Candidate Registration & Initial Assessment

This form is for initial assessment & screening only. After review, our team will contact eligible candidates.

Section 1 — Personal Information

Candidate Name *

Father's / Husband's Name

Age

Mobile Number *

WhatsApp Number

Education

Occupation

District

Block (Prakhand)

Panchayat

Post Contesting

Mukhiya Sarpanch Panchayat Samiti Member Zila Parishad Member Ward Member Other

Section 2 & 3 — Background & Panchayat Info

Contested before?

Family member held an elected post?

Main identity

Years active in panchayat

Total wards

Total villages / hamlets

Approx. total voters

Approx. male voters

Approx. female voters

Top local issues

Section 4–7 — Election & Self-Assessment

Last election winner

Approx. winning margin last time

Main rivals this time

Approx. active workers

Biggest concern

If election were today

Your biggest political strength

I certify that the information given is true to the best of my knowledge. I understand this is an initial assessment & screening form, and the BOOTH MASTER team may contact me for verification.