Application for inclusion of name in electoral roll ApplicationID:28611619

To,

The Electoral Registration Officer

*Assembly Constituency: TirupatiSir,

I request that my name be included in the electoral roll for the aboveConstituency. Particulars in support of my claim for inclusion in theelectoral roll are given below:

I. Applicant's Details:

Name: M V BHAVYA ర : ఎం భవ

Surname(if any): MAHADEVA VASU ఇంట ర : మహ ేవ ాసు

Date of birth if you know: Day:17 Month:03 Year:1993 Gender: F

Age as on 1st January2011: Year:18 Months:9

Place of birth Place of birth

Village/ Town: TIRUPATI

District: CHITTOOR State: ANDRAPRADESH

Relation Details

Relation TypeFather's/Mother's/Husband's:

F

Name: M V PRASAD ర : ఎం ప ా

Surname(if any): MAHADEVA VASU ఇంట ర : మహ ేవ ాసు

II. Particulars of place of present ordinary Residence(Full address)

House/Door number: 13.6.642,P.K.LAYOUT

Street /Area /Locality/Mohalla /Road: TIRUPATI /ఏ య /ల ా ట: ర ప

Town/ Village: TIRUPATI పటణం/ ామం: ర ప

Tehsil/ Taluka/Mandal/Thana: TIRUPATI URBAN ల క /మండలం: ర ప ఉర న

District: CHITTOOR Post Office: TIRUPATI

Pin code: 517501

III. Details of member(s) of applicant's family already included in the current electoral roll of the Constitutency:

Name: Relationship withapplicant:

RPart number of theroll of theConstitutency:

Serial number in thePart:

Elector's Photo IdentityCard Number:

1. M V PRASAD FATHER 0 0

2. M V POORNIMA MOTHER 0 0

Mobile No: 9491311167 Remarks:

Email-Id: m.v.bhavya@gmail.com

FORM-6 http://ceoaperms.ap.gov.in/erms/Postal/userdetails.aspx

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