Handbook for Electoral Registration Officers - Election Commission ...

ANNEXURE 6.2CHAPTER VI, PARA 22FORMAT FOR ISSUING CERTIFIED COPY OF EXTRACT FROMELECTORAL ROLL(with photograph)(Letter head of the authority issuing the extract)Dy. No. of the Application Date of issue :( as entered in the register onreceipt of each application)EXTRACT FROM ELECTORAL ROLL OF(Assembly/Parliamentary Constituency)in the State/UT ofPART NO.Section No.(here print the complete detail of the Section including PIN code)1EPIC No.Elector’s Name :Father’s Name :House No. :P h o t oAge : Sex :Certified to be true extract from the electoral roll of the above-mentioned constituency,revised w.r.t. 01.01. 20__ as the qualifying date and as in force on the date of issue of thiscertificate.Place:Date:(Signature and seal of competent authority)205