ±Éä±Éä ¨ÉiÉnùÉ®ú UôɪÉÉÊSÉjÉ +Éä³ýJÉ{ÉjÉ ¤Énù±ÉÚxÉ ½þ´Éä +ºÉ±ªÉɺÉ, iªÉÉxÉä xɨÉÖxÉÉ 8+ SªÉÉ +ÉvÉÉ®äú xÉ´ÉÒxÉ Ê`öEòÉhÉSÉÒ
xÉÉ´Éä xÉÉånùhÉÒ Eäò±ªÉÉxÉÆiÉ®ú, ¨ÉiÉnùÉ®ú UôɪÉÉÊSÉjÉ +Éä³ýJÉ{ÉjÉ ¤Énù±ÉÚxÉ näùhªÉɺÉÉ`öÒSÉÒ +ɴɶªÉEò ¡òÒ +ÉÊhÉ VÉÖxÉä ¨ÉiÉnùÉ®ú UôɪÉÉÊSÉjÉ +Éä³ýJÉ{ÉjÉ
ªÉÉƺɽþ xɨÉÖxÉÉ ¨ÉiÉnùÉ®ú UôɪÉÉÊSÉjÉ +Éä³ýJÉ{ÉjÉ-001 (VÉÉäb÷{ÉjÉ BEò ¨ÉvÉÒ±É xɨÉÖxªÉÉxÉÖºÉÉ®ú) +VÉÇ Eò®úÉ´ÉÉ.
 6

To be appended to Form-8A

GUIDELINES FOR FILLING UP THE APPLICATION

FORM-8A
How to Fill the Form-8A

1. The application should be addressed to the Electoral Registration Officer of the

constituency in which transpositions of the relevant entry is required. The name of the
constituency should be mentioned in the blank space.
2. In Item (a) and (b) of the Application, the applicant should write his name, as existing in
the electoral roll. In case the initials to applicant’s name printed in the electoral roll are
in abbreviated form and he wants them to be printed in expanded form he can write his
full name in expanded form. The full name except the surname should be written in the
first box and surname should be written in the second box. In case the applicant does not
have a surname, the given name only should be written. Caste should not be mentioned
except where the caste name is used as part of the elector’s name or a surname.
Honorific appellations like Shri, Smt., Kumari, Khan, Begum, Pandit etc. should not
be mentioned.
3. Item (c) and (d) : Fill the name Part No. and Serial No. of the electoral roll where already
registered and Electors Photo Identity Card No. (EPIC) in full. (as printed in the
electoral roll).
4. In item (g) of the Application please mention the complete address of the new place where
the Applicant/person concerned has shifted place of ordinary residence within the
constitutency. Please do not write incomplete address as in that case it may not be
possible to link the address to the relevant part of electoral roll where the entry is
required to be transposed.

5. Full name and address may also be given on the intimation portions. The Applicant may
give his mobile number and E-mail I.D. in the Form, which is optional, as the same, if
given, may be used by the Electoral Registration Officer for further communication with
the applicant whenever required.
Replacement EPIC
If the Applicant wants replacement EPIC with new address, he should apply for the same
in Form EPIC-001 (as per the Format as Annexure I), with requisite fee for replacement
EPIC, and old EPC, after enrolment at the new place on the basis of Form 8A.
 7

ANNEXURE I (For Form 8A)

Election Commission of India

FORM ID
(ANNEXURE-I)
Application for Issue of Replacement Elector’s Photo Identity Card (EPIC)) ECI-EPIC-001
A State/UT :
s
AC (No. & Name) :
District ;
B Elector’s Particulars (To be filled by Elector)
To, Sir/Madam,
The Electoral Registration Officer, I request that a Duplicate Elctoral Photo Identity Card be issued to me as my original card is lost/
....................................... Assembly/ destroyed/mutilated due to corrections in my eletor’s detail or due to change of address. I want to get
a fresh card with my new address. I am returning my EPIC to you along with fee for issue of duplicate
Parliamentrys Constituency EPIC. My name is included in the electoral roll for the above constituency. Particulars in support of
my claim for issue of duplicate EPIC are given below:
1. Name of Elector : 2. EPIC No. of
Original card (If known) :

3. Father’s / Mother’s 4. Sex (M/F) : 5. Date of Birth (DOB) if not

Husband’s Name : Known then Age in Year) as
on 1st Jan. 20___ .........

6. Address
(i) House / Door number :

(ii) Street / Mohalla / Road / Gali :

(iii) Area / Locality :

(iv) Town / Village : (v) PIN CODE

(vi) Police Station : (vii) District :

(viii) Reasons for applying

for a Duplicate card

1. I will collect EPIC from VRC/CSC

2. I wish to receive my EPIC by Post (self addressed and stamped envelope enclosed)
3. I will collect EPIC from BLO

( )
Signature of the applicant

(ix) Tick ( ) the appropriate box :

I hereby return my mutilated / old card Date :
I undertake to return my earlier card issued to me if the same Place :
recovered at a later date.

For official use

Authentication for issue of EPIC (To be filled by ERO’s Representative)

Part Serial No. of ID number of Designated Photography # Token No. or

No. : Elector in part : location (DPL) or Common Service Centers Reciept No.
(CSE), :

Register No. Serial No. in Register

verified by :
Date :—/—/20— Signature

D Acknowledgement of R-EPIC by the Elector

Received Duplicate EPIC on (date) : Elector’s Signature

or Thumb Impression

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