I ............................................................................. I.C.No ...................................................
                  (Name in full)
Address .................................................................................................................................
                 
declare that I am the person whose name appears as ......................................................
..........................  in the electoral roll now in force for the polling district
(registration unit )................................................................

   I further declare that I have not already voted either here or elsewhere in the
Constituency of ...............................................................................................
or in any other Constituency at the general election/ by-election.
 
 

Declare before me the....................................20....................