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<!DOCTYPE html
PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=utf-8">
<script src="http://ajax.googleapis.com/ajax/libs/jquery/1.11.2/jquery.min.js"></script>
<script src="https://unpkg.com/sweetalert/dist/sweetalert.min.js"></script>
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<meta http-equiv="X-UA-Compatible" content="ie=edge">
<link href="fonts.googleapis.com/css?family=Hind">
<link rel="stylesheet" href="Style.css">
<link rel="stylesheet" href="https://cdnjs.cloudflare.com/ajax/libs/font-awesome/5.15.3/css/all.min.css" referrerpolicy="no-referrer" />
<link rel="stylesheet" href="https://stackpath.bootstrapcdn.com/bootstrap/4.3.1/css/bootstrap.min.css" integrity="sha384-ggOyR0iXCbMQv3Xipma34MD+dH/1fQ784/j6cY/iJTQUOhcWr7x9JvoRxT2MZw1T" crossorigin="anonymous">
<script src="https://ajax.googleapis.com/ajax/libs/jquery/3.5.1/jquery.min.js"></script>
<script src="https://kit.fontawesome.com/2cdc036eb4.js" crossorigin="anonymous"></script>
<title> Voter Registration Portal</title>
<link rel="icon" type="image/png" sizes="32x32" href="./Images/favicon-32x32.png">
<script>
// Get current title and icon
var title = $('title').text();
var favicon = $('link[rel=icon]').attr('href');
var newtitle = 'Please Visit Again!';
// Active
window.addEventListener('focus', resetTitleicon);
// Inactive
window.addEventListener('blur', changeTitleicon);
// Change page title and icon
function changeTitleicon() {
$("title").text(newtitle);
$('link[rel=icon]').attr('href', './Images/folded.png');
}
// Reset the page title and icon
function resetTitleicon() {
$('title').text(title);
$('link[rel=icon]').attr('href', './Images/favicon-32x32.png');
}
</script>
<style>
#scrollToTopButton {
position: fixed;
bottom: 15px;
right: 10px;
font-size: 25px;
z-index: 99;
width: 50px;
height: 50px;
background-color: white;
color: black;
border: none;
cursor: pointer;
outline: none;
padding: 6px;
border-radius: 50%;
box-shadow: 0 6px 10px 0px gray;
}
.goog-logo-link {
display: none !important;
}
.goog-te-gadget {
color: transparent !important;
}
</style>
<!-- Captcha CSS -->
<style>
.captcha-container {
min-width: 37%;
max-width: 45%;
display: block;
background: #d5d5d5;
font-family: 'poppins', sans-serif;
}
.header9 {
background: #037AE2;
color: #FFF;
font-size: 1.5rem;
width: 100%;
text-align: center;
border-radius: 20px 20px 0 0;
padding: 15px;
}
.securityCode {
width: 99%;
height: 74px;
}
#code {
text-align: center;
letter-spacing: 5px;
user-select: none;
}
.securityCode p {
line-height: 63px;
color: rgb(36, 36, 36);
font-family: "Montserrat";
font-size: 5vw;
font-weight: bold;
}
.securityCode .icons .fas:hover {
color: #357fc9;
cursor: pointer;
}
</style>
<!-- Footer CSS -->
<style>
.three {
padding-left: 32px;
}
.three ul li a {
text-decoration: none;
}
.three ul li a:hover {
text-decoration: none;
}
.three ul li a h4:hover {
color: #037AE2;
}
.four ul li a {
text-decoration: underline;
}
</style>
<link rel="stylesheet" href="https://cdnjs.cloudflare.com/ajax/libs/font-awesome/5.14.0/css/all.min.css">
<script type="text/javascript">
function CopyElem(elem) {
$('form input[type=text]').each(function() {
$(this).attr('value', $(this).val());
});
$('form input[type=checkbox]').each(function() {
$(this).attr('checked', $(this).prop("checked"));
});
}
function PrintElem(elem) {
Popup($(elem).html());
}
function Popup(data) {
var mywindow = window.open('', 'my div', 'height=800,width=1000');
mywindow.document.write('<html><head><title>Voter Registration</title>');
mywindow.document.write('<link rel="stylesheet" href="css/main.css" type="text/css" />');
mywindow.document.write('</head><body >');
mywindow.document.write(data);
mywindow.document.write('data');
mywindow.document.write('</body></html>');
mywindow.document.close(); // necessary for IE >= 10
myDelay = setInterval(checkReadyState, 10);
function checkReadyState() {
if (mywindow.document.readyState == "complete") {
clearInterval(myDelay);
mywindow.focus(); // necessary for IE >= 10
mywindow.print();
mywindow.close();
}
}
return true;
}
</script>
</head>
<body>
<!-- navbar starts -->
<header>
<div class="navbar">
<div class="main-heading">
<div class="logo">
<div class="flip">
<div class="flip-inner">
<div class="flip-front">
<a href="#" class="endlogo">
<img src="./Images/Logo/logo1.jpg" id="header-image">
</a>
</div>
<div class="flip-back">
<a href="#" class="endlogo">
<img src="./Images/Logo/logo2.jpg" id="header-image">
</a>
</div>
</div>
</div>
</div>
<div class="heading">
<img class="emblem" src="./Images/emblem.png"></img>
<p class="hindi-heading" style="font-family: 'Hind', sans-serif; font-weight: bolder;">राष्ट्रीय मतदान सेवा डेमो पोर्टल</p>
<p class="english-heading" style="font-weight: bold;">NATIONAL VOTER'S SERVICES DEMO PORTAL</p>
</div>
</div>
</header>
<!-- navbar ends -->
<div class="fontsetting">
<!-- <div class="row"> -->
<!-- <div class="col col-md-6 col-sm-6"> -->
<button type="button" class="btn btn-primary" id="inc">A+</button>
<button type="button" class="btn btn-primary" id="dec">A-</button>
<!-- </div> -->
<!-- <div class="col col-md-6 col-sm-6"> -->
<span class="lang">Select Language :<div id='google_translate_element' class="btn "></div>
<!-- </div> -->
</span>
<br>
<br>
<!-- </div> -->
</div>
<!-- font ends -->
<span class="note" id="print">
<h3>Note: Fields marked with asterisks (<b style="color:rgb(255, 8, 8)"> * </b>) are mandatory
<span><i class="fa fa-print" aria-hidden="true" onclick="CopyElem();PrintElem('#container12')"
style="float: right; color: black;cursor: pointer;"></i></span>
</h3>
</span>
<!-- form starts -->
<div class="container">
<div id="container12">
<form>
<form action="" class="form1">
<div class="formheading">
Form 6<br> (See Rules 13(1) and 26) of Registration of Electors Rule-1960
</div>
<!-- form part 1 starts -->
<div class="descrip">Application for inclusion of name in the electoral roll for the first time due to the transfer of voter or any other constituency from any one constituency</div><br><br> In service <br><br> Electoral Registration Officer,<br><br>
<!-- -->
<div class="conatinerFluid">
<span>State</span> <sup style="color:rgb(255, 8, 8)">* </sup>
<select class="zoomeffect btn btn-secondary btn-sm dropdown-toggle" name="slct7" id="slct7" onchange="populate(this.id,'slct8')" style="width:156px !important; padding-left:9px; font-size: 15px;">
<option> --Choose State -- </option>
<option value="andaman and nicobar islands"> ANDAMAN AND NICOBAR ISLANDS</option>
<option value="andhra pradesh"> ANDHRA PRADESH</option>
<option value="arunachal pradesh"> ARUNACHAL PRADESH</option>
<option value="assam"> ASSAM</option>
<option value="bihar"> BIHAR</option>
<option value="chandigarh"> CHANDIGARH</option>
<option value="chattisgarh"> CHATTISGARH</option>
<option value="dadra and nagar haveli"> DADRA AND NAGAR HAVELI</option>
<option value="daman and diu"> DAMAN AND DIU</option>
<option value="delhi"> DELHI</option>
<option value="goa"> GOA</option>
<option value="gujarat"> GUJARAT</option>
<option value="haryana"> HARYANA</option>
<option value="himachal pradesh"> HIMACHAL PRADESH</option>
<option value="jammu and kashmir"> JAMMU AND KASHMIR</option>
<option value="jharkhand"> JHARKHAND</option>
<option value="karnataka"> KARNATAKA</option>
<option value="kerala"> KERALA</option>
<option value="ladakh"> LADAKH</option>
<option value="lakshadweep"> LAKSHADWEEP</option>
<option value="madhya pradesh"> MADHYA PRADESH</option>
<option value="maharashtra"> MAHARASHTRA</option>
<option value="manipur"> MANIPUR</option>
<option value="meghalaya"> MEGHALAYA</option>
<option value="mizoram">MIZORAM</option>
<option value="nagaland"> NAGALAND</option>
<option value="odisha"> ODISHA</option>
<option value="puducherry">PUDUCHERRY </option>
<option value="punjab"> PUNJAB</option>
<option value="rajasthan"> RAJASTHAN</option>
<option value="sikkim"> SIKKIM</option>
<option value="tamil nadu"> TAMIL NADU</option>
<option value="telangana"> TELANGANA</option>
<option value="tripura"> TRIPURA</option>
<option value="uttar pradesh"> UTTAR PRADESH</option>
<option value="uttarakhand"> UTTARAKHAND</option>
<option value="west bengal">WEST BENGAL</option>
</select>
<span class="district">
District
</span>
<select class="btn btn-secondary btn-sm dropdown-toggle" name="slct8" id="slct8">
<option> --Choose District -- </option>
</select><br><br>
<span>Legislative Assembly / Parliamentary constituency<sup style="color:rgb(255, 8, 8)"> * </sup> </span>
<select class="btn btn-secondary btn-sm dropdown-toggle select" name="Select" id="">
<option value="null">Select</option>
</select>
<br>
</div>
I request that my name be included in electoral rolls for all the aforesaid areas. <br><br>
<div class="conatinerFluid">
<ul class="radio">
<li><input type="radio" name="select" id=""> First time voter<br></li>
<li><input type="radio" name="select" id=""> Due to transfer from other meeting areas.</li>
</ul>
</div>
<!-- fprm part 1 ends -->
<!-- form part 2 starts -->
<br> Below are specifications in support of my claim to be included in the electoral rolls. <br><br>
<div class="descrip">Mandatory specifications</div><br>
<br>
<div class="conatinerFluid">
(A) Name
<sup style="color:rgb(255, 8, 8)"> *
</sup> <input type="text" name="" class="zoomeffect" id="name" placeholder="(In English)" required>
<input type="text" name="" id="nameregional" class="zoomeffect" placeholder="(In Regional)" required>
<button><i class="far fa-keyboard"></i></button><br>
<br> (B) Surname (if any) <input type="text" name="" id="" class="zoomeffect" placeholder="(In English)" required>
<input type="text" name="" id="" class="zoomeffect" placeholder="(In Regional)" required><button><i
class="far fa-keyboard"></i></button><br><br> (C) Name of the applicant's relative
<sup style="color:rgb(255, 8, 8)"> * </sup> <input type="text" name="" id="relative" class="zoomeffect" placeholder="(In English)" required>
<input type="text" name="" id="relativeregional" class="zoomeffect" placeholder="(In Regional)" required><button><i class="far fa-keyboard"></i></button><br><br> (D)Nickname of the applicant's relative
<input type="text" name="" id="nickname" class="zoomeffect" placeholder="(In English)" required>
<input type="text" name="" id="nicknameregional" class="zoomeffect" placeholder="(In Regional)" required><button><i class="far fa-keyboard"></i></button><br><br> (E) Type of the relationship<sup style="color:rgb(255, 8, 8)"> * </sup>
<select class="btn btn-secondary btn-sm dropdown-toggle select" name="Select" id="">
<option value="null">Select</option>
<option>Father</option>
<option>Mother</option>
<option>Husband</option>
<option>Wife</option>
<option>Other</option>
</select><br><br>
<ul class="radio">
<li>
<input type="radio" name="select" id="" checked="checked"> (F) Age [on January 1 of the current calender]<sup style="color:rgb(255, 8, 8)"> * </sup>
<input type="text" value="Age" class="zoomeffect field left" readonly></input>
<select class="btn btn-secondary btn-sm dropdown-toggle select" name="Select" id="">
<option value="null">Year</option>
<option>18</option>
<option>19</option>
<option>20</option>
<option>21</option>
<option>22</option>
<option>23</option>
<option>24</option>
<option>25</option>
<option>26</option>
<option>27</option>
<option>28</option>
<option>29</option>
<option>30</option>
<option>31</option>
<option>32</option>
<option>33</option>
</select>
<select class="btn btn-secondary btn-sm dropdown-toggle select" name="Select" id="">
<option value="null">Month</option>
<option>0</option>
<option>1</option>
<option>2</option>
<option>3</option>
<option>4</option>
<option>5</option>
<option>6</option>
<option>7</option>
<option>8</option>
<option>9</option>
<option>10</option>
<option>11</option>
</select><br><br>
</li>
<xml style="font-size:20px">Or</xml><br><br>
<li>
<input type="radio" name="select" id=""> (G) Date of birth (in the form of day/ month/ year)
<input type="date" class="zoomeffect" name="" id="">
<br>(if known)<sup style="color:rgb(255, 8, 8)"> * </sup>
</li>
</ul><br><br> (H) Applicant's gender<sup style="color:rgb(255, 8, 8)"> *
</sup>
<select class="btn btn-secondary btn-sm dropdown-toggle select" name="" id="">
<option>Select</option>
<option>Male</option>
<option>Female</option>
<option>Transgender</option>
</select><br><br>
</div>
<!-- form part 2 ends -->
<!-- form part 3 starts -->
<div class="descrip">
Current address where applicant is ordinarily resident
</div><br>
<div class="conatinerFluid">
<br>House no.
<sup style="color:rgb(255, 8, 8)"> * </sup> <input type="text" name="" id="" class="zoomeffect" placeholder="(In English)" required>
<input type="text" name="" id="" class="zoomeffect" placeholder="(In Regional)" required><button><i
class="far fa-keyboard"></i></button><br><br> Street / area / location
<sup style="color:rgb(255, 8, 8)"> * </sup> <input type="text" name="" id="" class="zoomeffect" placeholder="(In English)" required>
<input type="text" name="" id="" class="zoomeffect" placeholder="(In Regional)" required><button><i
class="far fa-keyboard"></i></button><br><br> City / Village: <sup style="color:rgb(255, 8, 8)"> * </sup> <input type="text" name="" id="" class="zoomeffect" placeholder="(In English)" required>
<input type="text" name="" id="" class="zoomeffect" placeholder="(In Regional)"><button><i
class="far fa-keyboard"></i></button><br><br> Post Office:
<sup style="color:rgb(255, 8, 8)"> * </sup> <input type="text" name="" id="" class="zoomeffect" placeholder="(In English)" required>
<input type="text" name="" id="" class="zoomeffect" placeholder="(In Regional)"><button><i
class="far fa-keyboard"></i></button><br><br> Pin Code <sup style="color:rgb(255, 8, 8)"> * </sup> <input class="zoomeffect" type="text" name="" id="pincode" required onkeypress="return isNumberKey(event);"><br><br> State / Union Territory
<sup style="color:rgb(255, 8, 8)"> * </sup>
<input class="zoomeffect" type="text" name="" id="state" required>
<br><br>
<span class="district">
District
</span>
<sup style="color:rgb(255, 8, 8)"> * </sup>
<input class="zoomeffect" type="text" name="" id="district" required>
<br><br>
<hr><br> Family / Neighbour Epic No. <input class="zoomeffect" type="text" name="" id="" required><br><br>
<hr><br>
</div>
<!-- form part 3 ends -->
<!-- form part 4 starts -->
<div class="descrip">Optional specialties</div><br>
<div class="conatinerFluid">
Disability (if any)
<br><br>
<fieldset>
<input type="checkbox" name="" id=""> Visual impairment
<input type="checkbox" name="" id=""> Speech & hearing disability
<input type="checkbox" name="" id=""> Locomotor disability
<input type="checkbox" name="" id=""> other
<input class="zoomeffect" type="text" required>
</fieldset>
<br> Email ID (optional) <input class="zoomeffect" type="text" name="" id="" required><br><br> Mobile No. (optional)
<span>+91</span>
<input class="zoomeffect" type="text" name="input" required><br><br>
</div>
<!-- form part 4 ends -->
<!-- form part 5 starts -->
<div class="descrip">
Upload supporting documents (Supported formats .jpg, .png, .bmp, .jpeg) (max. 2MB)
<span>
<button style="display: contents"><u id="myBtn">List of supported documents</u>
<div id="myModal" class="modal" style="width:84%;">
<div class="modal-content">
<span class="close">×</span>
<h4 class="head1">List of Acceptable Supporting Documents For Verification</h4>
<p>
<ol class="ol">
<li>Recent passport size photographs</li>
<li>Address proof (any one of the following)</li>
<ul class="ul">
<li>Copy of your Passport</li>
<li>Gas bill</li>
<li>Water bill</li>
<li>Ration Card</li>
<li>Bank Passbook</li>
<li>Aadhaar Card</li>
</ul>
<li>Copy of proof of age</li>
<ul class="ul">
<li>10th Standard Certificate</li>
<li>Birth Certificate</li>
<li>Pan Card</li>
<li>Aadhaar Card</li>
<li>Driving Licence</li>
<li>Copy of Passport</li>
<li>Kisan Card</li>
</ul class="ul">
<li>Identity proof (any one of the following)</li>
<ul class="ul">
<li>Pan Card</li>
<li>Driving Licence</li>
<li>Ration Card</li>
<li>Passport Copy</li>
<li>Bank Passbook with Photograph</li>
<li>SSLC Certificate</li>
<li>Student ID Card</li>
<li>Aadhaar Card</li>
</ul>
</ol>
</p>
</div>
</div>
</a> </span>
</div>
<div class="conatinerFluid">
<br><br> Your photo<sup style="color:rgb(255, 8, 8)"> * </sup><br>
<input type="file" name="" class="docs" onchange="loadFile1(event)"> Document type
<sup style="color:rgb(255, 8, 8)"> * </sup>
<select class="btn btn-secondary btn-sm dropdown-toggle select" name="" id="">
<option> .jpg </option>
<option> .png </option>
<option> .bmp </option>
<option> .jpeg </option>
</select>
<br> Age proof
<sup style="color:rgb(255, 8, 8)"> * </sup><br>
<input type="file" name="" class="docs" onchange="loadFile2(event)"> Document type<sup style="color:rgb(255, 8, 8)"> *
</sup>
<select class="btn btn-secondary btn-sm dropdown-toggle select" name="" id="">
<option> .jpg </option>
<option> .png </option>
<option> .bmp </option>
<option> .jpeg </option>
</select>
<br> Address proof<sup style="color:rgb(255, 8, 8)"> * </sup><br>
<input type="file" name="" class="docs" onchange="loadFile3(event)">
<!-- <span style="margin-left:100px"></span> -->
Document type
<sup style="color:rgb(255, 8, 8)"> * </sup>
<select class="btn btn-secondary btn-sm dropdown-toggle select" name="" id="">
<option> .jpg </option>
<option> .png </option>
<option> .bmp </option>
<option> .jpeg </option>
</select>
<br><br>
<!-- <div class="row"> -->
<!-- <div class="col-lg-4 col-md-4"> -->
<img style="padding: 5px;" id="output1" width="200" height="230" />
<!-- </div> -->
<!-- <div class="col-lg-4 col-md-4"> -->
<img style="padding: 5px;" id="output2" width="200" height="230" />
<!-- </div> -->
<!-- <div class="col-lg-4 col-md-4"> -->
<img style="padding: 5px;" id="output3" width="200" height="230" />
<!-- </div> -->
<!-- </div> -->
</div>
<!-- form part 5 ends -->
<!-- form part 6 starts -->
<div class="descrip">Declaration</div><br><br> I hereby declare that to the best of knowledge and belief <br> (i) I am a citizen of India and place of my birth is; <br>
<div class="conatinerFluid">
<div class="declaration_city">
City / Village:
<input class="zoomeffect" type="text" name="" id="" required><br>
</div>
Select state
<sup style="color:rgb(255, 8, 8)"> * </sup>
<select class="btn btn-secondary btn-sm dropdown-toggle" name="slct1" id="slct1" onchange="populate(this.id,'slct2')" style="width:156px !important; padding-left:9px; font-size: 15px;">
<option> --Choose State -- </option>
<option value="andaman and nicobar islands"> ANDAMAN AND NICOBAR ISLANDS</option>
<option value="andhra pradesh"> ANDHRA PRADESH</option>
<option value="arunachal pradesh"> ARUNACHAL PRADESH</option>
<option value="assam"> ASSAM</option>
<option value="bihar"> BIHAR</option>
<option value="chandigarh"> CHANDIGARH</option>
<option value="chattisgarh"> CHATTISGARH</option>
<option value="dadra and nagar haveli"> DADRA AND NAGAR HAVELI</option>
<option value="daman and diu"> DAMAN AND DIU</option>
<option value="delhi"> DELHI</option>
<option value="goa"> GOA</option>
<option value="gujarat"> GUJARAT</option>
<option value="haryana"> HARYANA</option>
<option value="himachal pradesh"> HIMACHAL PRADESH</option>
<option value="jammu and kashmir"> JAMMU AND KASHMIR</option>
<option value="jharkhand"> JHARKHAND</option>
<option value="karnataka"> KARNATAKA</option>
<option value="kerala"> KERALA</option>
<option value="ladakh"> LADAKH</option>
<option value="lakshadweep"> LAKSHADWEEP</option>
<option value="madhya pradesh"> MADHYA PRADESH</option>
<option value="maharashtra"> MAHARASHTRA</option>
<option value="manipur"> MANIPUR</option>
<option value="meghalaya"> MEGHALAYA</option>
<option value="mizoram">MIZORAM</option>
<option value="nagaland"> NAGALAND</option>
<option value="odisha"> ODISHA</option>
<option value="puducherry">PUDUCHERRY </option>
<option value="punjab"> PUNJAB</option>
<option value="rajasthan"> RAJASTHAN</option>
<option value="sikkim"> SIKKIM</option>
<option value="tamil nadu"> TAMIL NADU</option>
<option value="telangana"> TELANGANA</option>
<option value="tripura"> TRIPURA</option>
<option value="uttar pradesh"> UTTAR PRADESH</option>
<option value="uttarakhand"> UTTARAKHAND</option>
<option value="west bengal">WEST BENGAL</option>
</select>
<span class="district">
District
</span>
<sup style="color:rgb(255, 8, 8)"> * </sup>
<select class="btn btn-secondary btn-sm dropdown-toggle" name="slct2" id="slct2">
<option> --Choose District -- </option>
</select>
</div>
<br><br> (ii) I am ordinarily resident at the address given above since Date
<sup style="color:rgb(255, 8, 8);"> * </sup>
<input class="zoomeffect" type="date" name="" id=""><br><br> (iii) I have not applied for the inclusion of my name in the electoral roll for any other constituency<br><br>
<div class="conatinerFluid">
<ul class="radio">
<li>
<input type="radio" name="select" id=""> My name has not already been included in the electoral roll for this or any other assembly/ parliamentary constituency
</li><br>
<xml>Or</xml> <br><br>
<li>
<input type="radio" name="select" id="">My name may have been included in the electoral roll for<sup style="color:rgb(255, 8, 8)"> * </sup>
<select class="btn btn-secondary btn-sm dropdown-toggle" name="slct4" id="slct4">
<option> --Choose District -- </option>
</select> Constituency in
<sup style="color:rgb(255, 8, 8)"> * </sup>
<select class="btn btn-secondary btn-sm dropdown-toggle" name="slct3" id="slct3" onchange="populate(this.id,'slct4')" style="width:156px !important; padding-left:9px; font-size: 15px;">
<option> --Choose State -- </option>
<option value="andaman and nicobar islands"> ANDAMAN AND NICOBAR ISLANDS</option>
<option value="andhra pradesh"> ANDHRA PRADESH</option>
<option value="arunachal pradesh"> ARUNACHAL PRADESH</option>
<option value="assam"> ASSAM</option>
<option value="bihar"> BIHAR</option>
<option value="chandigarh"> CHANDIGARH</option>
<option value="chattisgarh"> CHATTISGARH</option>
<option value="dadra and nagar haveli"> DADRA AND NAGAR HAVELI</option>
<option value="daman and diu"> DAMAN AND DIU</option>
<option value="delhi"> DELHI</option>
<option value="goa"> GOA</option>
<option value="gujarat"> GUJARAT</option>
<option value="haryana"> HARYANA</option>
<option value="himachal pradesh"> HIMACHAL PRADESH</option>
<option value="jammu and kashmir"> JAMMU AND KASHMIR</option>
<option value="jharkhand"> JHARKHAND</option>
<option value="karnataka"> KARNATAKA</option>
<option value="kerala"> KERALA</option>
<option value="ladakh"> LADAKH</option>
<option value="lakshadweep"> LAKSHADWEEP</option>
<option value="madhya pradesh"> MADHYA PRADESH</option>
<option value="maharashtra"> MAHARASHTRA</option>
<option value="manipur"> MANIPUR</option>
<option value="meghalaya"> MEGHALAYA</option>
<option value="mizoram">MIZORAM</option>
<option value="nagaland"> NAGALAND</option>
<option value="odisha"> ODISHA</option>
<option value="puducherry">PUDUCHERRY </option>
<option value="punjab"> PUNJAB</option>
<option value="rajasthan"> RAJASTHAN</option>
<option value="sikkim"> SIKKIM</option>
<option value="tamil nadu"> TAMIL NADU</option>
<option value="telangana"> TELANGANA</option>
<option value="tripura"> TRIPURA</option>
<option value="uttar pradesh"> UTTAR PRADESH</option>
<option value="uttarakhand"> UTTARAKHAND</option>
<option value="west bengal">WEST BENGAL</option>
</select>
<br> State in which I was ordinarily resident earlier at the address mentioned below and if so, I request that the same may be deleted from that electoral roll.
</li>
</ul>
<br>
<hr> Location
<sup style="color:rgb(255, 8, 8)"> * </sup>
<input class="zoomeffect" type="text" name="" id="" required> date <input class="zoomeffect" type="date" name="" id=""><br>
</div>
<br><input type="radio" name="select" id=""> I am aware that making a statement or declaration which is false and which I know or believe to be false or do not believe to be true, is punishable under Section 31 of the Representation of the People
Act, 1950 (43 of 1950).
<br>
<br>
</form>
</div>
<div class="captcha-container" style="text-align: center;margin-left: auto; margin-right: auto; text-align: center; border: 2px solid black;">
<div class="securityCode">
<p id="code"></p>
<div class="icons">
<span class="readText" style="align-items: center;">
<i class="fas fa-headphones"></i>
</span>
<span class="changeText">
<i class="fas fa-sync-alt"></i>
</span>
<input type="text" placeholder="Type the text here">
</div>
</div>
</div>
<br>
<br>
<script src="https://code.responsivevoice.org/responsivevoice.js"></script>
<script src="./script.js"></script>
<!-- form part 6 ends -->
<!-- <div class="conatinerFluid">
<br>
Captcha
<form action="" name="passGen">
<div class="input-icons">
<input class="zoomeffect myInput text-center" id="out" type="text" name="output1">
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<input class="zoomeffect" type="text" name="" id="" required><br><br>
</div>
</form>
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<input type="reset" class="btn btn-success" value="Reset">
<input type="submit" class="btn btn-success" value="Submit" id="submitButton">
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<h2>Contact Us</h2>
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<h3>government of india</h3>
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if (s3.value == "andaman and nicobar islands") {
var optionArray = ['nicobar|Nicobar', 'north and middle andaman|North and Middle Andaman', 'south andaman|South Andaman'];
} else if (s3.value == "andhra pradesh") {
var optionArray = ['anantapur|Anantapur',
'chittoor|Chittor',
'east godavari|East Godavari',
'guntur|Guntur',
'kadapa|Kadapa',
'krishna|Krishna',
'kurnool|Kurnool',
'nellore|Nellore',
'prakasam|Prakasam',
'srikakulum|Srikakilum',
'vishakhapatnam|Vishakhapatnam',
'vizianagaram|Vizianagaram',
'west godavari|West Godavari'
];
} else if (s3.value == "arunachal pradesh") {
var optionArray = ['anjaw|Anjaw',
'changalng|Changlang',