I hereby declare that I am a citizen of India and that but for my service in the Armed Forces I would have been
ordinarily resident at
Full Name :
Father's/Mother's/Husband's name :
Age
Years
Description of post held outside India :
I hereby declare that I am a citizen of India and that but for my being employed under the Government of India in the above-mentioned post, I would have been ordinarily resident at (full postal address) : ........
This cancels any previous statement as to ordinary place of residence made by me.
Place :....................................
Date :....................................
(Signature)
.......................
Verified and found correct
Place............................................
(Signature)......................................
Date.............................................
Designation of the Head of Office....................................
(For use in the Election Office)
Statement received on the .................... 20.....
Registered in the electoral roll for the ..............................................................Assembly Constituency
(No...................). Service Voter's part, at S.No. ..................
Date....................
Electoral Registration Officer
Mail this Form To : jsad@mea.gov.in