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Question | Answer |
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Form Name | Eci Epic 002 Form |
Form Length | 1 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 15 sec |
Other names | voter card format, voter id card format pdf, form epic 002, voter card pdf download |
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Election Commission of India |
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FORM ID |
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Application for issue of Duplicate Elector’s Photo Identity Card (EPIC) |
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A |
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State/Ut : |
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AC$ (NO. & Name) : |
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District: |
Campaign ID: |
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B |
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Elector’s Particulars (To be filled by Elector) |
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To,
The Electoral Registration
Officer,…………………………
Assembly /Parliamentary$
Constituency
Sir/ Madam,
I request that a Duplicate Electoral Photo Identity Card be issued to me as my original card is lost/ destroyed /mutilated. My name is included in the electoral roll for the above constituency. Particulars in support of my claim for issue of duplicate EPIC are given below:
1. Name of Elector:
2. EPIC No of original Card:
3. Father’s/ Mother’s / Husband’s* Name:
4. Sex (M/F):
5.Age (Years) as on
1st Jan, 200__……….
6. Address
(i) House / Door Number:
(ii) Street/ Mohalla / Road / Gali :
(iii) Area / Locality:
(iv) Town/ Village: |
(v) PIN CODE |
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(vi) Police Station: |
(vii) District: |
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(viii) Reasons for applying for a Duplicate card |
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(ix) Tick (3) the appropriate box:
I hereby return my mutilated card.
I undertake to return the earlier card issued to me if the same is recovered at a later date.
Date:
Place:
Thumb Impression
Or Signature of Elector:
C Authentication for Issue of EPIC (To be filled by ERO’s Representative)
Part No: |
Serial No. of |
Designated Photography Location (DPL) |
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Elector in Part: |
No: |
Register NO. |
Serial No. in Register |
Field Unit No.: |
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Verified by : |
Signature |
Personal ID No.(PIN) |
Date:__/__/2000 |
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Token No. or Receipt No.
DEPIC Details (To be filled by the Photography Team)
EPIC Mode: (Tick 3 appropriate box) |
Date of Photography |
___/____/200__ |
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EPIC No.: |
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Preparing EPIC |
Authorised issue of EPIC |
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Date of Issue |
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(Tick 3 appropriate box when complete) |
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Editing of Data |
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Printout |
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Personal ID No.(PIN) |
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Lamination |
Signature |
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of ERO’s Rep. |
___/___/200__ |
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EAcknowledgement of Duplicate EPIC by the Elector
Received Duplicate EPIC on (Date):
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200__ |
* Strike out the inappropriate alternative.
Elector’s Signature
Or Thumb Impression
$ PC number in case of Union Territories not having Legislative Assemblies.