New Voter Card #1

State *

District *

Gender *

Assembly/Parliamentary Constituency

Name *

Name of Relative of Applicant *

Type of Relation *FatherMotherHusbandWifeLegal Guardian in case of OrphanGuru in case of Third Gender

Mobile Number *

Email Address *

Date of Birth *

Aadhaar Number

Please select proof of Date of Birth *

Upload self attested copy of document supporting age proof *

No file chosen

Supported formats.jpg,.jpeg, Max size 1 MB

House/Building/Apartment No.

Area/Locality/Mohalla/Road/Post Office/Tehsil

City

State

Area Pin Code

Country

Please select Proof of Address *

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 *

No file chosen

Supported formats.jpg,.jpeg, Max size 1 MB

Upload your photograph(unsigned passport size color photograph(4.5cm x 3.5 cm)showing frontal view of full face with white background)

No file chosen

Supported formats.jpg,.jpeg, Max size 1 MB

Do you have any DisabilityYesNo

Category of disability, if any(Optional)

LocomotiveVisualDeaf & DumbOther

Percent of Disability

Please Specify Others

Do you want to upload certificate?YesNo

Please Upload Disability Certificate

No file chosen

Supported formats.jpg,.jpeg, Max size 1 MB

Do you have any family member already included in the electoral roll at current addressYesNo

The details of my family member already included in the electoral roll at current address with whom I currently reside are as under

Name of family member

His/her EPIC No.

Type of Relation *FatherMotherHusbandWifeLegal Guardian in case of OrphanGuru in case of Third Gender

I HEREBY DECLARE that to the best of my knowledge and belief

I am a citizen of India and place of my birth is

Town/Village

State

District

Place

I am ordinarily resident at the address given at above since

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