Please print and sign the form and then return it to me for further processing. Thanks!
Name (in full)*
Eg: EESHWAR EKAMBAR
Sex*
Male Female
name (in full)*
Eg: EKAMBAR KP
Qualification*
Eg: Master of Arts (MA), Bachelor of Commerce (B Com)
Occupation*
Eg: Software engineer, XYZ Private Limited
House address (Place of ordinary residence)
Address Line1*
Address Line2
City / Town
PIN
Post office
District
Age
Consider the highest degree available on or before 01/11/2008*
I am a graduate
University*
Year of completion*
I am in posession of a Diploma certificate
Diploma issued by*
Year of completion*
My name has not been included in the electoral roll for this or any other graduates constituency
OR
My name has been included in the electoral roll for the graduates constituency under the address given below
Place*
Mobile Number
+91
Email*
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We will use this contact information to update you about the election.
