📝 Voter Signup Form
✅ Personal Details
Full Name (Official & English):
Upload Photograph (4.5cm x 3.5cm):
✅ Family/Guardian Information
Relative Name (Father/Mother/Husband/Wife/Guardian):
✅ Contact Details
Mobile Number:
Email ID:
✅ Identification
Aadhaar Number (or tick if not available):
Not Available
✅ Gender & DOB
Gender:
Male
Female
Third Gender
Date of Birth:
Attach Age Proof:
✅ Address Details
Residential Address:
Attach Address Proof:
✅ Disability (Optional)
Type of Disability:
Percentage:
Do you have a certificate?
Yes
No
✅ Family Linkage (Optional)
Family Member Name:
Relationship:
EPIC (Voter ID) Number:
✅ Declaration
I hereby declare that:
✅ I am a citizen of India.
✅ I reside at the address mentioned.
✅ This is my first time applying for voter registration.
✅ All attached documents are valid to the best of my knowledge.
✅ I understand providing false info is punishable.
Signature / Thumb Impression:
Date:
Place:
Submit