2
बहार गजट (असाधारण), 13 अूील 2011
8 vizhy 2011
fuokZpd jftLVªhdj.k fu;e] 1960 ds fu;e 8, ds vUrxZr vf/klwpuk
fuokZpd jftLVªhdj.k fu;e] 1960 ds fu;e 8, ds vUrxZr vf/klwpuk
fuokZpd jftLVªhdj.k fu;e] 1960 ds fu;e 8, ds vUrxZr vf/klwpuk
fuokZpd jftLVªhdj.k fu;e] 1960 ds fu;e 8, ds vUrxZr vf/klwpuk
la0&ch1&3&39@2011&20—yksd izfrfuf/kRo vf/kfu;e] 1950 dh /kkjk&20d] ftls yksd izfrfuf/kRo ¼la’kks/ku½
vf/kfu;e] 2010 }kjk varfoZ”V fd;k x;k gS vkSj tks fnukad 10 Qjojh] 2011 ls izHkkoh gks pqdk gS] esa fufgr izko/kkuksa ds vuqlkj
izR;sd izoklh fuokZpd vFkkZr~ Hkkjrh; ukxfjd tks fu;kstu] f’k{kk ;k vU; fdlh dkj.k ls Hkkjr esa vius lkekU; fuokl ds LFkku
ls vuqifLFkr jg jgk gS vkSj fdlh vU; ns’k dh ukxfjdrk izkIr ugha dh gS] vkSj ftldk uke ernkrk lwph esa lfEefyr ugha gS]
og ml fo/kku&lHkk fuokZpu {ks= dh fuokZpd lwph esa uke fucaf/kr djkus gsrq vf/kd`r gS] tks mlds ikliksVZ esa izfof”V ds vuqlkj
Hkkjr esa mldk fuokl LFkku gSA
izR;sd izoklh fuokZpd ftldk Hkkjr esa fuokl LFkku fuokZpd jftLVªhdj.k fu;e] 1960 ds fu;e 8d ds vuqlkj fcgkj
jkT; esa vofLFkr gS] ,oa ftlus 01 tuojh] 2011 dks 18 o”kZ dh vk;q iw.kZ dj yh gS vkSj tks viuk uke fuokZpd lwph esa fucaf/kr
djkus dk bPNqd gS] ls ,rn~ }kjk iz:i&6d esa ml fuokZpu {ks= dh fuokZpd lwph esa fuca/ku gsrq vkosnu vkefU=r fd;k tkrk gS]
ftlesa ikliksVZ dh izfof”V ds vuqlkj mldk fuokl LFkku vofLFkr gSA vkosndksa ds fy;s fn’kkfunsZ’kksa lfgr iz:i&6d uhps fn;k
tk jgk gSA iz:i&6d esa nkok laca/kh vkosnu Lo;a mifLFkr gksdj lacaf/kr fo/kku lHkk fuokZpu {ks= ds jftLVªhdj.k inkf/kdkjh dks
lefiZr fd;k tk ldrk gS vFkok ml jftLVªhdj.k inkf/kdkjh dks iz:i&6d rFkk fn’kkfunsZ’kksa esa mfYyf[kr vfHkys[kksa ds lkFk
Mkd }kjk Hkstk tk ldrk gSA tc nkok ls lacaf/kr vkosnu Mkd }kjk Hkst tk;s rc mlds lkFk ikliksVZ ds laxr i`”Bksa dh lE;d
:i ls Lor% vuqizekf.kr Nk;kizfr;ka layXu gksuh pkfg;sA
fcgkj jkT; ds 243 fo/kku&lHkk fuokZpu {ks=ksa esa ls izR;sd ds jftLVªhdj.k inkf/kdkjh dk irk eq[; fuokZpu
inkf/kdkjh] fcgkj ds osclkbZV http://ceobihar.nic.in ij ns[kk tk ldrk gSA
fcgkj&jkT;iky ds vkns’k ls]
lq/khj dqekj jkds’k]
eq[; fuokZpu inkf/kdkjhA
3
बहार गजट (असाधारण), 13 अूील 2011
^^iz:i 6d**
¼fu;e 8[k ns[ksa½
fdlh izoklh fuokZpd }kjk fuokZpd ukekoyh esa uke lfEefyr fd, tkus ds fy, vkosnu
lsok esa]
fuokZpd jftLVªhdj.k vkfQlj]
-------------------------------------------------------------------------------lHkk@lalnh; fuokZpu&{ks=
-------------------------------------------------------------------------------ftyk
-------------------------------------------------------------------------------Hkkjr dk jkT;
egksn;]
eSa izkFkZuk djrk gwa fd mDr fuokZpu&{ks= ds fy,] ftlesa uhps en 1¼t½ esa izLrqr fof’kf”V;ksa ds vuqlkj esjk fuokl
LFkku vofLFkr gS] fuokZpd ukekoyh esa esjk uke lfEefyr dj fy;k tk,A
Hkkx & d
fuokZpd ukekoyh esa lfEefyr fd, tkus ds fy, esjs nkos ds leFkZu esa fof’kf”V;ka uhps nh xbZ gSa %
¼d½ uke -----------------------------------------------------------------------
¼[k½ e/; uke -------------------------------------------------------------
¼x½ mi&uke----------------------------------------------------------------
¼?k½ tUe dh rkjh[k ---------------------fnu----------------------ekl----------------------------------o”kZ
¼M+½ fyax ¼iq:”k@L=h½
¼p½ tUe dk LFkku &
¼i½ xzke@uxj---------------------------------------------------------
¼ii½ ftyk -----------------------------------------------------------------
¼iii½ jkT; ------------------------------------------------------------------
¼N½ firk@ekrk@ifr dk C;kSjk
¼i½ uke----------------------------------------------------------------------------
¼ii½ e/; uke -----------------------------------------------------------------
¼iii½ miuke ---------------------------------------------------------------------
¼t½ Hkkjr esa ekewyh rkSj ij fuokl dk LFkku ¼ikliksVZ esa fn, x, vuqlkj iwjk irk½
¼i½ edku@x`g la------------------------------------------------------------------------------------------------------------------------------------------------------------------
¼ii½ xyh@{ks=@ifj{ks=@eksgYyk@lM+d ---------------------------------------------------------------------------------------------------------------------
¼iii½ uxj@xzke -----------------------------------------------------------------------------------------------------------------------------------------------------------------------
¼iv½ Mkd?kj ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
¼v½ fiu dksM --------------------------------------------------------------------------------------------------------------------------------------------------------------------------
¼vi½ rglhy@rkyqd@eaMy@Fkkuk ---------------------------------------------------------------------------------------------------------------------------------
¼vii½ ftyk ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
¼>½ ikliksVZ dk C;kSjk &
¼i½ ikliksVZ la[;k ----------------------------------------------------------------------------------------------------------------------------------------------------------------
¼ii½ orZeku Hkkjrh; ikliksVZ ds tkjh gksus dk LFkku -------------------------------------------------------------------------------------------------
¼iii½ orZeku Hkkjrh; ikliksVZ ds tkjh gksus dh rkjh[k ----------------------------------------------------------------------------------------------
¼iv½ orZeku Hkkjrh; ikliksVZ ds volku dh rkjh[k --------------------------------------------------------------------------------------------------
{ mij en ¼d½ ls ¼>½ esa of.kZr fof’kf”V;ksa dks varfoZ”V djus okys ikliksVZ ds lqlaxr i`”Bksa dh & ;fn Mkd
}kjk Hkstk tkrk gS rks lE;d :i ls Lor% vuqizekf.kr izfr;ksa dks vkSj ;fn O;fDrxr :i ls jftLVªhdj.k vkfQlj ds
le{k izLrqr fd;k tkrk gS rks izfr;ksa ds lkFk ewy ikliksVZ ds lkFk layXu djsaA}
¼¥½ orZeku fuokl ds ns’k ds ohtk dk C;kSjk &
bl [kkus ds Hkhrj iw.kZ eq[k dks
nf’kZr djus okyk ¼3-5 ls-eh-½ dk
gky gh esa [khapk x;k ikliksVZ
vkdkj dk QksVks fpidkus ds fy,
LFkku
4
बहार गजट (असाधारण), 13 अूील 2011
¼i½ ohtk la[;k ---------------------------------------------------------------------------------------------------------------------------------------------------------------------
¼ii½ ohtk dk izdkj ¼,dy izos’k@cgqfo/k izos’k@i;ZVd@dk;Z ohtk vkfn½ ----------------------------------------------------
¼iii½ ohtk ds tkjh gksus dh rkjh[k -----------------------------------------------------------------------------------------------------------------------------------
¼iv½ ohtk ds tkjh gksus dk LFkku -------------------------------------------------------------------------------------------------------------------------------------
¼v½ ohtk ds volku dh rkjh[k ---------------------------------------------------------------------------------------------------------------------------------------
¼vi½ tkjhdrkZ izkf/kdkjh dk uke -------------------------------------------------------------------------------------------------------------------------------------
{ mij mfYyf[kr orZeku fof/kekU; ohtk i`”Bkadu dks varfoZ”V djus okys ikliksVZ ds lqlaxr i`”Bksa dh &
;fn Mkd }kjk Hkstk tkrk gS rks lE;d :i ls Lor% vuqizekf.kr izfr;ksa dks vkSj ;fn O;fDrxr :i ls jftLVªhdj.k
vkfQlj ds le{k izLrqr fd;k tkrk gS rks izfr;ksa ds lkFk ewy ikliksVZ ds lkFk layXu djsaA}
2- Hkkjr esa ekewyh rkSj ls fuokl ds LFkku ls vuqifLFkfr dk o.kZu -------------------------------------------------
¼d½ Hkkjr esa ekewyh rkSj ij fuokl ds LFkku ls vuqifLFkr gksus dk dkj.k &
¼i½ fu;kstu@¼ii½ f’k{kk@ ¼iii½ vU; ¼fooj.k nsa½
-------------------------------------------------------------------------------------------------------------------------------------------------------------
¼[k½ og rkjh[k ftlls Hkkjr esa ekewyh rkSj ij fuokl ls vuqifLFkr jgk gSA
------------------------------------------------------------------------------------------ ¼fnu@ekl@o”kZ½
3- Hkkjr ls ckgj ds ns’k dk iw.kZ vkoklh; irk] tgka og orZeku esa fuokl dj jgk gS -----------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------A
4- Hkkjr ls ckgj ds ns’k dk iw.kZ ‘kkldh; irk tgka og orZeku esa fuokl dj jgk gS ¼fu;kstu ;k ‘kS{kf.kd laLFkk] tgka
og v/;;u dj jgk gS] ds LFkku dk irk½ --------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------------------------------------------A
5- ?kks”k.kk & eSa ?kks”k.kk djrk gwa fd esjs loksZÙke Kku vkSj fo’okl ds vuqlkj &
¼d½ bl vkosnu esa nh xbZ laiw.kZ tkudkjh lR; gSA
¼[k½ eSa tUe ls@vf/kokl ls@ns’kh;dj.k }kjk Hkkjr dk ukxfjd gwaA
¼x½ eSaus fdlh vU; ns’k dh ukxfjdrk vftZr ugha dh gSA
¼?k½ fdUrq Åij 2¼d½ esa fn, x, dkj.k ls Hkkjr esa esjs ekewyh fuokl ds LFkku ls vuqifLFkr gksus ds dkj.k]
eSa esjs Hkkjrh; ikliksVZ esa fn, x, irs ij ekewyh rkSj ij fuoklh jgwaxk] ftls Åij 1¼t½ esa mn~/k`r
fd;k x;k gSA
¼M+½ eSa esjs }kjk Hkkjrh; ukxfjdrk dk R;kx fd, tkus ;k esjs }kjk fdlh vU; ns’k dh ukxfjdrk vftZr
fd, tkus ij esjs orZeku fuokl ds ns’k esa Hkkjrh; fe’ku ds ek/;e ls fuokZpd jftLVªhdj.k
vkWfQlj dks rRdky lwfpr djus dk opu nsrk gwaA
¼p½ esjs fuokl ds ns’k esa esjs fuokl ds irs esa dksbZ ifjorZu gksus ij fuokZpd jftLVªhdj.k vkfQlj ds
vfHkys[k ds fy, eSa esjs orZeku fuokl ds ns’k esa Hkkjrh; fe’ku ds ek/;e ls fuokZpd jftLVªhdj.k
vkWfQlj dks rRdky lwfpr djus dk opu nsrk gwaA eSa ;g tkurk gwa fd esjs fuokl ij Hkstk x;k
dksbZ uksfVl] tks fd fuokZpd jftLVªhdj.k vkfQlj ds vfHkys[k ds vuqlkj esjs orZeku fuokl ds
ns’k esa esjs fuokl dk irk gS] yksd izfrfuf/kRo vf/kfu;e] 1950 vkSj mlds v/khu cuk, x, fu;eksa
ds v/khu eq>s uksfVl dh lE;d~ rkehy le>h tk,xh] vkSj ;g esjk mÙkjnkf;Ro gS fd esjs orZeku
fuokl ds ns’k esa esjs v|ru fuokl ds irs dh lwpuk eSa fuokZpd jftLVªhdj.k vkWfQlj dks nsrk
jgwaA
¼N½ ;fn eSa Hkkjr okil ykSVrk gwa vkSj Hkkjr esa ekewyh rkSj ij fuoklh gks tkrk gwa] rks eSa lacaf/kr fo/kku
lHkk@lalnh; fuokZpu&{ks= ds fuokZpd jftLVªhdj.k vkWfQlj dks rRdky lwfpr d:axkA
¼t½ eSaus fdlh vU; fuokZpu&{ks= dh fuokZpd ukekoyh esa esjk uke lfEefyr fd, tkus ds fy, vkosnu ugha
fd;k gSA
¼>½ bl ;k fdlh vU; fuokZpu&{ks= esa esjk uke igys lfEefyr ugha fd;k x;k gSA
;k
esjk uke -------------------------------------------------------jkT; ds --------------------------------fuokZpu&{ks= ds] ftlesa
eSa uhps mfYyf[kr irs ij igys ls gh ekewyh rkSj ls fuokl dj jgk Fkk] fuokZpd ukekoyh esa
lfEefyr fd;k tk ldsxk vkSj ;fn ,slk gS rks eSa izkFkZuk djrk gwa fd mls ml fuokZpd ukekoyh
ls gVk fn;k tk, ;k LFkkukarfjr dj fn;k tk,] tSlk Hkh mi;qDr gks A
iwjk irk ¼ekewyh rkSj ls fuokl dk iwoZ LFkku½ ----------------------------------------------------------------------------------------------------
fuokZpd QksVks igpku i= la[;kad ¼;fn tkjh fd;k x;k gS½ -----------------------------------------------------------------------
----------------------------------------------------------------------------------tkjh djus dh rkjh[k------------------------------------------------------------------
5
बहार गजट (असाधारण), 13 अूील 2011
¼¥½ eq>s Hkkjr esa fuokZpd QksVks igpku i= tkjh ugha fd;k x;k gS@fuokZpd QksVks igPkku i= tkjh fd;k
x;k gS tks fujLrhdj.k ds fy, bl vkosnu ds lkFk layXu gSA
LFkku ------------------------------------------------
gLrk{kj---------------------------------------------
rkjh[k ---------------------------------------------
Hkkx & [k
Hkkx & [k
Hkkx & [k
Hkkx & [k
¼fuokZpd jftLVªhdj.k vk
¼fuokZpd jftLVªhdj.k vk
¼fuokZpd jftLVªhdj.k vk
¼fuokZpd jftLVªhdj.k vkWfQlj ds dk;kZy; esa iz;ksx ds fy,½
fQlj ds dk;kZy; esa iz;ksx ds fy,½
fQlj ds dk;kZy; esa iz;ksx ds fy,½
fQlj ds dk;kZy; esa iz;ksx ds fy,½
-------------------------------------------------¼fnu@ekl@o”kZ½ dks vkosnu izkIr gqvk
Jh@Jherh@dqekjh -----------------------------------------------------------------------------------------------------dk iz:i 6d esa vkosnu %&
¼d½ Lohdkj dj fy;k x;k gS vkSj mlds uke dks --------------------------¼fuokZpu {ks=½ dh fuokZpd ukekoyh ds Hkkx la------------------
----esa Øe la -----------------------------ij lfEefyr dj fy;kA
¼[k½ ukeatwj djus ds foLr`r dkj.k ----------------------------------------------------------------------------------------------------------------------------------------------
Rkkjh[k ------------------------------------------------------
[fuokZpd jftLVªhdj.k vkWfQlj]
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Hkkx & x
Hkkx & x
Hkkx & x
Hkkx & x
vkosnu dh vfHkLohd`fr
vkosnu dh vfHkLohd`fr
vkosnu dh vfHkLohd`fr
vkosnu dh vfHkLohd`fr
¼tc O;fDrxr :i ls jftLVªhdj.k vkfQlj dks izLrqr fd;k tk,½
iz:i 6d esa Jh@Jherh@dqekjh ---------------------------------------------------------------------------------------irk ------------------------------------------------------dk
vkosnu izkIr gqvkA
rkjh[k --------------------------------------------
lR;kiu djus okys vf/kdkjh ds gLrk{kj---------------------------------------
irk ----------------------------------------------------------A
6
बहार गजट (असाधारण), 13 अूील 2011
iz:i 6d esa vkosnu Hkjs tkus ds fy, ekxZn’kZd fl)kUr
iz:i 6d esa vkosnu Hkjs tkus ds fy, ekxZn’kZd fl)kUr
iz:i 6d esa vkosnu Hkjs tkus ds fy, ekxZn’kZd fl)kUr
iz:i 6d esa vkosnu Hkjs tkus ds fy, ekxZn’kZd fl)kUr
lk/kkj.k vuqns’k
lk/kkj.k vuqns’k
lk/kkj.k vuqns’k
lk/kkj.k vuqns’k
iz:i 6d fdlds }kjk Hkjk tk ldrk gS
iz:i 6d fdlds }kjk Hkjk tk ldrk gS
iz:i 6d fdlds }kjk Hkjk tk ldrk gS
iz:i 6d fdlds }kjk Hkjk tk ldrk gS
1- fons’k esa jgus okyk Hkkjr dk izR;sd ,slk ukxfjd] ftlus fdlh fons’k dh ukxfjdrk vftZr ugha dh gS vkSj o”kZ dh 1
tuojh dks 18 o”kZ dh vk;q iwjh dj yh gS] ml voLFkku ls] ftlesa mlds ikliksVZ esa ;FkkmfYyf[kr Hkkjr esa mldk
fuokl LFkku vofLFkr gS] lacaf/kr fuokZpu&{ks= dh ukekoyh esa jftLVªhdj.k ds fy, iz:i 6d esa vkosnu dj ldrk gSA
iz:i 6d esa vkosnu dks lacaf/kr jftLVªhdj.k vkfQlj ds le{k izLrqr fd;k tk ldrk gSA
2- vkosnd us o”kZ dh 1 tuojh] dks vBkjg o”kZ dh vk;q iwjh dj yh gksA mnkgj.kkFkZ] ;fn fuokZpd ukekoyh esa uke dks
lfEefyr djus ds fy, vkosnu 1 tuojh 2011 dh vgZd rkjh[k ds izfrfunsZ’k ls gS] rks vkosnd }kjk 1 tuojh 2011
dks 18 o”kZ dh vk;q iwjh dj yh xbZ gksA
iz:i 6d esa vkosnu dks dgka izLrqr fd;k tk,
iz:i 6d esa vkosnu dks dgka izLrqr fd;k tk,
iz:i 6d esa vkosnu dks dgka izLrqr fd;k tk,
iz:i 6d esa vkosnu dks dgka izLrqr fd;k tk,
3- vkosnu dks ml fuokZpu {ks= ds] ftlds Hkhrj fof/kekU; ikliksVZ esa fn, x, vuqlkj vkosnd ds ekewyh fuokl dk LFkku
vkrk gS] fuokZpd jftLVªhdj.k vkfQlj ¼bvkjvks½ dks lh/ks izLrqr fd;k tkuk pkfg,A iz:i 6d esa vkosnu dks bvkjvks
dks O;fDrxr :i ls izLrqr fd;k tk ldrk gS ;k lacaf/kr bvkjvks ds Mkd irs ij Hkstk tk ldrk gSA
[Hkkjr ds lHkh fuokZpu {ks=ksa ds bvkjvks dh fof’kf”V;ka vkSj Mkd irs Hkkjr fuokZpu vk;ksx dh osclkbV
¼http://eci.nic.in½ ij ns[kh tk ldrh gSa]
layXu fd, tkus okys nLrkost
layXu fd, tkus okys nLrkost
layXu fd, tkus okys nLrkost
layXu fd, tkus okys nLrkost
4- vkosnd ds iw.kZ eq[k dks nf’kZr djus okyk ,d gky gh esa [khapk x;k vkosnd dk ikliksVZ vkdkj dk ,d jaxhu QksVks
fpidk,a] ftldh i`”BHkwfe gYds jax ¼vf/kekur% lQsn½ dh gksA
5- iz:i 6d ds lHkh LraHk HkjsaA fof/kekU; Hkkjrh; ikliksVZ esa fn, x, vuqlkj viuk uke vkSj vU; fof’kf”V;ka fy[ksaA
6- ;fn vkosnu Mkd }kjk Hkstk tkrk gS rks blds lkFk vkosnd ds QksVks vkSj vU; lHkh fof’kf”V;ka vUrfoZ”V djus okys
ikliksVZ ds lqlaxr i`”Bksa vkSj fof/kekU; ohtk i`”Bkadu vUrfoZ”V djus okys i`”B dh QksVks izfr;ka layXu dh tkuh
pkfg,A ;s QksVks izfr;ka lE;d :i ls Lor% vuqizekf.kr gksuh pkfg,A bu nLrkostksa dh vuqizekf.kr QksVks izfr;ksa ds
fcuk Hksts x, vkosnu lh/ks ukeatwj fd, tkus ds nk;h gksaxsA
7- ;fn vkosnu dks O;fDrxr :i ls bvkjvks ds le{k izLrqr fd;k tkrk gS rks vkosnu ds lkFk Åij ;FkkmfYyf[kr
ikliksVZ ds lqlaxr i`”Bksa dh QksVks izfr;ka layXu dh tkuh pkfg,A jftLVªhdj.k vkfQlj }kjk lR;kiu ds fy, vkosnu
ds lkFk ewy ikliksVZ Hkh izLrqr fd;k tkuk pkfg,A lR;kiu ds rqjUr i'pkr~ ikliksVZ dks ykSVk fn;k tk,xkA
ernku
ernku
ernku
ernku
8- ;g mYys[kuh; gS fd vki ds ukekadu ds i'pkr~] vki fuokZpu {ks= esa ernku djus esa ml le; leFkZ gksaxs ;fn vki
ernku ds fnol dks vius ewy ikliksVZ ds lkFk ernku dsUnz esa Lo;a mifLFkr gSaA
The 8th April, 2011
Notification under Rule 8A of the Registration of Electors Rules, 1960.
No.-B1-3-39/2011–20—Under Section-20A of the Representation of the People
Act, 1950, inserted vide Representation of the People (Amendment) Act, 2010, which has
come into effect w.e.f. 10th February, 2011, every overseas elector, i.e., Indian citizen
who is absenting from his place of ordinary residence in India owing to employment,
education or otherwise, and has not acquired citizenship of any other country and who is
not included in the electoral roll, is entitled to have his/her name registered in the
electoral roll of the constituency in which his/her place of residence in India as mentioned
in his/her passport is located.
In terms of rule 8A of the Registration of electors Rules, 1960, every overseas
elector whose place of residence in India is located in the State of Bihar who has
completed 18 years of age as on 1st January, 2011 and is desirous of registering his/her
place of residence as shown in the passport is located. Form-6A may be either submitted
7
बहार गजट (असाधारण), 13 अूील 2011
in person directly to the registration officer of the constituency concerned or sent to such
registration officer by post along with the document mentioned in Form-6A and the
guidelines. When the claim application is sent by post, it should be accompanied by
photocopies of the relevant pages of the passport duly self attested.
Address of the registration officers of each of the 243 Assembly Constituencies in
the State of Bihar can be seen on the website www.ceobihar.nic.in.
By order and in the name of the Governor of Bihar,
SUDHIR KUMAR RAKESH,
Chief Electoral Officer.
“FROM 6A”
(See rule 8B)
Application for inclusion of name in electoral roll by an overseas elector
To
The Electoral Registration Officer,
…………………………Assembly/Parliamentary Constituency.
District…………………………….
State in India………………………
Sir
I request that my name be included in the electoral roll for the Constituency in
which my place of residence, as per the particulars furnished below in item 1(h), is
located.
PART-A
Particulars in support of my claim for inclusion in the electoral roll are given
below:-
(a) Name-…………………………………………………………………………
(b) Middle Name…………………………………………………………………
(c) Surname………………………………………………………………………
(d) Date of Birth: ……………Day………… Month…………… Year
(e) Sex (Male/Female)………………
(f) Place of Birth-
(i) Village/Town……………………………………………………………
(ii) District……………………………………………………………...........
(iii)State………………………………………………………………...........
(g) Father’s/Mother’s/Husband’s detail
(i) Name……………………………………………………………………
(ii) Middle Name……………………………………………………………
(iii) Surname………………………………….
(h) Place of Ordinary Residence in India (Full Address as given in the Passport)
(i) House/Door number……………………
(ii) Street/Area/Locality/Mohalla/Road……………………………………
(iii)Town/Village……………………………………………………………
(iv) Post Office………………………………………………………………
(v) Pin Code…………………………………………………………………
(vi) Tahsil/Taluka/Mandal/Thana……………………………………………
Space for pasting
one recent passport
size
photograph
(3.5x3.5CM)
showing
frontal
view of full face
within this box
8
बहार गजट (असाधारण), 13 अूील 2011
(vii) District…………………………………………………………………
(i) Passport Details –
(i) Passport Number……………………………………………………………
(ii) Place of Issue of current Indian passport ......................................................
(iii) Date of Issue of current Indianpassport…………………………………
(iv) Date of expiry of current IndianPassport…………………………………
{Copies of the relevant pages of the passport containing the particulars mentioned at
items (a)to (i) above to be enclosed--- duly self attested if sent by post and produced
with the original passport if presented in person before the registration officer}
(j) Details of Visa of the Country of current residence-
(i) Visa Number………………………………
(ii) Type of visa (single Entry/Multiple
Entry/Tourist/Work Visa etc./…………………………………...
(iii)Date of issue of Visa………………………………………….
(iv) Place of issue of Visa………………………………………....
(v) Date of expiry of Visa………………………………………...
(vi) Name of the Issuing Authority……………………………….
{Copies of the relevant pages of the passport containing the current valid visa
endorsement mentioned above to be enclosed – duly self attested if sent by post and
produced with the original passport if presented in person before the registration
officer}
2. Description of Absence from Place of Ordinary Residence in India-
(a) Reason of being absent from the place of ordinary residence in India- (i)
employment/(ii) education/(iii) others (Give Description)………………
(b)
Date
from
which
absenting
from
ordinary
residence
in
India-
….…………………………….. (DD/MM/YYYY)
3. Full residential address in the country outside India where currently residing
………………………………………………………………………………………
4. Full official address in the country outside India currently residing (address of
the
place
of
employment
or
the
education
Institution
where
studying)……………………………………………………………………………
………………………………………………………………………………………
5. Declaration – I hereby declare that to the best of knowledge and belief-
(a) All information given in this application is true.
(b) I am a citizen of India by birth/domicile/naturalization.
(c) I have not acquired citizenship of any other country.
(d) But for being absent from the place of my ordinary residence in India
owing to the reason given in 2(a) above, I would have been ordinarily
resident at the address given in my Indian Passport, which has been
reproduced at I (h) above.
(e) I undertake to immediately inform the Electoral Registration Officer
through the Indian Mission in the Country of my current residence if I
renounce my Indian Citizenship of if I acquire the citizenship of any
other country.
(f) I undertake to immediately inform the Electoral Registration Officer
through the Indian Mission in the country of my current residence of any
change in my residential address in the country of my residence for the
records of the Electoral Registration Officer. I understand that any notice
sent to me at the address, which is my residential address in the country
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बहार गजट (असाधारण), 13 अूील 2011
of my current residence according to the records of the Electoral
Registration Officer, shall be considered as due service of notice to me
under the Representation of the people Act, 1950 and the rules made
thereunder, and that it is my responsibility to keep the Electoral
Registration Officer informed of my latest residential address in the
country of my current residence.
(g) If I return to India and become ordinarily resident in India, I shall
immediately inform the Electoral Registration Officer of the concerned
Assembly/Parliamentary Constituency.
(h) I have not applied for inclusion of my name in the electoral roll of any
other constituency.
(i) My name has not already been included in this or any other
constituency.
OR
My name may have been included in the electoral roll of
……………………………………..Constituency in
………………………………… in State in which I was ordinarily
resident earlier at the address mentioned below and, if so, I request that
the same may be deleted from that electoral roll, or transposed. as may
be appropriate.Full Address (Earlier place of ordinary
residence)…..……………………………Electoral Photo Identity Card
(if issued)number…………………….date of Issue……………
(j) I have not been issued an EPIC in India/have been issued an EPIC
which is enclosed with this application for cancellation.
Signature……………
Place………………
Date……………….
………………………………………………………………………………………………
PART-B
(For use in the office of Electoral Registration Officer)
Application received on ……………………………………………….(DD/MM/YYYY)
The application in Form 6A of
Shri/Shrimati/Kumari……………………………………………………………has been:-
(a) Accepted and the name has been registered in the electoral roll of
…………………………………………… (Constituency) at S. No. ………….
Part No…………
(b) Rejected for the reason…………………………………………………………
…………………………………………………………………………………
………………………………………….………………………………………
Date……………………. [Electoral Registration Officer]
10
बहार गजट (असाधारण), 13 अूील 2011
PART- C
Acknowledgement for Application
(When presented in person to the registration officer)
Received the application in Form 6A of
Shri/Shrimati/Kumari………………………………………………………….
Address……………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………….…………………
………………………………………………………………………………………………
…………………….
Date…………………..
Signature of the Verifying Officer…………
Address……………….……………………
GUIDELINES FOR FILLING UP THE APPLICATION FORM-6A
General Instructions
Who can file Form-6A
1. Every citizen of India staying in a foreign country, who has not acquired
citizenship of a foreign country, and has completed 18 years of age as on 1st
January of the year, can make an application in Form 6A for being registered in
the roll for the constituency pertaining to the locality in which his place of
residence in India as mentioned in the passport is located. The application in Form
6A can be presented to the registration officer concerned.
2. The applicant should have completed eighteen years of age as on 1st January of
the year. For example, if the application is for inclusion of name in the electoral
roll with reference to 1st January 2011 as the qualifying date, the applicant should
have completed 18 years of age as on 1st January 2011.
Where to submit the application in Form-6A
3. The application should be submitted directly to the Electoral Registration officer
(ERO) of the constituency within which the place of ordinary residence of the
applicant as given in the valid passport falls. The Application in Form 6A can be
presented in person to the ERO or sent by post addressed to the ERO concerned.
[The particulars and Postal address of the EROs of all the constituencies of
India can be seen on the website of Election Commission of India
(http://eci.nic.in)]
Documents to be attached
4. Paste one recent passport size coloured photograph with a light background
(preferably white) showing the full face of the applicant.
5. Fill in all the columns in Form-6A. Write your name and other particulars as
given in the valid Indian Passport.
6. If application is sent by post, it should be accompanied by photo-copy of the
relevant pages of the passport containing the valid visa endorsement. These
photo-copies should be got duly self attested. Applications without the attested
photo-copies of these documents will be liable to be summarily rejected.
7. If the application is submitted in person before the ERO, the application should be
accompanied by a photo-copy of the relevant pages of the passport as mentioned
above. The original passport should also be produced alongwith the application
11
बहार गजट (असाधारण), 13 अूील 2011
for verification by the registration officer. The passport will be returned
immediately after verification.
Voting
8. It may be noted that after your enrolment, you will be able to cast vote in election
in the constituency, if you are physically present in the polling station alongwith
your original passport on the day of poll.
————
अधी+क, सिचवालय मुिणालय,
बहार, पटना ारा ूकािशत एवं मु/ित।
बहार गजट (असाधारण) 130-571+500-ड0ट0पी0।
Website: http://egazette.bih.nic.in
