Personal Details



Relation Details

(Please provide details of any one of your following relatives)

Current Residence



Family Details

Voter ID card details of previously registered Family members

Add voter ID card details of up to two family members to ensure you get assigned to the same polling booth (Fill in as many details as you can)

Family Member 1


Family Member 2


Review & Submit


Fields marked * are required. Fields in red are missing or invalid.

PERSONAL DETAILS

Name (First and Middle) *
John
Surname *
Doe
Gender *
Male
Email address *
john.doe@gmail.com
Phone number
6508624342
Education
Gold Medallist
Relation details
Relation
Father
Relative Name
Jack
Relative Surname (if any)
Doe

BIRTH INFORMATION

Date of Birth *
07/11/1982
Town / Village *
Aluva
State *
Kerala
District *
Ernakulam
Language spoken at home
Swahili

CURRENT RESIDENCE

Pincode *
683101
House / Door number
3389
Street / Area / Locality / Mohalla / Road *
Lovedale Avenue
Town / Village *
Aluva
Post Office
Asokapuram
Tehsil / taluka / mandal / thana
Aluva
Since when have you been living here? *
11/11/2001

ASSEMBLY CONSTITUENCY

State *
Kerala
District *
Ernakulam
Assembly Constituency *
Aluva

FAMILY DETAILS

Voter ID card details of Family members
Family member 1
Relation
Brother
Name
Johnny Doe
Part number of the roll of the constituency
2
Serial number in that Part
24
Elector's Photo Identity Card Number
22423
Family member 2
Relation
Mother
Name
Jane Doe
Part number of the roll of the constituency
6
Serial number in that Part
44
Elector's Photo Identity Card Number
38383

PREVIOUS VOTER ID

State
Karnataka
District
Bangalore
Assembly Constituency
Yelahanka
Previously Registered Address
My Home
Elector's Photo Identity Card Number
120291210
Elector's Photo Identity Card Issue Date
7/12/2002


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