Please print and sign the form and then return it to me for further processing. Thanks!
Name (in full)*
Eg: EESHWAR EKAMBAR
name (in full)*
Eg: EKAMBAR KP
Eg: Master of Arts (MA), Bachelor of Commerce (B Com)
Eg: Software engineer, XYZ Private Limited
House address (Place of ordinary residence)
City / Town
Consider the highest degree available on or before 01/11/2008*
I am a graduate
I am in posession of a Diploma certificate
My name has not been included in the electoral roll for this or any other graduates constituency
My name has been included in the electoral roll for the graduates constituency under the address given below
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We will use this contact information to update you about the election.