Election commission of _________________ [mention the name of the country who has issued the card]
Voter Identity Card Number: _________ [Mention the card number]
[Photograph of the candidate]
Elector’s name: ________________ [Name of the person for whom card is issued]
Father’s or Mother’s or Husband’s name: _____________
Date of birth: __________________________________ [Date of birth of the person]
Gender: ____________
Street address: _________ Name of city: _________ State: _____________
Postal code: _______
Date of issue: _______________
__________________
Signature of the Electoral Registration officer for __________ [name of the constituency]