Form 6

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11/24/13 FORM-6

123.176.47.59/ERMS/Postal/userdetails.aspx 1/2
Application for inclusion of name in electoral roll ApplicationID:04065912
To,
The Electoral Registration Officer
*Assembly Constituency: Patancheru
Sir,
I request that my name be included in the electoral roll for the above
Constituency. Particulars in support of my claim for inclusion in the
electoral roll are given below:
I. Applicant's Details:
Name: HARSHA VARDHAN REDDY .a: ' oc
Surname(if any): YERUVA .a: oa
Date of birth if you know: Day:04 Month:06 Year:1995 Gender: M
Age as on 1st January 2014: Year:18 Months:6
Place of birth Place of birth
Village/ Town: MARKAPUR
District: PRAKASAM State: ANDHRA PRADESH
Relation Details
Relation Type
Father's/Mother's/Husband's:
F
Name: SIVA NARAYANA REDDY .a: -c -o oc
Surname(if any): YERUVA .a: oa
II. Particulars of place of present ordinary Residence(Full address)
House/Door number: MIG-499
Street /Area /Locality
/Mohalla /Road:
PHASE 1
Dc /o/
's0:
- 1
Town/ Village: B H E L /n : O c C
Tehsil/ Taluka/Mandal/
Thana:
Ramchandrapur c /: oc y
District: MEDAK Post Office: RAMACHANDRAPUR
Pin code: 502032
III. Details of member(s) of applicant's family already included in the current electoral roll of the Constitutency:
11/24/13 FORM-6
123.176.47.59/ERMS/Postal/userdetails.aspx 2/2
Name:
Relationship with
applicant:
RPart number of the
roll of the
Constitutency:
Serial number in the
Part:
Elector's Photo Identity Card
Number:
1. SIVANARAYANA REDDY FATHER 0 0 1346253
2. RAMANJANEYA DEVI MOTHER 0 0 1346360
Mobile No: 8143020221 Remarks:
Email-Id: harshavardhan080@gmail.com
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