10/22/2016

FORM18
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FORM18(GRADUATES)
Claimforinclusionofnameintheelectoralrollfora
Graduates'Constituency

ApplicationID:

To,TheElectoralRegistrationOfficer
*GraduatesConstituency:

Select

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Upload
*District:

Sir,Irequestthatmynamebeincludedintheelectoralrollforthe
aboveGraduatesConstituency.Particularsinsupportofmyclaimfor
inclusionintheelectoralrollaregivenbelow:

1.Applicant'sDetails:
*Name:

Surname(ifany):

*
:

:

*EducationalQualification:

Occupation:

Dateofbirth:

Day:

Month:

Year:

Age:

Select

Gender:

*RelationName:

RelationSurname(ifany):

:

:

Relation
Type:

Select

HouseAddress(Placeofordinaryresidence):
*Town/
Village:

*House/Doornumber:

*Tehsil/
Taluka/
Mandal/
Thana:

Select

*Street/Area/Locality
/Mohalla/Road:

*Town/Village:

*PostOffice:

*PinCode:

DetailsofAC&EPIC,Iftheapplicant'snameisincluded:
District:

PleaseSelect

EPICNo(IDCARD
NO):

AcNo&Name:

Polling
Station:

Sl.NoinPS:

2.Iamagraduateofthe

degree/diplomaexaminationintheyear

universityhavingpassedthe

(dd/mm/yyyy)

OR
Iaminpossessionofadiploma/cerificatein

whichisaqualificationequivalenttothatofagratuateofa

univeristyinindiahavingpassedexaminationforthediploma/certificateintheyear

(dd/mm/yyyy)

3.Insupportofmyclaimasbeingagraduate/inpossessionoftheabovediploma/certificate,Isubmitherewithabovediploma/certificate
Graduation

Diploma

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4.MynamehasnotbeenincludedintheelectoralrollforthisoranyotherGraduatesconstituency
Or
MynamehasbeenincludedintheelectoralrollforConstituency

House
No:

Select

andDistrict

underthegivenaddressbelowandIrequestthatittobedeletedfromthatroll.
Street/Mohalla:

Town/Village:

MobileNo:

EmailID:

IdeclarethatIamcitizenofIndiaandthatalltheparticularsgivenabovearetruetothebestofmyknowledge.

Translate

http://ceoaperms.ap.gov.in/mlc_ereg_ap/ero/form18.aspx

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