New Voter Card #1 State *District *Gender *Please SelectMaleFemaleThird GenderAssembly/Parliamentary ConstituencyName *Name of Relative of Applicant *Type of Relation *FatherMotherHusbandWifeLegal Guardian in case of OrphanGuru in case of Third GenderMobile Number *Email Address *Date of Birth *Aadhaar NumberPlease select proof of Date of Birth *Please SelectBirth Certificate issued by competent Local Body/Municipal Authority/Registrar Births and DeathsIndian PassportPAN CardDriving LicenseAadhaar CardCertificate of Class X or XII issued by CBSE/ICSE/State Education Boards if it contains Date of BirthUpload self attested copy of document supporting age proof *Choose FileNo file chosenDelete uploaded fileSupported formats.jpg,.jpeg, Max size 1 MBHouse/Building/Apartment No.Area/Locality/Mohalla/Road/Post Office/TehsilCityStateArea Pin CodeCountry AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaAustraliaArubaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCabo VerdeCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGuernseyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSaint HelenaSaint Pierre & MiquelonSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUS Minor Outlying IslandsUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemen Arab Rep.Yemen DemocraticZambiaZimbabwePlease select Proof of Address *Please SelectIndian PassportAadhaar CardRevenue Department's Land Owning Records including Kisan BahiRegistered Rent Lease Deed (in case of tenants)Water connection Bill for that address (atleast 1 year)Electricity connection Bill for that address (atleast 1 year)Gas connection Bill for that address (atleast 1 year)Current passbook of Nationalized/Scheduled Bank/Post OfficeRegistered Sale Deed (In case of own house)Upload self-attested copy of address proof either in the name of applicant or any of the parents/spouse/adult child, if already enrolled as elector at the same address *Choose FileNo file chosenDelete uploaded fileSupported formats.jpg,.jpeg, Max size 1 MBUpload your photograph(unsigned passport size color photograph(4.5cm x 3.5 cm)showing frontal view of full face with white background)Choose FileNo file chosenDelete uploaded fileSupported formats.jpg,.jpeg, Max size 1 MBDo you have any DisabilityYesNoCategory of disability, if any(Optional)LocomotiveVisualDeaf & DumbOtherPercent of DisabilityPlease Specify OthersDo you want to upload certificate?YesNoPlease Upload Disability CertificateChoose FileNo file chosenDelete uploaded fileSupported formats.jpg,.jpeg, Max size 1 MBDo you have any family member already included in the electoral roll at current addressYesNoThe details of my family member already included in the electoral roll at current address with whom I currently reside are as underName of family memberHis/her EPIC No.Type of Relation *FatherMotherHusbandWifeLegal Guardian in case of OrphanGuru in case of Third GenderI HEREBY DECLARE that to the best of my knowledge and belief I am a citizen of India and place of my birth is Town/VillageStateDistrictPlaceI am ordinarily resident at the address given at above sinceSubmit