Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697804577176.pdf (India)
ELECTION COMMISSION OF INDIA Form-8 FORM No.

(To be filled by office) Voter Application Form for shifting of Residence/Correction of Entries in Existing Electoral Roll/Replacement of EPIC/Marking of PwD (See Rules 13(3) and (26) of the Registration of Electors Rules, 1960) To, The Electoral Registration Officer, No.

& Name of Assembly Constituency Or No.

& Name of Parliamentary Constituency@ No.

No.


Name Name (@ only for Union Territories not having Legislative Assembly) (I) Name of the applicant EPIC No.

Aadhaar Details:- (Please tick the appropriate box) Aadhaar Number (a) or (b) I am not able to furnish my Aadhaar Number because I don't have Aadhaar Number.

Mobile No.

of Self (or) Mobile No.


of Father/Mother/Any other relative (if available) Email Id of Self (or) Email Id of Father/Mother/Any other relative (if available) (II) I submit application for (Tick any one of the following) 1.

2.

3.

4.

Shifting of Residence (or) Correction of Entries in Existing Electoral Roll (or) Issue of Replacement EPIC without correction (or) Request for marking as Person with Disability 1.
Application for Shifting of Residence I have shifted my residence and I request that my name may be deleted from the previous address and shifted to the current address mentioned below.

I request that a replacement EPIC may be issued to me due to change in my address.

I hereby return my old EPIC.

Present Ordinary Residence (Full Address) House/Building/Apartment No.
Town/Village PIN Code District Tehsil/Taluqa/Mandal State/UT Street/Area/Locality/ Mohalla/Road Post Office Self-attested copy of address proof either in the name of applicant or anyone of the parents/spouse/adult child, if already enrolled with as elector at the same address (Attach any one of them) Core Document ^:- 1.
Water/Electricity/Gas connection Bill for that address (atleast 1 year) Current passbook of Nationalized/Scheduled Bank/Post Office Revenue Department's Land Owning records including KisanBahi 2.

4.

Aadhaar Card Indian Passport Registered Rent Lease Deed (In case of tenant) 7.

Registered Sale Deed (In case of own house) 3.

5.

6.

Any Other:- (Pl.

Specify) 2.


Application for Correction of Entries in Existing Electoral Roll Please correct my following details in Electoral Roll/EPIC: (Maximum of 4 entries/particulars can be corrected) (Put a tick  in appropriate box below.)

Copy of self-attested Documentary Proof in support of claim to be attached.

1.

4.

Name Relation Type 7.

Mobile Number 2.

5.

8.

Gender Relation Name Photo 3.

6.


DoB/Age Address The correct particulars in the entry to be corrected are as under:- Name of Document in support of above claim attached SPACE FOR PASTING ONE RECENT PASSPORT SIZE UNSIGNED COLOR PHOTOGRAPH (4.5 CM X 3.5 CM) SHOWING FRONTAL VIEW OF FULL FACE WITH WHITE BACKGROUND (ONLY IF PHOTO TO BE CHANGED) I request that a replacement EPIC may be issued to me due to change in my personal details.

I hereby return my old EPIC.

3.


Application for Issue of Replacement EPIC without correction I request that a replacement EPIC may be issued to me as my original EPIC is- (Put a tick in appropriate box ) Lost Destroyed due to reason beyond control like floods, fire, other natural disaster etc.

Mutilated I hereby return my mutilated/ old EPIC (OR) I have attached copy of FIR/Police report for lost EPIC & I undertake to return the earlier EPIC issued to me if the same is recovered at a later stage.

4.
Application for Marking Person with Disability Category of disability (Tick the appropriate box for category of disability) Locomotive Visual Deaf & Dumb If any other (Give description) DECLARATION I HEREBY DECLARE that to the best of my knowledge and belief that I am a citizen of India and I am aware that making a statement or declaration which is false and which I know or believe to be false or do not believe to be true, is punishable under Section 31 of Representation of the People Act,1950 (43 of 1950) with imprisonment for a term which may extend to one year or with fine or with both.
Date:______________ Place:_____________ Accessibility Instructions:- In the light of provisions of Rights of Persons with Disabilities Act 2016 and Rights of Persons with Disabilities Rules, 2017, in case of persons with intellectual disability, autism, cerebral palsy and multiple disabilities etc., signature or left hand thumb impression of person with disability, or of signature or left hand thumb impression of his/her legal guardian will be required.
^ Submission of self-attested copy of core document will ensure speedy delivery of services.

 Acknowledgement/Receipt for application  Signature of Applicant/Thumb Impression Acknowledgment Number Received the application in Form 8 of Shri/Smt./Ms.

Date Name/Signature of ERO/AERO/BLO To be appended to Form-8 GUIDELINES FOR FILLING UP THE APPLICATION FORM-8 1.
General Instruction:- (a) The application can be made by a registered/enrolled elector for shifting of residence, or for correction of entries or for issue of replacement EPIC or for marking as PwD.
(b) Incase of approval of application by Electoral Registration Officer (ERO) for shifting of residence, correction of entries and issue of replacement EPIC without correction, a new replacement EPIC will be issued to the applicant and he has to return his old EPIC to the Electoral Registration Officer immediately.

2.

Item No.

I (Name of the applicant)- The applicant shall mention his name, EPIC no., Aadhaar number, mobile number and email id of self or relative mentioned therein.
Aadhaar Number should be furnished for the purpose of authentication of entries.

If the applicant does not have Aadhaar number, the same may be mentioned in box at item I (b).

3.

Item No.

II (Option for application)- The applicant has to tick any one of the options for making application and fill the details in the relevant section of the application.

All other sections which are not relevant should be struck off.

4.
4.

Application for shifting of residence-(a) The application has to be made to the Electoral Registration Officer of the constituency in which the new address of the applicant is located.

(b) The applicant has to mention his new address, where he has shifted to and presently staying and attach a self-attested copy of any one of the mentioned documents as address proof in his own name or in name of his parents/spouse.

He has to tick the mentioned document which he has given as address proof.
Mentioned document will ensure speedy delivery of services.

If he does not possess any of the mentioned documents, he has to mention name of the other document given for address proof in the blank space.

5.

Application for correction of entries in existing roll - (a) If an applicant intends to get any existing entry relating to him in the electoral roll corrected, he has to tick in the appropriate box and attach the document in the support of his claim.
The name of the document must be mentioned in the blank space given.

(b) In case, the applicant desires to change his photograph, he has to paste a recent good quality passport size unsigned colour photograph (4.5 cm X 3.5 cm) with white background, in the box meant for it.

6.

Application for replacement EPIC without correction- The applicant shall put a tick in appropriate box seeking for a replacement EPIC.

He shall return his mutilated/old EPIC or submit a copy of FIR/Police report for lost EPIC.

7.
7.

DECLARATION - The applicant must give a 'DECLARATION' that the facts and particulars mentioned in the application are true to the best of his/her knowledge and belief.

Please note that giving any false statement made in the DECLARATION portion is a punishable offence under Section 31 of the Representation of People Act, 1950 with imprisonment with a term which may extend to one year or with fine or with both.

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