Bareilly Moradabad Division

Form 18 – Graduates Constituency

Claim for inclusion of name in electoral roll for Graduates’ Constituency

Full Name (As per the Aadhaar card (for high school records))

Father/Husband Name (As per the Aadhaar card (for high school records))

Date of Birth (As Per High School)

Age

Occupation

Permanent Address(As per the Aadhaar card)

Temporary Address(If Any)

Mobile Number

EPIC Number Voter Card (If Any)

Aadhar Number

Assembly Constituency Name

Qualification

University Name

Year Of Passing

Final Year Marksheet

Aadhar Card Front

Aadhar Card Back

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I declare that all the above information is true to the best of my knowledge.

False declaration is punishable under Section 31 of the Representation of the People Act, 1950.