Tamil Nadu Elections Department
Online Enrollment

FORM 6
[See rules 13(1) and 26]

   

Application for inclusion of name in Electoral Roll (** -- indicates compulsory)

   --> Click Virtual Keyboard to type in Tamil

( For transliteration of your names, type the name in English and press space bar.   You can also edit the spelling by clicking the virtual key board )




Select District
 
Select Assembly Constituency
 
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I. Applicants Details
Name**
 
பெயர் **
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Sur Name(if any)
குடும்பப்பெயர் (ஏதேனுமிருப்பின் )
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Age as on 1st January 2015 **
Years Months
Sex**

 

Date of Birth, if known **
 
Place of Birth **
Village/Town   
District          
State                
பிறந்த இடம்**
கிராமம்/நகரம்   Click here to select a Your Tamil TextClick the Virtual Keyboard to Edit
மாவட்டம்       Click here to select a Your Tamil Text Click the Virtual Keyboard to Edit
மாநிலம்          
Father's /Mother's/Husband's Name **
Name  
 
Surname
 
Relationship
 
தந்தை/தாய்/கணவர் பெயர்**
பெயர்    
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குடும்பப்பெயர் 
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உறவுமுறை
 
II. Particulars of place of ordinary residence (Full Address)
House / Door Number **
New No.   Old No. Enter NA if you do not have Old House Number
Enter " - " instead of " / "
Flat Name/ Building Name
Street/Area/Locality/Mohalla/Road **
 
Town / Village **
 
II.சாதாரணமாக குடியிருந்து வரும் இடத்தின் விவரங்கள் (முழுமையான முகவரி)
அடுக்குமாடி குடியிருப்பின்/ கட்டிடத்தின் பெயர்  
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தெரு/ பகுதி/இடம்/சாலை : **
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நகரம் /கிராமம் **
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Post Office Name and Pincode **
Pincode
Tehsil/Taluka/Mandal/Thana :  **
 
தாலுகா /மண்டலம் /வட்டம் : **
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Telephone**
STD CODE Land Line Number Mobile Number
E-Mail**
   
Photo Upload (Maximum size 350kb) **
   
                                                                                                           
III. Details of member(s) of applicants family already included in the current electoral roll of the Constituency
Name Relationship with applicant Part number of the roll of the constituency Serial number in that part Photo Identity Card Number
IV. Declaration (fill either a or b)

a) I here by 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 since
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)

b) 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 No. if issued

Date of Issue(dd/mm/YYYY)

Verification Code  Refresh