PAKISTAN TEHREEK-E-INSAF

LOCAL GOVERNMENT ELECTION 2015

ISALAMABAD

APPLICATION FORM

Photo
White Backgound

Application No._______________
Bank Receipt No.______________
1.

Application For: _________________________________________________________________________

2.

Union Council: _________________________________

4.

Applicant Name:_________________________________________________________________________

5.

Father/ Husband Name:__________________________

7.

Date Of Birth:_________________

10.

Highest Qualification:___________________

11.

Occupation:______________________

12.

NTN No: ______________________________

13.

Tax Payer:

14.

Affiliation with PTI Since:_______________________

15.

Designation:_______________(If Any)

16.

Vote No: ______________________________

17.

Block Code:______________________

18.

Conviction / Cases: __________________________________________________________( If Any Attach Details )

19.

Present Address :____________________________________________________________Since:_______

20.

Previous Affiliation With Any Political Party If Yes Please Mention With Designation

8.

3.
6.

UC No:___________________________
CNIC No:_________________________

Gender:___________

9. Religion:___________
Yes /

No (If Yes Attach Last Year Tax Return)

______________________________________________________________________________________
21.

Additional Info If Any / Political Contribution:

______________________________________________________________________________________

22.

Contact Details:
Cell:______________________ Landline:___________________

Email:__________________________

Declaration
I Mr. /Mrs. / Miss :_____________________________S/O. D/O. W/O:___________________________, Solemnly
pledge that I am not defaulter of any financial institution. I will remain faithful to the party and will abide by all
the rules, regulations and discipline. I will accept the decision of parliamentary board if the ticket is not being
awarded to me and shall continue supporting the party ticket holders.
Statement above is true to my best knowlaged and I am responsible for it.
Signature: ________________________

Dated:___________________________

Proposer No.1

Proposer No.2 :

Name: ___________________________

Name: __________________________

Signature:________________________

Signature:________________________

CNIC:____________________________

CNIC:____________________________

PAKISTAN TEHREEK-E-INSAF
LOCAL GOVERNMENT ELECTION 2015
ISALAMABAD

APPLICATION FORM

Attachments:
1. Photographs (2).
2. CNIC Copies . (Applicant And Proposers)
3. Voter Certificate From ECP.
4. Bank Draft/Pay Order In Favor Of Pakistan Tehreek-E-Insaf (Non Refundable)
Rs.10,000 For Chairman & V-Chairman
Rs.5000 For All Other Positions
6. All other supporting documents