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Handbook for Electoral Registration Officers - Election Commission ...

Handbook for Electoral Registration Officers - Election Commission ...

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ANNEXURE 6.3CHAPTER VI, PARA 22FORMAT FOR ISSUING CERTIFIED COPY OF EXTRACT FROMELECTORAL ROLL(without 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)Sl.No.HouseNo.Name of ElectorRelationshipName of relation Sex Age EPIC No.(ifissued)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 <strong>for</strong>ce on the date of issue of thiscertificate.Place:Date:(Signature and seal of competent authority)206

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