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ELECTION COMMISSION OF INDIA Ranjeet Kumar Gupta
Enumeration Form - ( Preview )
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Elector’s Name: Guriya Devi EPIC: ZKK1378108
ZKK1378108 Serial No: 528 Elector’s Name: Guriya
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Devi
Part No & Name: 15-Jauharimal AC/PC Name: 23-Riga
Uchcha Vidyalay Bairgania (Purwi
Bhag)
State: Bihar
✓ Prefilled Information
Date of Birth
Elector's Name: AADHAAR No. (Optional) Mobile No. Guriya Devi
EPIC: 1981-01-01 343050025148 9955635065 ZKK1378108
Serial No: 528
Part No. & Name: 15 - Jauharimal Uchcha Vidyalay Bairgania (Purwi Bhag)
Father’s/Legal Guardian Name EPIC No. (if available)
AC/PC Name: 23 - Riga
State: Bihar
Mother’s Name 📝 Details EPIC No. (if available) 📋 Declaration
Mobile No. *
9955635065
Spouse’s Name (if applicable) EPIC No. (if available) verified
Ranjeet Kumar Gupta
DECLARATION
Enumeration Form for EPIC No : ZKK1378108 has already been submitted by you. Click on Preview to
I HEREBY DECLARE that to the best of my knowledge and belief-
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(i)I am above 18 years of age, an ordinary resident of the above assembly/parliamentary constituency, and a
citizen of India, and (tick any one)
Indian with Voter Card issued prior to Intensive Revision 01.01.2003
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Voter Card/E-roll Extract issued prior to Intensive Revision 01.01.2003
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I was born in India before 01.07.1987
Provide any document, for Self, from the list given below establishing date of birth and/or place of
birth.
I was born in India between 01.07.1987 and 02.12.2004
Provide any document, for Self, from the list given below establishing date of birth and/or place
of birth.
Provide any document, for Father , from the list given below establishing date of birth and/or
place of birth.
Provide any document, for Mother, from the list given below establishing date of birth and/or
place of birth.
I was born in India after 02.12.2004
Provide any document, for Self, from the list given below establishing date of birth and/or place
of birth.
Provide any document, for Father, from the list given below establishing date of birth and/or
place of birth.
Provide any document, for Mother, from the list given below establishing date of birth and/or
place of birth.
If any parent is not Indian, provide a copy of his/her valid passport & visa at the time of your birth.
I was born outside of India (attach proof of Birth Registration issued by Indian Mission abroad),
Provide any document,for Birth Registration.
I have acquired Indian citizenship by Registration/Naturalisation (attach Certificate of Registration of
Citizenship)
Provide a Certificate of Registration of Citizenship.
(ii) I have not acquired the citizenship of any other country.
(iii) I am applying for inclusion in the Electoral Roll and my name is not included in any other Assembly
Constituency/ Parliamentary Constituency.
(iv) I am aware that making the above statement or declaration in relation to this application 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