form

1. VOTER REGISTRATION by
You are NOT REGISTERED until you SIGN and SUBMIT your Voter
Registration Form
EASY INSTRUCTIONS to complete your voter registration: To view the complete list of VALID address proof and age
proof documents, refer to Page 3. If you have opted as a
1. PRINT this form. Make sure you print pages 3 and 4 (Form 6) STUDENT while filling your online registration, you will find a
on one page in back to back print format. This is your Voter copy of STUDENT DECLARATION FORM on last page.
Registration Form - the official application required by the
Election Commission to register you as a voter. 4. SIGN and SUBMIT the completed form to the
2. FILL additional fields, if applicable. Check Electoral Registration Officer (ERO) of your Assembly
If anybody from your house is already registered on Constituency (AC). You will find your ERO’s address below.
electoral rolls, fill in their details on Page 5.
If you are already a registered voter from a different While submitting the Voter Registration form, do not forget to
constituency, fill in those details on Page 4. This will help ask for Receipt of Application.
Election Commission to cancel your previous voter
registration. Check out www.jaagore.com to join the Jaago Re! movement!
If you have already been issued a Voter ID card, mention
your card number and date of issue on Page 4.
3. ATTACH additional documents. To register
for voting, you will also need to submit:
a. Address Proof document
b. Age Proof document (for first time voters)
c. Student Declaration Form (if you are a student residing
outside your native city)
Either of the above documents should be an official
Government issued document, which will also act as your
proof of citizenship.
SUBMIT YOUR FORM TO:
Electoral Registration Officer (ERO) of Assembly Constituency
116-Bidhannagar
Sanjay Kumar Das
Sub Divisional Officer, Bidhannagar
Mayukhbhavan, Saltlake
Kolkata-700091
Ph:033-23595270

2. GENERAL INSTRUCTIONS
DOCUMENTS REQUIRED TO REGISTER 5 MYTHS ON VOTING
1. ADDRESS Proof document 1. I am registering to get my voter ID card
This document is required for the BLO (Booth Level Officer) to When you register to vote, you are registering only to get your
come and verify your residence status. It is therefore not name included in the electoral rolls (also called voter list) and
essential for the address proof document to have your name. It NOT to get a voter ID card. To get a voter ID card, you have to
needs to have only the address of the place where you are register separately.
staying. Remember, on election day, only 2 things are mandatory for
Any one of the following documents is acceptable for address you to be allowed to vote:
proof:
Your name should be present on voter list
1. Landline phone bill You should have a valid IDENTITY PROOF. Voter ID card is
2. Mobile telephone bill only one of the valid proofs
3. Water bill
4. Electricity bill 2. I can vote only from the place of my birth / permanent residence
5. Property tax receipt As a citizen of India greater than 18 years of age, you are
6. Bank statement eligible to vote from any place in India, provided you have been
7. Passport an ORDINARY RESIDENT i.e. you have been staying at your
8. Ration card current address for at least 6 months or more.
9. House Lease/Rental agreement
10. LPG receipt 3. I do not have a valid ADDRESS PROOF document to register for
11. Driving license Voting
12. Identity cards given by the employer It is not essential for the address proof document to have your
name. It needs to have only the address of the place where you
2. AGE Proof document name. It needs to have only the address of the place where you
If you are a first time voter, you will also need to submit an age are staying. You can use address proof document on the name
proof document. You can submit the proof of Date of Birth from of your parents, relatives, friends etc. with whom you are
any government agency authorized document like: staying.
1. Birth certificate
2. Passport 4. As a voter, I can vote in 2 kinds of elections – State Assembly
3. PAN Card Elections & General Elections
4. Driving Licence As a registered voter you can vote in more than 2 elections!
5. State board exam certificate etc. Besides General and Assembly elections, you can also vote in
your Local Body Elections or Municipal Corporation Elections,
3. For STUDENTS only as called in cities.
If you are a student residing outside your native city in a hostel /
mess, you might not have any of the above mentioned address 5. Registering to Vote is a cumbersome process
proof documents. In this case, you can get a Student Earlier perhaps, but not any more! With Jaago Re!
Declaration Form (Page 5 of this form) signed by your college not only can you fill and submit your registration form
dean/principal/registrar and submit it along with your voter easily, you can also get to know when your name gets on the
registration form. voter list.
And all of this from the convenience of your home!
DISCLAIMER
While all efforts have been made to make all data on the website ( www.jaagore.com ) or this Registration Form as error free as
possible, users are requested to refer to the officially published error free copies of the Constitution of India, Acts, Rules and Orders
made there under and to the latest editions of the various Handbooks, Compendia and Reports published by the Election Commission
of India (ECI), for their authentic version. Tata Tea Ltd. will be responsible for any loss to any person caused
by any shortcoming, defect or inaccuracy in the above data. We also do not assure that any particular person will be on the electoral
rolls of ECI.

3. FORM 6
[See rules 13(1) and 26]
Application for inclusion of name in electoral roll
To
The Electoral Registration Officer,
116-Bidhannagar Assembly/Parliamentary£ Constituency.,
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 Name Surname (if any)
Details Satyajit Routray
Age as on 1st January 2012# Years: 25 Months: 8 Sex (Male/Female): Male
Date of birth, if known: Day: 16 Month: 05 Year: 1986
Place of Village/Town kolkata
birth: District: State: West Bengal
Father's/Mother's/Husband's Name Surname (if any)
Jogendra Routray
II. Particulars of place of ordinary residence (Full address):
House/Door Number: Police Abasan, A1/702
Street/Area/Locality/Mohalla/Road: AF-block, Saltlake
Town/Village: Kolkata
Post Office: Pincode:700064
Tehsil/Taluka/Mandal/Thana:
District:
£ In case of Union territories having no Legislative Assembly and the State of Jammu and Kashmir.
# Please give the year i.e. 2003, 2004, etc.
* Strike out the inappropriate alternative.
P.T.O.
..................................................................................(Perforation)...................................................................................
Receipt for application
Received the application in Form 6 of ** Shri/ Shrimati/Kumari Satyajit Routray
**Address: police Abasan, A1/702, AF-block, Saltlake, Kolkata, 700064,
Date: Signature of the officer receiving the application on
behalf of the Electoral Registration Officer
(Address)...........................................................
**To be filled in by the applicant.

4. III.Details of member(s) of applicant's family already included in the current electoral roll of the Constituency :
Name Relationship Part number of Serial Elector's
with applicant the roll of the number in Photo Identity
Constituency that Part Card Number
1.
2.
IV. Declaration
I hereby declare that to the best of my knowledge and belief:-
(i) I am a citizen of India; (ii) I am ordinarily resident at the address given in para II above since01-01-2003
(iii) I have not applied for the inclusion of my name in the electoral roll for any other constituency;
(iv) *My name has not already been included in the electoral roll for this or any other assembly constituency;
Or
*My name may have been included in the electoral roll for ................................................................. Constituency in
................State in which I was ordinarily resident earlier at the address mentioned below and if so, I request that the same
may be deleted from that electoral roll.
Full Address (Earlier Place of ordinary residence) :
Electors photo identity card (if issued) number;
......................... date of issue .............................
Place : Date : Signature or thumb impression of the elector
Note — Any person who makes a statement or declaration which is false and which he either knows or believes to be false
or does not believe to be true, is punishable under section 31 of the Representation of the People Act, 1950 (43 of 1950).
* Strike out the inappropriate alternative
Details of action taken
(To be filled by Electoral Registration Officer of the constituency)
The application of Shri/Smt./Km................................................................................................................................... for inclusion of
name in the electoral roll in Form 6 has been accepted* / rejected*.
Detailed reasons for *acceptance [under or in pursuance of rule 18*/20* /26(4)]£ or *rejection [under or in pursuance of
rule 17*/20* / 26(4)£] :
Place : Signature of (Seal of the Electoral
Date : Electoral Registration Officer Registration Officer)
£ During continuous updating after final publication of electoral roll.
* Strike out the inappropriate alternative

5. SPACE FOR PASTING
DECLARATION BY STUDENTS LIVING IN ONE RECENT
PASSPORT SIZE
HOSTELS/MESSES/ELSEWHERE PHOTOGRAPH (3.5x
(TO BE ATTACHED WITH FORM 6) 3.5 CM) SHOWING
FRONTAL VIEW OF
FULL FACE WITHIN
THIS BOX
I. I, ................................................................................................(NAME IN BLOCK LETTERS),
son/daughter of .............................................................................................................................resident of .............................
...................................................................................(complete postal address of native place), hereby declare that :----
(a) I am a bonafide student of ____________________________________________________(name of the institution) and
pursuing ________________________________(details of the course) from ________(month)_________(year) to
_________(month)________(year);
*(b) I am presently residing at -
(i)______________________________________________________(if residing in hostel/mess,mention Room No./Block
No./ Block Name, etc. of the hostel/mess).
OR
* (ii)_______________________________________________________________(if residing elsewhere outside the
hostel/mess, mention complete postal address of the place of stay outside the hostel/mess).
(c) * I want to be registered in the electoral roll/retain my registration in the electoral roll of my native place at my above-mentioned
residential address with my parents/guardian.
OR
*I want to be registered in the electoral roll of the constituency where I am presently residing.
II. I am aware that registration in the electoral roll of more than one constituency or more than once in a constituency is not permitted
under the election law and am also aware of the penal provisions of Sec. 31 of the R.P.Act, 1950, which reads as follows: -
"If any person makes in connection with (a) the preparation, revision or correction of an electoral roll, or (b) the inclusion or exclusion of
any entry in or from an electoral roll, a statement or declaration in writing which is false and which he either knows or believes to be
false or does not believe to be true, he shall be punishable with imprisonment for a term which may extend to one year, or with fine, or
with both".
Place : (signature of the student)
Date :
It is certified that the information given in the declaration at (a) above and the photograph have been verified from the records of the
institution and are found to be correct.
Place/Date: Signature and seal of the Head
Master/Principal/Registrar/Director/Dean
* Strike out the inapplicable alternatives.
Note- The onus of delivery of the declaration to the ERO concerned will lie on the applicant.