FORM 8 ECI-EPIC-001A

ELECTION COMMISSION OF INDIA

Form for submission of photograph (optional) alongwith Form 6 / 8 / 8A
NAME OF STATE / UNION TERRITORY : NO. & NAME OF THE CONSTITUENCY : DETAILS OF APPLICANT AS GIVEN IN FORM 6 / 8 / 8A 1. NAME OF APPLICANT :
2. FATHER/MOTHER/HUSBANDS NAME : 3. PARTICULARS OF PLACE OF ORDINARY RESIDENCE (FULL ADDRESS) :

Paste recent passport size photograph (3.5 cm. X 3.5 cm.)

(DO NOT SIGN (ON THIS PHOTO)

House/ Door number: Street/ Area/Locality/ Mohalla/Road : Town/ Village : Post Office: Tehsil/ Taluka/Mandal/ Thana: District: Pin Code: : : : : : :

I am submitting two copies of my recent passport size photograph. One pasted on right side top corner of Form 6 / Form 8 / Form 8A with my signature/T.I affixed across the photograph . The other photograph has been pasted on this application for the purpose of preparation of Elector Photo Identity Card (EPIC). I am aware that no EPIC will be issued using this photograph if my claim for inclusion in the electoral roll in Form 6 or for transposition of entry in Form 8A is not accepted and the photographs will not be returned to me.
OR

This photograph may be used to replace wrong photograph appearing in the photo electoral roll against my name as per application for correction made in Form 8. Place : Date : Signature/T.I. of applicant. :

Note : Please enclose photocopy of some document like Passport, Driving Licence, Arms Licence etc. showing your photograph and same address as in the application, if available. Show original for verification at the time of submission of the application and also at the time of field verification or hearing, if required. .
(for official use only) CERTIFIED that I,______________________, s/o___________________________, ________________________ (designation of verifying/attesting officer) have verified the authenticity of the applicants photograph with original passport/driving licence/arms licence/others (specify name of document and get one photocopy if not already attached) or on the basis of the statement of Shri/Smt.___________________(name of the person) supporting the authenticity of the photograph, whose name is included in the electoral roll.

Signature of official