ELECTION COMMISSION OF INDIA
FORM-6A Acknowledgement No.____________
(See Rule-8B of Registration of Electors Rules, 1960) (To be filled by office)
Application for Inclusion of Name in Electoral Roll by an Overseas Elector
PASTE ONE RECENT
To, The Electoral Registration Officer, …………………………...…………………………...Assembly / Parliamentary Constituency PASSPORT SIZE
I request that my name may be included in the electoral roll for the Constituency in which my place of PHOTOGRAPH (3.5 CM X 3.5
residence is located as mentioned in (j) below: CM) SHOWING FRONTAL
VIEW OF FULL FACE WITHIN
(a) Name * THIS BOX
(b)Last Name*
(c) Name of relative* Father Mother Husband Wife Other
(d)Last Name of relative*
(e) Date of Birth (dd/mm/yyyy)
(f)Place of Birth Village/Town
District
State
(g) Gender(Put a cross mark in proper box) Male Female Third Gender
(h) Email id#
(i) Mobile No.#
(j)Address in India as House
mentioned in original passport No.
Street/Area/Locality
Town/Village
District Pin Code
(k)Details of current Passport Place of Issue
Passport No. Date of
expiry(dd/mm/yyyy)
Date of issue(dd/mm/yyyy)
(l) Details of Visa of the Country of current Visa Number
residence
Date of issue Date of expiry
Type of Visa Name of issuing Authority
* To be filled in capital letters only
# Optional
FORM-6A Acknowledgement No.____________
(See Rule-8B of Registration of Electors Rules, 1960) (To be filled by office)
Application for Inclusion of Name in Electoral Roll by an Overseas Elector
PASTE ONE RECENT
To, The Electoral Registration Officer, …………………………...…………………………...Assembly / Parliamentary Constituency PASSPORT SIZE
I request that my name may be included in the electoral roll for the Constituency in which my place of PHOTOGRAPH (3.5 CM X 3.5
residence is located as mentioned in (j) below: CM) SHOWING FRONTAL
VIEW OF FULL FACE WITHIN
(a) Name * THIS BOX
(b)Last Name*
(c) Name of relative* Father Mother Husband Wife Other
(d)Last Name of relative*
(e) Date of Birth (dd/mm/yyyy)
(f)Place of Birth Village/Town
District
State
(g) Gender(Put a cross mark in proper box) Male Female Third Gender
(h) Email id#
(i) Mobile No.#
(j)Address in India as House
mentioned in original passport No.
Street/Area/Locality
Town/Village
District Pin Code
(k)Details of current Passport Place of Issue
Passport No. Date of
expiry(dd/mm/yyyy)
Date of issue(dd/mm/yyyy)
(l) Details of Visa of the Country of current Visa Number
residence
Date of issue Date of expiry
Type of Visa Name of issuing Authority
* To be filled in capital letters only
# Optional
