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Elector s Signature or Thumb Impression * Strike out inappropriate alternative # Not applicable for those who have applied in Form ID-ECI-EPIC-001 Election Commission of India EPIC Record of Photograph FORM ID ECI-EPIC-003 (In respect of Applications for Rectification of Defects in Electors Photo Identity Cards & Issue of Duplicate Cards) RECEIPT NO DPL ID CAMPAIGN ID : WB-2000-01 STATE / UT (Code & Name): S-25 WEST BENGAL DISTRICT(Code & Name): CONSTITUENCY NO. & NAME: RECORD OF.
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