Voter Card Correction I submit application for (Tick any one of the following) *Shifting of ResidenceCorrection of Entries in Existing Electoral Roll (Name,Gender,DOB,Age,Type of Relation,Name of Relative,Address,Mobile no.,Photograph)Issue of Replacement EPIC without correctionRequest for marking as Person with DisabilityPlease tick the entry which is to be corrected *NameGenderDate of Birth/AgeType of RelationName of RelativeAddressMobile No.(if available)My PhotographState *District *Assembly/Parliamentary ConstituencyName *As per Voter CardNameCorrect NameUpload supporting DocumentChoose FileNo file chosenDelete uploaded file(Supported formats .jpg,.jpeg)Name of Relative of Applicant *As per Voter CardName of Relative of ApplicantCorrect Name of RelativeUpload supporting DocumentChoose FileNo file chosenDelete uploaded file(Supported formats .jpg,.jpeg)Type of Relation *FatherMotherHusbandWifeLegal Guardian in case of OrphanGuru in case of Third GenderAs per Voter CardType of RelationFatherMotherHusbandWifeLegal Guardian in case of OrphanGuru in case of Third GenderCorrect Type of RelationDate of Birth *As per Voter CardDate of BirthCorrect Date of BirthPlease 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 MBGender *Please SelectMaleFemaleThird GenderAs per Voter CardGenderPlease SelectMaleFemaleThird GenderCorrect GenderEPIC Number *Aadhaar NumberMobile Number *As Per Voter CardMobile NumberCorrect Mobile NumberEmail Address *House/Building/Apartment No.As Per Voter CardArea/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 DemocraticZambiaZimbabweHouse/Building/Apartment No.Correct AddressArea/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 MBIssue new EPICLostDestroyed due to reason beyond control like floods, fire, other natural disaster etc.MutilatedI request that a replacement EPIC may be issued to me as my original EPIC isApplication for Marking Person with DisabilityLocomotiveVisualDeaf & 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 MBPlaceDateSubmit
