Eci Epic 002 Form PDF Details

Eci Epic 002 Form is an online form builder that helps you create custom forms and surveys without any programming required. With Eci Epic 002 Form, you can easily build complex forms with a wide variety of input fields, including text fields, check boxes, radio buttons, drop-down menus, and more. In addition, you can customize the look and feel of your forms to match your website's design. And best of all, Eci Epic 002 Form is free to use!

QuestionAnswer
Form NameEci Epic 002 Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesvoter card format, voter id card format pdf, form epic 002, voter card pdf download

Form Preview Example

 

 

Election Commission of India

 

FORM ID

 

Application for issue of Duplicate Elector’s Photo Identity Card (EPIC)

ECI-EPIC-002

 

 

 

 

 

A

 

State/Ut : S-25

 

 

 

 

 

 

 

 

 

AC$ (NO. & Name) :

 

 

 

 

 

 

 

 

District:

Campaign ID: WB-2000-01

 

 

 

 

 

B

 

Elector’s Particulars (To be filled by Elector)

 

 

 

 

 

 

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(vi) Police Station:

(vii) District:

 

 

 

 

 

 

 

 

(viii) Reasons for applying for a Duplicate card

 

 

 

 

 

 

 

(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)

 

Elector in Part:

No:

Register NO.

Serial No. in Register

Field Unit No.:

 

 

 

Verified by :

Signature

Personal ID No.(PIN)

Date:__/__/2000

 

 

 

 

 

Token No. or Receipt No.

DEPIC Details (To be filled by the Photography Team)

EPIC Mode: (Tick 3 appropriate box)

Date of Photography

___/____/200__

 

 

 

 

On-line

 

 

 

 

 

 

 

 

 

 

 

Off-line

EPIC No.:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Preparing EPIC

Authorised issue of EPIC

 

 

Date of Issue

(Tick 3 appropriate box when complete)

 

 

 

 

 

 

 

Editing of Data

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Printout

 

 

Personal ID No.(PIN)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Lamination

Signature

 

of ERO’s Rep.

___/___/200__

 

 

 

 

 

 

 

 

 

 

 

 

EAcknowledgement of Duplicate EPIC by the Elector

Received Duplicate EPIC on (Date):

-

-

200__

* Strike out the inappropriate alternative.

Elector’s Signature

Or Thumb Impression

$ PC number in case of Union Territories not having Legislative Assemblies.