Application for Deletion of Entry in Electoral Roll

(See Rule 27) Application for Deletion of Entry in Electoral Roll To The Electoral Registration Officer, ______________________constituency, Sir, I submit that the entry at Serial No,____________________in Part No. ___________________ of the electoral roll for the above mentioned constituency related to Shri/Shrimati/Kumari_____________________ son/wife/daughter of__________________ requires to be deleted as the said person is dead/is no longer ordinarly resident in this locality/is not entitled to be registered in the electoral roll for the following reasons:- _______________________________________________________________________________ _____ I hereby declare that the facts mentioned above are true to the best of my knwoledge and belief. I declare that I am an elector of this constituency, being enrolled at Serial No, _____________ in Part No. -------------- of the roll. Date ___________________ Place____________________ _______________________________ Signature/Thumb-impression of Objector Full Postal Address_________________ *strike out the inappropriate words. __________________________(Perforation)______________________ Intimation of action taken The application in Form 18 lodged by Shri/Shrimati/Kumar___________________________Address___________________has been____________________________________________________ (a)accepted and the name of Shri/Shrimati/Kumari______________________as appearing at Serial No.in Part No.__________________________________has been dated. (b)rejected for the reason__________________________________________ Date:________________________ ______________________ Electoral Registration Officer Address_________________ __________________(Perforation)_________________________ Receipt for application Received the application in Form 18 from Shri/Shrimati/Kumari*_________ Address_____________ Date________________ _____________ Electoral Registration officer Address_______________ *To be filled by applicant.