The time within which any person interested who is aggrieved by the amount of compensation determined under sub-section (1) of Section 168 or within which the owner of a vehicle, vessel or animal who is aggrieved by the amount of compensation determined under sub-section (2) of that Section may make an application for referring the matter to arbitration shall be fourteen days from the date of determination of the amount of such compensation or where the amount of such compensation has been determined in the absence of the person interested or, as the case may be, the owner, fourteen days from the date on which the intimation of such determination is sent to that person or owner.
119[Form 1
(See Rule 3)
Notice of Election
Notice is hereby given that:
(1) an election is to be held of a member to the House of the People/ Legislative Assembly/ Legislative Council in the . .. constituency;
or
(1) an election is to be held of a member(s) to the Council of States/ . Legislative Council/ . by the elected members of the Legislative Assembly;
(2) nomination papers may be delivered by a candidate or by any of his proposers to the Returning Officer or to Assistant Returning Officer, at .. between 11 a.m. and 3 p.m. on any day (other than a public holiday) not later than the ..
(3) forms of nomination paper may be obtained at the place and time aforesaid;
(4) the nomination papers will be taken up for scrutiny at .. on at .
(5) notice of withdrawal of candidature may be delivered either by a candidate or by any of his proposers or by his election agent who has been authorised in writing by the candidate to deliver it to either of the officers specified in paragraph (2) above at his office before 3 p.m. on the .
(6) in the event of the election being contested, the poll will be taken on . between the hours of .. and .
| Place |
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| Date |
Returning Officer.] |
120[Form 2-A
(See Rule 4)
NOMINATION PAPER
Election to the House of the People
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Recent stamp size (2cm 2.5cm) photograph in white/off white background with full face view to be attached. |
STRIKE OFF PART I OR PART II BELOW WHICHEVER IS NOT APPLICABLE
Part I
(To be used by candidate set up by recognised political party)
I nominate as a candidate for election to the House of the People from the Parliamentary constituency.
Candidate's name Father's/mother's/husband's name His postal address .His name is entered at Sl. No .in Part No .. of the electoral roll for . (Assembly constituency comprised within) .. Parliamentary Constituency.
My name is and it is entered at Sl. No .in Part No ..of the electoral roll for . (Assembly constituency comprised within) .Parliamentary constituency.
| Date . |
Signature of Proposer |
Part II
(To be used by candidate NOT set up by recognised political party)
We hereby nominate as candidate for election to the House of the People from the .. Parliamentary Constituency.
Candidate's name Father's/mother's/husband's name His postal address ..His name is entered at Sl. No ..in Part No .of the electoral roll for (Assembly constituency comprised within) Parliamentary constituency.
We declare that we are electors of the above Parliamentary Constituency and our names are entered in the electoral roll for that Parliamentary Constituency as indicated below and we append our signatures below in token of subscribing to this nomination
Particulars of the proposers and their signatures
| Sl. No. |
Name of component Assembly Constituency |
Elector Roll No. of Proposer |
Full Name |
Signature |
Date |
| Part No. of Electoral Roll |
Sl. No. in that part |
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N.B. There should be ten electors of the constituency as proposers.
Part III
I, the candidate mentioned in Part I/Part II (Strike out which is not applicable) assent to this nomination and hereby declare that
(a) I am a citizen of India and have not acquired the citizenship of any foreign State or country;
(b) I have completed .years of age;
[STRIKE OUT c(i) or c(ii) BELOW WHICHEVER IS NOT APPLICABLE]
(c)(i) I am set up at this election by the .party, which is a recognised National Party/State Party in this State and that the symbol reserved for the above party be allotted to me;
OR
(c)(ii) I am set up at this election by the party, which is a registered unrecognised political party/that I am contesting this election as an independent candidate (Strike out which is not applicable) and that the symbols I have chosen, in order of preference, are:
(i) (ii) (iii) ..
(d) my name and my father's/mother's/husband's name have been correctly spelt out above in (name of the language);
(e) to the best of my knowledge and belief, I am qualified and not also disqualified for being chosen to fill the seat in the House of the People.
*I further declare that I am a member of the ..**Caste/tribe which is a scheduled **caste/tribe of the State of ..in relation to (area) in that State.
I also declare that I have not been, and shall not be nominated as a candidate at the present general election/the bye-elections being held simultaneously, to the House of the People from more than two Parliamentary Constituencies.
Date . Signature of Candidate
Score out the words assembly constituency comprised within in the case of Jammu and Kashmir, Andaman and Nicobar Islands, Chandigarh, Dadra and Nagar Haveli, Daman and Diu and Lakshadweep.
*Score out this paragraph, if not applicable.
**Score out the words not applicable.
N.B. A recognised political party means a political party recognised by the Election Commission under the Election Symbols (Reservation and Allotment) Order, 1968, in the State concerned.
Part III-A
(To be filled by the candidate)
121[(1)] Whether the candidate
| (i) has been convicted (a) of any offence(s) under sub-section (1); or (b) for contravention of any law specified in sub-section (2), of Section 8 of the Representation of the People Act, 1951 (43 of 1951); or Yes/No (ii) has been convicted for any other offence(s) for which he has been sentenced to imprisonment for two years or more. |
.png) |
If the answer is Yes , the candidate shall furnish the following information:
(i) Case/first information report No./Nos .
(ii) Police station(s) ..District(s) . State(s) . ..
(iii) Section(s) of the concerned Act(s) and brief description of the offence(s) for which he has been convicted .. ..
(iv) Date(s) of conviction(s) . ..
(v) Court(s) which convicted the candidate
(vi) Punishment(s) imposed [indicate period of imprisonment(s) and/or quantum of fine(s)]
(vii) Date(s) of release from prison
(viii) Was/were any appeal(s)/revision(s) filed against above conviction(s) Yes/No
(ix) Date and particulars of appeal(s)/application(s) for revision filed
(x) Name of the court(s) before which the appeal(s)/application(s) for revision filed
(xi) Whether the said appeal(s)/application(s) for revision has/have been disposed of or is/are pending
(xii) If the said appeal(s)/application(s) for revision has/have been disposed of
(a) Date(s) of disposal
(b) Nature of order(s) passed ..
122[(2) Whether the candidate is holding any office of profit under the Government of India or State Government? ..(Yes/No)
If Yes, details of the office held
(3) Whether the candidate has been declared insolvent by any Court? .(Yes/No)
If Yes, has he been discharged from insolvency
(4) Whether the candidate is under allegiance or adherence to any foreign country? (Yes/No)
If Yes, give details ..
(5) Whether the candidate has been disqualified under Section 8-A of the said Act by an order of the President? (Yes/No)
If Yes, the period for which disqualified ..
(6) Whether the candidate was dismissed for corruption or for disloyalty while holding office under the Government of India or the Government of any State? (Yes/No)
If Yes, the date of such dismissal ..
(7) Whether the candidate has any subsisting contract(s) with the Government either in individual capacity or by trust or partnership in which the candidate has a share for supply of any goods to that Government or for execution of works undertaken by that Government? ..(Yes/No)
If Yes, with which Government and details of subsisting contract(s)
(8) Whether the candidate is a managing agent, or manager or Secretary of any company or Corporation (other than a cooperative society) in the capital of which the Central/Government or State Government has not less than twenty-five percent share? (Yes/no)
If Yes, with which Government and the details thereof ..
(9) Whether the candidate has been disqualified by the Commission under Section 10-A of the said Act ..(Yes/No)
If yes, the date of disqualification ]
| Place: .. Date: |
Signature of Candidate |
Part IV
(To be filled by the Returning Officer)
Serial No. of nomination paper
This nomination was delivered to me at my office at .(hour) on .. (date) by the *candidate/proposer (name).
Part V
Decision of Returning Officer Accepting or Rejecting the Nomination Paper
I have examined this nomination paper in accordance with Section 36 of the Representation of the People Act, 1951(43 of 1951) and decide as follows:
(Perforation)
Part VI
Receipt for Nomination Paper and Notice of Scrutiny
(To be handed over to the person presenting the Nomination Paper)
Serial No. of nomination paper ..
The nomination paper of .. ..a candidate for election from the .. Parliamentary constituency was delivered to me at my office at (hour) on .(date) by the *candidate/proposer. All nomination papers will be taken up for scrutiny at (hour) on (date) at .(Place).
| Date .. |
Returning Officer |
*Score out the word not applicable.
Form 2-B
(See Rule 4)
NOMINATION PAPER
Election to the Legislative Assembly of (State)
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| |
Recent stamp size (2cm 2.5cm) photograph in white/off white background with full face view. |
STRIKE OFF PART I OR PART II BELOW WHICHEVER IS NOT APPLICABLE
Part I
(To be used by candidate set up by recognised political party)
I nominate as a candidate for election to the Legislative Assembly from the .. Assembly Constituency.
Candidate's name Father's/mother's/husband's name .. His postal address His name is entered at Sl. No . in Part No . of the electoral roll for . Assembly constituency.
My name is . and it is entered at Sl. No. in Part No of the electoral roll for the .Assembly constituency.
| Date .. |
Signature of the Proposer |
Part II
We hereby nominate as candidate for election to the Legislative Assembly from the . Assembly Constituency.
Candidate's name Father's/mother's/husband's name His postal address ..
His name is entered at Sl. No ..in Part No .of the electoral roll for ..Assembly constituency.
We declare that we are electors of this Assembly constituency and our names are entered in the electoral roll for this Assembly constituency as indicated below and we append our signatures below in token of subscribing to this nomination
Particulars of the proposers and their signatures
| Sl. No. |
Elector Roll No. of Proposer |
Full Name |
Signature |
Date |
| Part No. of Electoral Roll |
Sl. No. in that part |
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2 |
3 |
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5 |
6 |
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N.B There should be ten electors of the constituency as proposers.
Part III
I, the candidate mentioned in Part I/Part II (Strike out which is not applicable) assent to this nomination and hereby declare that
(a) I am a citizen of India and have not acquired the citizenship of any foreign State;
(b) I have completed ..years of age;
[STRIKE OUT c(i) OR c(ii) BELOW WHICHEVER IS NOT APPLICABLE]
(c)(i) I am set up at this election by the ..party, which is recognised National Party/State Party in this State and that the symbol reserved for the above party be allotted to me.
OR
(ii) I am set up at this election by the ..party, which is a registered unrecognised political party/that I am contesting this election as an independent candidate (Strike out which is not applicable) and that the symbols I have chosen, in order of preference, are
(i) (ii) (iii) ..
(d) my name and my father's/mother's/husband's name have been correctly spelt out above in . (name of the language); and
(e) to the best of my knowledge and belief, I am qualified and not also disqualified for being chosen to fill the seat in the Legislative Assembly of this State.
* I further declare that I am a member of the ..**Caste/tribe which is a scheduled
**caste/tribe of the State of .in relation to (area) in that State.
I also declare that I have not been, and shall not be nominated as a candidate at the present general election/the bye-elections being held simultaneously, to the Legislative Assembly of (State) from more than two Assembly constituencies.
| Date .. |
Signature of Candidate |
_____________________________________________________________________________________
* Score out this paragraph, if not applicable.
** Score out the words not applicable.
N.B. A recognised political party means a political party recognised by the Election Commission under the Election Symbols (Reservation and Allotment) Order, 1968 in the State concerned.
Part III-A
(To be filled by the candidate)
123[(1)] Whether the candidate
| (i) has been convicted (a) of any offence(s) under sub-section (1); or (b) for contravention of any law specified in sub-section (2) of Section 8 of the Representation of the People Act, 1951 (43 of 1951); or Yes/No (ii) has been convicted for any other offence(s) for which he has been sentenced to imprisonment for two years or more. |
.png) |
If the answer is Yes , the candidate shall furnish the following information:
(i) Case/First information report No./Nos. ..
(ii) Police station(s) District(s) State(s) ..
(iii) Section(s) of the concerned Act(s) and brief description of the offence(s) for which he has been convicted
(iv) Date(s) of conviction(s)
(v) Court(s) which convicted the candidate ..
(vi) Punishment(s) imposed [indicate period of imprisonment(s) and/or quantam of fine(s)] .
(vii) Date(s) of release from prison
(viii) Was/were any appeal(s)/revision(s) filed against above conviction(s) ..Yes/No
(ix) Date and particulars of the appeal(s)/application(s) for revision filed
(x) Name of the court(s) before which the appeal(s)/application(s) for revision filed .
(xi) Whether the said appeal(s)/application(s) for revision has/have been disposed of or is/are pending
(xii) If the said appeal(s)/application(s) for revision has/have been disposed of
(a) Date(s) of disposal
(b) Nature of order(s) passed .
124[(2) Whether the candidate is holding any office of profit under the Government of India or State Government? ..(Yes/No)
If Yes, details of the office held
(3) Whether the candidate has been declared insolvent by any Court? .(Yes/No)
If Yes, has he been discharged from insolvency
(4) Whether the candidate is under allegiance or adherence to any foreign country? (Yes/No)
If Yes, give details ..
(5) Whether the candidate has been disqualified under Section 8-A of the said Act by an order of the President? (Yes/No)
If Yes, the period for which disqualified ..
(6) Whether the candidate was dismissed for corruption or for disloyalty while holding office under the Government of India or the Government of any State? (Yes/No)
If Yes, the date of such dismissal ..
(7) Whether the candidate has any subsisting contract(s) with the Government either in individual capacity or by trust or partnership in which the candidate has a share for supply of any goods to that Government or for execution of works undertaken by that Government? ..(Yes/No)
If Yes, with which Government and details of subsisting contract(s)
(8) Whether the candidate is a managing agent, or manager or Secretary of any company or Corporation (other than a cooperative society) in the capital of which the Central/Government or State Government has not less than twenty-five percent share? (Yes/no)
If Yes, with which Government and the details thereof ..
(9) Whether the candidate has been disqualified by the Commission under Section 10-A of the said Act ..(Yes/No)
If yes, the date of disqualification ]
| Place: |
|
| Date: |
Signature of the candidate |
Part IV
(To be filled by the Returning Officer)
Serial No. of nomination paper ..
This nomination was delivered to me at my office at .. (hour) on (date) by the *candidate/proposer (Name).
| Date .. |
Returning Officer |
*Score out the word not applicable.
Part V
Decision of Returning Officer Accepting or Rejecting the Nomination Paper
I have examined this nomination paper in accordance with Section 36 of the Representation of the People Act, 1951 and decide as follows
.
| Date .. |
Returning Officer |
(Perforation) .
Part VI
Receipt for Nomination Paper and Notice of Scrutiny
(To be handed over to the person presenting the Nomination Paper)
Serial No. of nomination paper .
The nomination paper of .a candidate for election from the ..Assembly constituency was delivered to me at my office at (hour) on . (date) by the *candidate/proposer. All nomination papers will be taken up for scrutiny at ..(hour) on (date) at ..(Place).
*Score out the word not applicable.
Form 2-C
(See Rule 4)
NOMINATION PAPER
Election to the Council of States
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|
| |
Recent stamp size (2cm 2.5cm) photograph in white/off white background with full face view. |
Part I
We hereby nominate as a candidate for election to the Council of States:
Candidate's Name . [father's/mother's/husband's name] . His postal address . His name is entered at Sl. No. in Part No. .. of the electoral roll for the .assembly/*Parliamentary constituency.
We declare that we are elected members of the Legislative Assembly of electoral college for and our names are entered as indicated below in the list maintained under Section 152 and we append our signatures below in token of subscribing to his nomination:
Particulars of the proposers and their signatures
| Sl. No. |
Sl. No. as entered in the list maintained under Section 152 |
Full Name |
Signature |
Date |
| 1 |
2 |
3 |
4 |
5 |
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* For Jammu and Kashmir only.
**There should be ten per cent of the elected members of the Legislative Assembly or ten per cent of the members of the electoral college or ten members concerned, whichever is less, as proposers.
I, the abovementioned candidate, assent to this nomination and hereby declare that
(a) I am a citizen of India and have not acquired the citizenship of any foreign State;
(b) I have completed .years of age;
(c) I am set up at this election by the .party;
(d) my name and my [father's/mother's/husband's name] have been correctly spelt out above in . (name of the language); and
(e) to the best of my knowledge and belief, I am qualified and not also disqualified for being chosen to fill the seat in the Council of States.
I also declare that I have not been, and shall not be, nominated as a candidate at the present biennial election/bye-elections being held simultaneously, to the Council of States for more than two seats.
| Date .. |
Signature of the candidate |
Part II
(To be filled by the candidate)
125[(1)] Whether the candidate
| (i) has been convicted (a) of any offence(s) under sub-section (1); or (b) for contravention of any law specified in sub-section (2), of Section 8 of the Representation of the People Act, 1951 (43 of 1951); or Yes/No (ii) has been convicted for any other offence(s) for which he has been sentenced to imprisonment for two years or more. |
.png) |
If the answer is Yes , the candidate shall furnish the following information:
(i) Case/First information report No./Nos. ..
(ii) Police station(s) District(s) State(s) ..
(iii) Section(s) of the concerned Act(s) and brief description of the offence(s) for which he has been convicted .
(iv) Date(s) of conviction(s)
(v) Court(s) which convicted the candidate .
(vi) Punishment(s) imposed [indicate period of imprisonment(s) and/or quantam of fine(s)] .
(vii) Date(s) of release from prison
(viii) Was/were any appeal(s)/revision(s) filed against above conviction(s) ..Yes/No
(ix) Date and particulars of appeal(s)/application(s) for revision filed .
(x) Name of the court(s) before which the appeal(s)/application(s) for revision filed ..
(xi) Whether the said appeal(s)/application(s) for revision has/have been disposed of or is/are pending ..
(xii) If the said appeal(s)/application(s) for revision has/have been disposed of
(a) Date(s) of disposal
(b) Nature of order(s) passed .
126[(2) Whether the candidate is holding any office of profit under the Government of India or State Government? ..(Yes/No)
If Yes, details of the office held
(3) Whether the candidate has been declared insolvent by any Court? .(Yes/No)
If Yes, has he been discharged from insolvency
(4) Whether the candidate is under allegiance or adherence to any foreign country? (Yes/No)
If Yes, give details ..
(5) Whether the candidate has been disqualified under Section 8-A of the said Act by an order of the President? (Yes/No)
If Yes, the period for which disqualified ..
(6) Whether the candidate was dismissed for corruption or for disloyalty while holding office under the Government of India or the Government of any State? (Yes/No)
If Yes, the date of such dismissal ..
(7) Whether the candidate has any subsisting contract(s) with the Government either in individual capacity or by trust or partnership in which the candidate has a share for supply of any goods to that Government or for execution of works undertaken by that Government? ..(Yes/No)
If Yes, with which Government and details of subsisting contract(s)
(8) Whether the candidate is a managing agent, or manager or Secretary of any company or Corporation (other than a cooperative society) in the capital of which the Central/Government or State Government has not less than twenty-five percent share? (Yes/no)
If Yes, with which Government and the details thereof ..
(9) Whether the candidate has been disqualified by the Commission under Section 10-A of the said Act ..(Yes/No)
If yes, the date of disqualification ]
| Place: |
|
| Date: |
Signature of the candidate |
Part III
(To be filled by the Returning Officer)
Serial No. of Nomination Paper ..
This nomination was delivered to me at my office at .. (hours) on .(date) by the candidates/proposer ..(Name).
| Date .. |
Returning Officer |
NOTE. Wherever alternative is provided score out the word(s) not applicable.
Part IV
Decision of Returning Officer accepting or rejecting the Nomination Paper
I have examined this nomination paper in accordance with Section 36 of the Representation of the People Act, 1951(43 of 1951) and, decide as follows
| Date .. .. |
Returning Officer |
Perforation
Part V
Receipt of Nomination Paper and Notice of Scrutiny
(To be handed over to the person presenting the nomination paper)
Serial No. of Nomination Paper .. .
The nomination paper of ..a candidate for election to the Council of States by the elected members of the Legislative Assembly of .. (State)/Members of the Electoral College of . (State)/was delivered to me at my office at ..(hour) on ..(date) by the candidate/proposer . .(Name). All nomination papers will be taken up for scrutiny at ..(hour) on .. .(date) at .(place).
| Date . .. |
Returning Officer(s) |
Form 2-D
(See Rule 4)
NOMINATION PAPERS
Election to the Legislative Council of (State) by the Members of the Legislative Assembly.
| |
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| |
Recent stamp size (2cm 2.5cm) photograph in white/off white background with full face view. |
Part I
We hereby nominate as a candidate for the above election:
Candidate's name . father's/mother's/husband's name His postal address His name is entered at Sl. No .in Part No .of the electoral roll for the ..assembly constituency.
We declare that we are members of Legislative Assembly of ..and our names are entered as indicated below in the list maintained under Section 152 and we append our signatures below in token of subscribing to his nomination.
Particulars of the proposers and their signatures
| Sl. No. |
Sl. No. as entered in the list maintained under Section 152 |
Full Name |
Signature |
Date |
| 1 |
2 |
3 |
4 |
5 |
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*There should be ten per cent of the members of the Legislative Assembly or ten members concerned, whichever is less, as proposers.
I, the abovementioned candidate, assent to this nomination and hereby declare that
(a) I am a citizen of India and have not acquired the citizenship of any foreign State;
(b) I have completed .years of age;
(c) I am set up at this election by the .party;
(d) my name and my [father's/mother's/husband's name] have been correctly spelt out above in ..(name of the language); and
(e) to the best of my knowledge and belief, I am qualified and not also disqualified for being chosen to fill the seat in the Legislative Council of .(State) by the members of the Legislative Assembly.
| Date |
Signature of the candidate |
Part II
(To be filled by the candidate)
127[(1)] Whether the candidate
| (i) has been convicted (a) of any offence(s) under sub-section (1); or (b) for contravention of any law specified in sub-section (2), of Section 8 of the Representation of the People Act, 1951 (43 of 1951); or Yes/No (ii) has been convicted for any other offence(s) for which he has been sentenced to imprisonment for two years or more. |
.png) |
If the answer is Yes , the candidate shall furnish the following information:
(i) Case/First information report No./Nos. ..
(ii) Police station(s) District(s) State(s) ..
(iii) Section(s) of the concerned Act(s) and brief description of the offence(s) for which he has been convicted
(iv) Date(s) of conviction(s)
(v) Court(s) which convicted the candidate
(vi) Punishment(s) imposed [indicate period of imprisonment(s) and/or quantam of fine(s)] .
(vii) Date(s) of release from prison
(viii) Was/were any appeal(s)/revision(s) filed against above conviction(s) ..Yes/No
(ix) Date and particulars of appeal(s)/application(s) for revision filed
(x) Name of the court(s) before which the appeal(s)/application(s) for revision filed
(xi) Whether the said appeal(s)/application(s) for revision has/have been disposed of or is/are pending .
(xii) If the said appeal(s)/application(s) for revision has/have been disposed of
(a) Date(s) of disposal ..
(b) Nature of order(s) passed .
128[(2) Whether the candidate is holding any office of profit under the Government of India or State Government? ..(Yes/No)
If Yes, details of the office held
(3) Whether the candidate has been declared insolvent by any Court? .(Yes/No)
If Yes, has he been discharged from insolvency
(4) Whether the candidate is under allegiance or adherence to any foreign country? (Yes/No)
If Yes, give details ..
(5) Whether the candidate has been disqualified under Section 8-A of the said Act by an order of the President? (Yes/No)
If Yes, the period for which disqualified ..
(6) Whether the candidate was dismissed for corruption or for disloyalty while holding office under the Government of India or the Government of any State? (Yes/No)
If Yes, the date of such dismissal ..
(7) Whether the candidate has any subsisting contract(s) with the Government either in individual capacity or by trust or partnership in which the candidate has a share for supply of any goods to that Government or for execution of works undertaken by that Government? ..(Yes/No)
If Yes, with which Government and details of subsisting contract(s)
(8) Whether the candidate is a managing agent, or manager or Secretary of any company or Corporation (other than a cooperative society) in the capital of which the Central/Government or State Government has not less than twenty-five percent share? (Yes/no)
If Yes, with which Government and the details thereof ..
(9) Whether the candidate has been disqualified by the Commission under Section 10-A of the said Act ..(Yes/No)
If yes, the date of disqualification ]
| Place: |
|
| Date: |
Signature of the candidate |
Part III
(To be filled by the Returning Officer)
Serial No. of Nomination Paper ..
This nomination was delivered to me at my office at .. .(hour) on .(date) by the candidate/proposer .(Name).
Date
Returning Officer
Part IV
Decision of Returning Officer accepting or rejecting the Nomination Paper
I have examined this nomination paper in accordance with Section 36 of the Representation of the People Act, 1951, and decide as follows:
Dated .
Returning Officer
.. (Perforation)
Part V
Receipt for Nomination Paper and Notice of Scrutiny
(To be handed over to the person presenting the nomination paper)
Serial No. nomination paper .
The nomination paper of ..a candidate for election to the Legislative Council of (State) by the Members of Legislative Assembly was delivered to me at my office at (hour) on ..(date) by the candidate/proposer (Name). All nomination papers will be taken up for scrutiny at ..(hour) on ..(date) at (place).
| Date .. |
Returning Officer |
Note: wherever alternative is provided score out the word(s) not applicable.
Form 2-E
(See Rule 4)
NOMINATION PAPER
Election to the Legislative Council of (State) from a Council constituency
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Recent stamp size (2cm 2.5cm) photograph in white/off white background with full face view. |
Part I
We hereby nominate as a candidate for election to the Legislative Council of ..(State) from the constituency.
Candidate's name .(Father's/Mother's/Husband's name) ..His Postal address His name is entered at Sl. No .in Part No. ..of the electoral roll for ..Assembly Constituency.
We declare that we are electorals and our name entered in the electoral roll for (Council) constituency as indicated below and we append our signatures below in token of subscribing to this nomination
Particulars of the proposers and their signatures
| Sl. No. |
Elector Roll No. of Proposer |
Full Name |
Signature |
Date |
| Part No. of Electoral Roll |
Sl. No. in that part |
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*There should be ten per cent of the electors of the constituency or ten such electors whichever is less, as proposers.
I, the abovementioned candidate, assent to this a nomination and hereby declare that
(a) I am a citizen of India and have not acquired the citizenship of any foreign State;
(b) I have completed .years of age;
(c) I am set up at this election by the ..party;
(d) my name and my (father's/mother's/husband's name) has been correctly spelt out above in .(name of the language); and
(e) to the best of my knowledge and belief, I am qualified and not also disqualified for being chosen to fill the seat in the Legislative Council of (State) from . Council constituency.
I also declare that I have not been and shall not be, nominated as a candidate at the present biennial election/bye-elections being held simultaneously, to the Legislative Council of .(State) from more than two Council constituencies in the State.
Date ..
Signature of the Candidate
*Score out the words not applicable
Part II
(To be filled by the candidate)
129[(1)] Whether the candidate
| (i) has been convicted (a) of any offence(s) under sub-section (1); or (b) for contravention of any law specified in sub-section (2), of Section 8 of the Representation of the People Act, 1951 (43 of 1951); or Yes/No (ii) has been convicted for any other offence(s) for which he has been sentenced to imprisonment for two years or more. |
.png) |
If the answer is Yes , the candidate shall furnish the following information:
(i) Case/First information report No./Nos. ..
(ii) Police station(s) District(s) State(s) ..
(iii) section(s) of the concerned Act(s) and brief description of the offence(s) for which he has been convicted ..
(iv) date(s) of conviction(s)
(v) Court(s) which convicted the candidate ..
(vi) Punishment(s) imposed [indicate period of imprisonment(s) and/or quantam of fine(s)] .
(vii) Date(s) of release from prison
(viii) Was/were any appeal(s)/revision(s) filed against above conviction(s) ..Yes/No
(ix) Date and particulars of appeal(s)/application(s) for revision filed .
(x) Name of the court(s) before which the appeal(s)/application(s) for revision filed .
(xi) Whether the said appeal(s)/application(s) for revision has/have been disposed of or is/are pending .
(xii) If the said appeal(s)/application(s) for revision has/have been disposed of
(a) Date(s) of disposal ..
(b) Nature of order(s) passed .
130[(2) Whether the candidate is holding any office of profit under the Government of India or State Government? ..(Yes/No)
If Yes, details of the office held
(3) Whether the candidate has been declared insolvent by any Court? .(Yes/No)
If Yes, has he been discharged from insolvency
(4) Whether the candidate is under allegiance or adherence to any foreign country? (Yes/No)
If Yes, give details ..
(5) Whether the candidate has been disqualified under Section 8-A of the said Act by an order of the President? (Yes/No)
If Yes, the period for which disqualified ..]
(6) Whether the candidate was dismissed for corruption or for disloyalty while holding office under the Government of India or the Government of any State? (Yes/No)
If Yes, the date of such dismissal ..
(7) Whether the candidate has any subsisting contract(s) with the Government either in individual capacity or by trust or partnership in which the candidate has a share for supply of any goods to that Government or for execution of works undertaken by that Government? ..(Yes/No)
If Yes, with which Government and details of subsisting contract(s)
(8) Whether the candidate is a managing agent, or manager or Secretary of any company or Corporation (other than a cooperative society) in the capital of which the Central/Government or State Government has not less than twenty-five percent share? (Yes/no)
If Yes, with which Government and the details thereof ..
(9) Whether the candidate has been disqualified by the Commission under Section 10-A of the said Act ..(Yes/No)
If yes, the date of disqualification ]
| Place: |
|
| Date: |
Signature of the candidate |
Part III
(To be filled by the Returning Officer)
Serial No. of Nomination Paper
This nomination was delivered to me at my office at (hour) on (date) by the candidate/proposer .(Name).
Date ..
Returning Officer
Part IV
Decision of Returning Officer accepting or rejecting the Nomination Paper
I have examined this nomination paper in accordance with Section 36 of the Representation of the People Act, 1951 and decide as follows
Date
Returning Officer
Part V
Receipt for Nomination Paper and Notice of Scrutiny
(To be handed over to the person presenting the nomination paper)
Serial No. of nomination paper
The nomination paper of a candidate for election to the Legislative Council of .. (State) from the Graduates'/(Teachers'/Local Authorities') constituency was delivered to me at my office at (hour) on (date) by the candidate/proposer . (Name). All nomination papers will be taken up for scrutiny at (hour) on (date) at (Place).
Date ..
Returning Officer
Note: wherever alternative is provided score out the word(s) not applicable.
Form 2-F
(See Rule 4)
NOMINATION PAPER
Election to the Legislative Assembly of Sikkim from a Constituency reserved for Sikkimese of Bhutia-Lepcha origin
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Recent stamp size (2cm 2.5cm) photograph in white/off white background with full face view to be attached. |
Part I
(To be used by candidate set up recognised political party)
I nominate as a candidate for election to the Legislative Assembly of Sikkim from the . .. Assembly Constituency.
Candidate's name Father's/mother's/husband's Name his postal address .. .. his name is entered at Sl. No in Part number of the electoral roll for the ..Assembly Constituency.
My name is . and it is entered at Sl. No ..in Part No ..of the electoral roll for the .. Assembly Constituency.
| Date |
Signature of Proposer |
Part II
(To be used by candidate not set up recognized political party)
We hereby nominate as candidate for election to the Legislative Assembly of Sikkim from the . Assembly Constituency.
Candidate's name Father's/mother's husband's name his postal address .. His name is entered at Sl. No in Part number of the electoral roll for the ..Assembly Constituency.
We declare that we are electors of this Assembly Constituency and our names are entered in the electoral roll for this Assembly Constituency as indicated below and we append our signatures below in token of subscribing to this nomination:
Particulars of the proposers and their signatures
| Sl. No. |
Elector Roll No. of Proposer |
Full Name |
Signature |
Date |
| Part No. of Electoral Roll of the Constituency |
Sl. No. in that part |
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2 |
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6 |
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N.B. There should be ten electors of the constituency as proposers as required under the proviso to sub-section (1) of Section 33 of the Representation of the People Act, 1951.
Part III
I, the candidate mentioned in Part I*/Part II* assent to this nomination and hereby declare that
(a) I am a citizen of India and have not acquired the citizenship of any foreign State.
(b) I have completed .years of age;
(c)(i) * I am set up at this election by the party, which is recognised National Party*/State Party* in this State and that the symbol reserved for the above party be allotted to me;
(c)(ii) * I am set up at this election by the . party, which is a registered/unrecognised political party*/that I am contesting this election as an independent candidate* and that the symbols that I have chosen, in order of preference, are
(1) . (2) (3) ..
(d) my name and my father's/mother's/husband's name have been correctly spelt out above in (name of the language); and
(e) to the best of my knowledge and belief, I am qualified and not also disqualified for being chosen to fill the seat in the Legislative Assembly of this State.
I further declare that I am a Sikkimese of Bhutia/Lepcha origin.
131[I also declare that I have not been, and shall not be nominated as a candidate at the present general election or the bye-elections being held simultaneously, to the Legislative Assembly of Sikkim from more than two Assembly constituencies.]
| Date |
Signature of Candidate |
*Strike out which is not applicable.
_____________________________________________________________________________________
N.B. A recognised political party means a political party recognised by the Election Commission under the Election Symbols (Reservation and Allotment) Order, 1968 in the State of Sikim.
Part IV
(To be filled by the candidate)
132[(1)] Whether the candidate
| (i) has been convicted (a) of any offence(s) under sub-section (1); or (b) for contravention of any law specified in sub-section (2), of Section 8 of the Representation of the People Act, 1951 (43 of 1951); or Yes/No (ii) has been convicted for any other offence(s) for which he has been sentenced to imprisonment for two years or more. |
.png) |
If the answer is Yes , the candidate shall furnish the following information:
(i) Case/First information Report No./Nos. ..
(ii) Police Station(s) .District(s) State(s) .
(iii) Section(s) of the concerned Act(s) and brief description of the offence(s) for which he has been convicted
(iv) Date(s) of conviction(s)
(v) Court(s) which convicted the candidate
(vi) Punishment(s) imposed [indicate period of imprisonment(s) and/or quantum of fine(s)] ..
(vii) Date(s) of release from prison
(viii) Was/were any appeal(s)/revision(s) filed against above conviction(s) Yes/No.
(ix) Date and particulars of appeal(s)/application(s) for revision filed .
(x) Name of the court(s) before which the appeal(s)/application(s) for revision filed
(xi) Whether the said appeal(s)/application(s) for revision has/have been disposed of or is/are pending
(xii) If the said appeal(s)/application(s) for revision has/have been disposed of
(a) Date(s) of disposal
(b) Nature of order(s) passed
133[2. Whether the candidate is holding any office of profit under the Government of India or the State Government? . . . . . . . . (Yes/No).
If Yes, details of the office held . . . . . . . .
3. Whether the candidate has been delcared as an insolvent by any court? . . . . . (Yes/No)
If Yes, has he been discharged from the insolvency . . . . . . . .
4. Whether the candidate is under allegiance or adherence to any foreign country? . . . . . . . . . (Yes/No).
If Yes, give details . . . . . . . .
5. Whether the candidate has been disqualified under Section 8-A of the Representation of the People Act, 1951, by an order of the President? . . . . . . (Yes/No)
If Yes, the period for which the candiate has been disqualified. . . . . . .
6. Whether the candidate was dismissed for corruption or for disloyalty while holding office under the Government of India or the Government of any State? . . . . . (Yes/No)
If Yes, the date of such dismissal . . . . . . . .
7. Whether the candidate has any subsisting contract(s) with the Government either individual capacity or by trust or partnership in which the candidate has a share for supply of any goods to that Government or for execution of works undertaken by that Government? . . . . . . (Yes/No)
If Yes, with which Government and the details of subsisting contract(s) . . . . . . . .
8. Whether the candidate is a managing agent, or manager or secretary of any company or corporation (other than a cooperative society) in the capital of which the Central Government or the State Government has not less than twenty five per cent share? . . . . . . (Yes/No)
If Yes, with which Government and the details thereof . . . . . . . .
9. Whether the candidate has been disqualified by the Election Commission under Section 10-A of the Representation of the People Act, 1951 . . . . . . (Yes/No)
If Yes, the date of disqualification . . . . . . . .]
| Place: |
Signature of the candidate |
| Date: |
|
Part V
(To be filled by the Returning Officer)
Serial number of nomination paper
This nomination was delivered to me at my office at (hour) on (date) by the *candidate/*proposer .
*Strike out which is not applicable.
Part VI
Decision of Returning Officer accepting or rejecting the nomination paper
I have scrutinised this nomination paper in accordance with the provisions of Section 36 of the Representation of the People Act, 1951 and decide as follows
| Date .. |
Returning Officer |
Part VII
Receipt for Nomination Paper and Notice of Scrutiny
(To be handed over to the person presenting the nomination paper)
Serial No. of nomination paper ..
The nomination paper of a candidate for election from the Assembly Constituency was delivered to me at my office at (hour) on (date) by the *candidate/*proposer. All nomination papers will be taken up for scrutiny at (hour) on .. (date) at (place).
*Strike out which is not applicable].
Form 2-G
(See Rule 4)
NOMINATION PAPER
Election to the Legislative Assembly of Sikkim from a general Constituency or a constituency Reserved for Scheduled Caste
| |
|
| |
Recent stamp size (2cm 2.5cm) photograph in white/off white background with full face view to be attached. |
Part I
(To be used by candidate set up by recognised political party)
I nominate as a candidate for election to the Legislative Assembly of Sikkim from the . Assembly Constituency.
Candidate's name Father's/mother's/husband's name his postal address .. his name is entered at Sl. No in Part number of the electoral roll for the ..Assembly Constituency.
My name is . and it is entered at Sl. No .in Part No ..of the electoral roll for the .. Assembly Constituency.
| Date |
Signature of proposer |
Part II
(To be used by candidate not set up recognized political party)
We hereby nominate as candidate for election to the Legislative Assembly of Sikkim from the Assembly Constituency.
Candidate's name Father's/mother's husband's name
His postal address his name is entered at Sl. No in Part number of the electoral roll for the ..Assembly Constituency.
We declare that we are electors of this Assembly Constituency and our names are entered in the electoral roll for this Assembly Constituency as indicated below and we append our signatures below in token of subscribing to this nomination:
Particulars of the proposers and their signatures
| Sl. No. |
Elector Roll No. of Proposer |
Full Name |
Signature |
Date |
| Part No. of Electoral Roll of the constituency |
Sl. No. in that part |
| 1. |
2 |
3 |
4 |
5 |
6 |
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N.B. There should be ten electors of the constituency as proposers as required under the proviso to sub-section (1) of Section 33 of the Representation of the People Act, 1951.
Part III
I, the candidate mentioned in Part I*/Part II*, assent to this nomination and hereby declare that
(a) I am a citizen of India and have not acquired the citizenship of any foreign State.
(b) I have completed .year of age;
(c)(i) *I am set up at this election by the party; which is recognised National Party/*State Party* in this State and that the symbol reserved for the above party be allotted to me.
(c)(ii) *I am set up at this election by the party, which is a registered-unrecognised political party*/that I am contesting this election as an independent candidate* and that the symbols I have chosen, in order of preference, are
(1) (2) (3)
(d) my name and my father's/mother's/husband's name have been correctly spelt out above in (name of the language); and
(e) to the best of my knowledge and belief, I am qualified and not also disqualified for being chosen to fill the seat in the Legislative Assembly of this State.
*I further declare that I am a Member of the caste which is a Scheduled Caste of the State of Sikkim
134[I also declare that I have not been, and shall not be nominated as a candidate at the present general election or the bye-elections being held simultaneously, to the Legislative Assembly of Sikkim from more than two Assembly constituencies.]
| Date . |
Signature of Candidate |
*Strike out which is not applicable.
N.B. A recognised political party means a political party recognised Election Commission under the Election Symbols (Reservation and Allotment) Order, 1968 in the State of Sikkim.
Part IV
(To be filled by the candidate)
135[(1)] Whether the candidate
(i) has been convicted
(a) of any offence(s) under sub-section (1); or
(b) for contravention of any law specified in sub-section (2), of Section 8 of the Representation of the People Act, 1951 (43 of 1951); or Yes/No
(ii) has been convicted for any other offence(s) for which he has been sentenced to imprisonment for two years or more.
If the answer is Yes , the candidate shall furnish the following information:
(i) Case/First information Report No./Nos. ..
(ii) Police Station(s) .District(s) .State(s) .
(iii) Section(s) of the concerned Act(s) and brief description of the offence(s) for which he has been convicted
(iv) Date(s) of conviction(s) .
(v) Court(s) which convicted the candidate .
(vi) Punishment(s) imposed [indicate period of imprisonment(s) and/or quantum of fine(s)] .
(vii) Date(s) of release from prison
(viii) Was/were any appeal(s)/revision(s) filed against above conviction(s) Yes/No.
(ix) Date and particulars of appeal(s)/application(s) for revision filed
(x) Name of the court(s) before which the appeal(s)/application(s) for revision filed
(xi) Whether the said appeal(s)/application(s) for revision has/have been disposed of or is/are pending
(xii) If the said appeal(s)/application(s) for revision has/have been disposed of
(a) Date(s) of disposal ..
(b) Nature of order(s) passed
136[2. Whether the candidate is holding any office of profit under the Government of India or the State Government? . . . . . . . . (Yes/No).
If Yes, details of the office held . . . . . . . .
3. Whether the candidate has been delcared as an insolvent by any court? . . . . . (Yes/No)
If Yes, has he been discharged from the insolvency . . . . . . . .
4. Whether the candidate is under allegiance or adherence to any foreign country? . . . . . . . . . (Yes/No).
If Yes, give details . . . . . . . .
5. Whether the candidate has been disqualified under Section 8-A of the Representation of the People Act, 1951, by an order of the President? . . . . . . (Yes/No)
If Yes, the period for which the candiate has been disqualified. . . . . . .
6. Whether the candidate was dismissed for corruption or for disloyalty while holding office under the Government of India or the Government of any State? . . . . . (Yes/No)
If Yes, the date of such dismissal . . . . . . . .
7. Whether the candidate has any subsisting contract(s) with the Government either individual capacity or by trust or partnership in which the candidate has a share for supply of any goods to that Government or for execution of works undertaken by that Government? . . . . . . (Yes/No)
If Yes, with which Government and the details of subsisting contract(s) . . . . . . . .
8. Whether the candidate is a managing agent, or manager or secretary of any company or corporation (other than a cooperative society) in the capital of which the Central Government or the State Government has not less than twenty five per cent share? . . . . . . (Yes/No)
If Yes, with which Government and the details thereof . . . . . . . .
9. Whether the candidate has been disqualified by the Election Commission under Section 10-A of the Representation of the People Act, 1951 . . . . . . (Yes/No)
If Yes, the date of disqualification . . . . . . . .]
| Place: |
Signature of the candidate |
| Date: |
|
Part V
(To be filled by the Returning Officer)
Serial number of nomination paper
This nomination was delivered to me at my Office at (hour) on (date) by the
*candidate/*proposer .
*Strike out which is not applicable.
Part VI
Decision of Returning Officer accepting or rejecting the Nomination Paper
I have scrutinised this nomination paper in accordance with the provisions of Section 36 of the Representation of the People Act, 1951 and decide as follows:
| Date .. |
Returning Officer |
Part VII
Receipt for nomination paper and notice of scrutiny
(To be handed over to the person presenting the nomination paper)
Serial No. of nomination paper ..
The nomination paper of a candidate for election from the .Assembly Constituency was delivered to me at my office at (hour) on (date) by the *candidate/*proposer. All nomination papers will be taken up for scrutiny at (hour) on (date) at (place).
| Date .. |
Returning Officer |
*Strike out which is not applicable.
Form 2-H
(See Rule 4)
NOMINATION PAPER
Election to the Legislative Assembly of Sikkim from Sangha Constituency
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|
| |
Recent stamp size (2cm 2.5cm) photograph in white/off white background with full face view to be attached. |
Part I*
(To be used by candidate set up by recognised political party)
I nominate as a candidate for election to the Legislative Assembly of Sikkim from the Sangha Constituency.
Candidate's name Father's/mother's/husband's name his postal address ..his name is entered at Sl. No ..in part number ..of the electoral roll for the Assembly Constituency.
My name is. .and it is entered at Sl. No .in Part No. of the electoral roll for the Sangha Constituency.
| Date .. |
Signature of proposer |
Part II*
(To be used by the candidate not set up by the recognized political party)
We hereby nominate as candidate for election to the Legislative Assembly of Sikkim from the Sangha Constituency.
Candidate's name . Father's/mother's/husband's name .. his postal address .. .. is name is entered at Sl. No. ..in part number .of the electoral roll for the . Sangha Constituency.
We declare that we are electors of this Assembly Constituency and our names are entered in the electoral roll for this Assembly Constituency as indicated below and we append our signatures below in token of subscribing to this nomination:
Particulars of the proposers and their signatures
| Sl. No. |
Elector Roll No. of Proposer |
Full Name |
Signature |
Date |
| Part No. of Electoral Roll of the Constituency |
Sl. No. in that part |
| 1. |
2 |
3 |
4 |
5 |
6 |
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N.B. There should be ten electors of constituency as proposers as required under the proviso to sub-section (1) of Section 33 of the Representation of the People Act, 1951.
*Strike out the part which is not applicable.
Part III
I, the candidate mentioned in Part I*/Part II* assent to this nomination and hereby declare that
(a) I am a citizen of India and have not acquired the citizenship of any foreign State.
(b) I have completed .years of age;
(c)(i) *I am set up at this election by the party, which is recognised National Party/*State Party* in this State and that the symbol reserved for the above party be allotted to me.
(c)(ii) *I am set up at this election by the party, which is a registered-unrecognised political party*/that I am contesting this election as an independent candidate* and that the symbols I have chosen, in order of preference, are:
(1) (2) (3) ;
(d) my name and my father's/mother's/husband's name have been correctly spelt out above in (name of the language); and
(e) to the best of my knowledge and belief, I am qualified and not also disqualified for being chosen to fill the seat in the Legislative Assembly of this State.
I further declare that I am a member of the caste which is a Scheduled Caste of the State of Sikkim.
137[I also declare that I have not been, and shall not be nominated as a candidate at the present general election or the bye-elections being held simultaneously, to the Legislative Assembly of Sikkim from more than two Assembly constituencies.]
| Date |
Signature of Candidate |
N.B. A recognised political party means a political party recognised by the Election Commission under the Election Symbols (Reservation and Allotment) Order, 1968 in the State of Sikkim.
Part IV
(To be filled by the candidate)
138[(1)] Whether the candidate
(i) has been convicted
(a) of any offence(s) under sub-section (1); or
(b) for contravention of any law specified in sub-section (2), of Section 8 of the Representation of the People Act, 1951 (43 of 1951); or Yes/No.
(ii) has been convicted for any other offence(s) for which he has been sentenced to imprisonment for two years or more.
If the answer is Yes , the candidate shall furnish the following information:
(i) Case/First information report No./Nos.
(ii) Police Station(s) .District(s) .State(s)
(iii) Section(s) of the concerned Act(s) and brief description of the offence(s) for which he has been convicted
(iv) Date(s) of conviction(s)
(v) Court(s) which convicted the candidate
(vi) Punishment(s) imposed [indicate period of imprisonment(s) and/or quantum of fine(s)]
(vii) Date(s) of release from prison
(viii) Was/were any appeal(s)/revision(s) filed against above conviction(s) Yes/No.
(ix) Date and particulars of appeal(s)/application(s) for revision filed
(x) Name of the court(s) before which the appeal(s)/application(s) for revision filed
(xi) Whether the said appeal(s)/application(s) for revision has/have been disposed of or is/are pending
(xii) If the said appeal(s)/application(s) for revision has/have been disposed of
(a) Date(s) of disposal ..
(b) Nature of order(s) passed
139[2. Whether the candidate is holding any office of profit under the Government of India or the State Government? . . . . . . . . (Yes/No).
If Yes, details of the office held . . . . . . . .
3. Whether the candidate has been delcared as an insolvent by any court? . . . . . (Yes/No)
If Yes, has he been discharged from the insolvency . . . . . . . .
4. Whether the candidate is under allegiance or adherence to any foreign country? . . . . . . . . . (Yes/No).
If Yes, give details . . . . . . . .
5. Whether the candidate has been disqualified under Section 8-A of the Representation of the People Act, 1951, by an order of the President? . . . . . . (Yes/No)
If Yes, the period for which the candiate has been disqualified . . . . . . .
6. Whether the candidate was dismissed for corruption or for disloyalty while holding office under the Government of India or the Government of any State? . . . . . (Yes/No)
If Yes, the date of such dismissal . . . . . . . .
7. Whether the candidate has any subsisting contract(s) with the Government either individual capacity or by trust or partnership in which the candidate has a share for supply of any goods to that Government or for execution of works undertaken by that Government? . . . . . . (Yes/No)
If Yes, with which Government and the details of subsisting contract(s) . . . . . . . .
8. Whether the candidate is a managing agent, or manager or secretary of any company or corporation (other than a cooperative society) in the capital of which the Central Government or the State Government has not less than twenty five per cent share? . . . . . . (Yes/No)
If Yes, with which Government and the details thereof . . . . . . . .
9. Whether the candidate has been disqualified by the Election Commission under Section 10-A of the Representation of the People Act, 1951 . . . . . . (Yes/No)
If Yes, the date of disqualification . . . . . . . .]
| Place: |
Signature of the candidate |
| Date: |
|
Part V
(To be filled by the Returning Officer)
Serial number of nomination paper
This nomination was delivered to me at my Office at (hour) on (date) by the *candidate/*proposer
| Date .. |
Returning Officer |
*Strike out which is not applicable.
Part VI
Decision of Returning Officer accepting or rejecting the nomination paper
I have scrutinised this nomination paper in accordance with the provisions of Section 36 of the Representation of the People Act, 1951 and decide as follows:
Part VII
Receipt for Nomination Paper and Notice of Scrutiny
(To be handed over to the person presenting the nomination paper)
Serial No. of nomination paper .
The nomination paper of a candidate for election from the Sangha Constituency was delivered to me at my office at (hour) on (date) by the *candidate/*proposer.
All nomination papers will be taken up for scrutiny at (hour) on (date) at (place).
*Score out which is not applicable.]
140[Form 3-A
(See Rule 7)
Notice of Nominations
Election to the *House of the People/Legislative Assembly from the Constituency
Notice is hereby given that the following nominations in respect of the above election have been received up to 3 p.m. today:
| Sl. No. of Nomination paper |
Name of Candidate |
Name of father/mother/husband |
Age of candidate |
Address |
| 1 |
2 |
3 |
4 |
5 |
| |
|
|
|
|
| |
|
|
|
|
| |
|
|
|
|
| |
|
|
|
|
| |
|
|
|
|
| Party affiliation |
Particulars of castes, or tribes for candidates belonging to Scheduled Castes or Scheduled Tribes |
Electoral roll number of candidate |
Names of proposers |
Electoral roll No. of proposers |
| 6 |
7 |
8 |
9 |
10 |
| |
|
|
|
|
| Place Date |
Returning Officer |
* Strike off the inappropriate alternative.
141[Form 3-B
(See Rule 7)
Notice of Nomination
Election to the Council of States/Legislative Council by the elected members of the Legislative Assembly/Electoral College of ..
Notice is hereby given that the following nominations in respect of the above election have been received up to 3 p.m. today:
| Sl. No. of Nomination paper |
Name of Candidate |
Name of 142[father/mother/husband] |
Age of candidate |
Address |
| 1 |
2 |
3 |
4 |
5 |
| |
|
|
|
|
| Party affiliation |
Electoral roll number of candidate |
Names of proposers |
Serial Numbers of proposers in the list maintained under Section 152 |
| 6 |
7 |
8 |
9 |
| |
|
|
|
| Place .. Date |
Returning Officer |
Note: Wherever alternative is provided score out the word(s) not applicable.
Form 3-C
(See Rule 7)
Notice of Nomination
Election to the Legislative Council of (State) from the .. constituency
Notice is hereby given that the following nominations in respect of the above election have been upto 3 p.m. today:
| Sl. No. of Nomination paper |
Name of Candidate |
Name of 143[father/mother/husband] |
Age of candidate |
Address |
| 1 |
2 |
3 |
4 |
5 |
| |
|
|
|
|
| Party affiliation |
Electoral roll number of candidate in assembly constituency |
Names of proposers |
Electoral roll Nos. of proposers in the Council constituency |
| 6 |
7 |
8 |
9 |
| |
|
|
|
|
| |
|
|
|
|
| Place Date |
Returning Officer |
Note: Wherever alternative is provided score out the word(s) not applicable.
144[Form 4
(See Rule 8)
List of Validly Nominated Candidates
Election to the*
| Sl. No. |
Name of candidate |
Name of **Father/mother/husband |
Address of candidate |
@Party affiliation |
| 1 |
2 |
3 |
4 |
5 |
| |
|
|
|
|
| |
|
|
|
|
(i) Candidates of recognised National and State Political Parties.
(ii) Candidates of registered political parties (other than recognised National and State Political Parties).
(iii) Other candidates.
| Place . |
|
| Date .. |
Returning Officer |
*Appropriate particulars of the election to be inserted here.
**Strike off the inappropriate alternative.]
@Applicable in the case of candidates mentioned under categories (i) and (ii) above.
N.B. Under Col. 1 above, the serial numbers of candidates of all the three categories shall be given consecutively and not separately for each category.]
Form 5
[See Rule 9(1)]
Notice of Withdrawal of Candidature
Election to the* .
The Returning Officer,
I, .., a 145[candidate validly nominated] at the above election do hereby give notice that I withdraw my candidature.
| Place . |
|
| Date .. |
Signature of 146[validly nominated candidate] |
This notice was delivered to me at my office at (hour) on .. (date) by (name), the .
| Date .. |
Returning Officer. |
Receipt for Notice of Withdrawal
(To be handed over to the person delivering the notice)
The notice of withdrawal of candidature by , a 147[validly nominated candidate] at the election to the* .was delivered to me by the at my office at .. (hour) on . (date).
Returning Officer.
*Here insert one of the following alternatives as may be appropriate:
(1) House of the People from the . constituency.
(2) Legislative Assembly from the constituency.
(3) Council of States by the elected members of the Legislative Assembly of . (State).
(4) Council of States by the members of the electoral college of .. (Union Territory).
(5) Legislative Council by the members of the Legislative Assembly.
(6) Legislative Council from the . constituency.
Here insert one of the following alternatives as may be appropriate:
(1) Candidate.
(2) Candidate's proposer who has been authorised in writing by the candidate to deliver it.
(3) Candidate's election agent who has been authorized in writing by the candidate to deliver it.
Form 6
[See Rule 9(2)]
Notice of Withdrawal of Candidatures
Election to the* .
Notice is hereby given that the following 148[validly nominated candidate]/candidates at the above election withdraw his candidature/their candidatures today.
| Name of 149[validly nominated candidate] |
Address of 150[validly nominated candidate] |
Remarks |
| 1. |
|
|
| 2. |
|
|
| 3. |
|
|
| etc. |
|
|
| Date .. |
Returning Officer |
*Appropriate particulars of the election to be inserted here.
Strike off the inappropriate alternative.
151[Form 7-A
[See Rule 10(1)]
List of Contesting Candidates
Election to the House of the People/Legislative Assembly from the Constituency.
| Sl. No. |
Name of candidate |
Address of candidate |
@Party affiliation |
Symbol allotted |
| 1 |
2 |
3 |
4 |
5 |
| |
|
|
|
|
(i) Candidates of recognised National and State Political Parties.
(ii) Candidates of registered political parties (other than recognised National and State Political Parties).
(iii) Other candidates.
| Place |
|
| Place Date .. |
Returning Officer |
*Applicable in the case of candidates mentioned under categories (i) and (ii) above.
N.B. Under Col. 1 above, the serial numbers of candidates of all the three categories shall be given consecutively and not separately for each category.]
152[Form 7-B
[See Rule 10(1)]
List of Contesting Candidates
Election to the* ..
| Sl. No. |
Name of candidate |
Address of candidate |
**Party affiliation |
| 1 |
2 |
3 |
4 |
| |
|
|
|
(i) Candidates of recognised National and State Political parties.
(ii) Candidates of registered political parties (other than recognised National and State Political Parties).
(iii) Other candidates.
| Place . |
|
| Date .. |
Returning Officer |
* Here insert one of the following alternatives as may be appropriate:
(1) Council of States by the elected members of the Legislative Assembly of .. (State).
(2) Council of States by the members of the electoral college .. (Union Territory).
(3) Legislative Council of . (State), by the members of the Legislative Assembly.
(4) Legislative Council of . (State), from the .. Constituency.
**Applicable in the case of candidates mentioned under categories (i) and (ii) above.
N.B. Under Col. 1 above, the serial numbers of candidates of all the three categories shall be given consecutively and not separately for each category.].
Form 8
[See Rule 12(1)]
Appointment of Election Agent
Election to the* ..
To
The Returning Officer,
I, ., of ..a candidate at the above election do hereby appoint .. of .. as my election agent from this day at the above election.
| Place . |
|
| Date .. |
Signature of candidate. |
I accept the above appointment.
Place .
Date ..
Signature of election agent.
153[Approved.
Signature and Seal of the
Returning Officer.]
*Here insert one of the following alternatives as may be appropriate:
(1) House of the People from the .. constituency.
(2) Legislative Assembly from the .. constituency.
(3) Council of States by the elected members of the Legislative Assembly of .. (State).
(4) Council of States by the members of the electoral college of . (Union territory).
(5) Legislative Council by the members of the Legislative Assembly.
(6) Legislative Council from the constituency.
Form 9
[See Rule 12(2)]
Revocation of Appointment of Election Agent
Election to the* .
To
The Returning Officer,
I, .., a candidate at the above election, hereby revoke the appointment of ..my election agent.
| Place .. |
|
| Date .. |
Signature of candidate. |
*Here insert one of the following alternatives as may be appropriate:
(1) House of the People from the . constituency.
(2) Legislative Assembly from the constituency.
(3) Council of States by the elected members of the Legislative Assembly of . (State).
(4) Council of States by the members of the electoral college of .. (Union territory).
(5) Legislative Council by the members of the Legislative Assembly.
(6) Legislative Council from the . constituency.
Form 10
[See Rule 13(2)]
*Appointment of Polling Agent
Election to the**
I, . a candidate/the election agent of who is a candidate at the above election do hereby 154[appoint (Name and address)] .as a polling agent to attend polling station No . at/place fixed for the poll .. at
| Place |
|
| Date .. |
Signature of candidate/election agent. |
| I agree to act as such polling agent. Place |
|
| Date .. |
Signature of polling agent. |
Declaration of polling agent to be signed before Presiding Officer
I hereby declare that at the above election I will not do anything forbidden by Section 128 of the Representation of the People Act, 1951, which I have read/has been read over to me.
| Date .. |
Signature of polling agent. |
| Signed before me. |
|
| Date .. |
Presiding Officer |
*To be handed over to the polling agent for production at the polling station or at the place fixed for the poll.
**Here insert one of the following alternatives as may be appropriate:
(1) House of the People from the .. constituency.
(2) Legislative Assembly from the .. constituency.
(3) Council of States by the elected members of the Legislative Assembly of . (State).
(4) Council of States by the members of the electoral college of .. (Union territory).
(5) Legislative Council by the members of the Legislative Assembly.
(6) Legislative Council from the . constituency.
Strike off the inappropriate alternative.
Section 128 of the Representation of the People Act, 1951:
128. Maintenance of secrecy of voting. (1) Every officer, clerk, agent or other person who performs any duty in connection with the recording or counting of votes at an election shall maintain, and aid in maintaining, the secrecy of the voting and shall not (except for some purpose authorised by or under any law) communicate to any person any information calculated to violate such secrecy.
(2) Any person who contravenes the provisions of sub-section (1) shall be punishable with imprisonment for a term which may extend to three months or with fine or with both. .
Form 11
[See Rule 14(1)]
Revocation of Appointment of Polling Agent
Election to the* .
To
The Presiding Officer,
I, [the election agent of ] a candidate at the above election, hereby revoke the appointment of .. my/his polling agent.
Place ..
Date
Signature of person revoking
*Here insert one of the following alternatives as may be appropriate:
(1) House of the People from the .constituency.
(2) Legislative Assembly from the . constituency.
(3) Council of States by the elected members of the Legislative Assembly of (State).
(4) Council of States by the members of the electoral college of . (Union territory).
(5) Legislative Council by the members of the Legislative Assembly.
(6) Legislative Council from the constituency.
N.B. Omit the words marked [] as necessary.
Form 12
(See Rules 19 and 20)
Letter of Intimation to Returning Officer
To
The Returning Officer for
Assembly/Parliamentary constituency.
Sir,
Legislative Assemble
I intend to cast my vote by post at the ensuing election to the from the
House of the People
Assembly
. constituency.
Paliamentary
My name is entered at Sl. No in Part No .. of the electoral roll for . assembly constituency comprised within Parliamentary constituency.
The ballot paper may be sent to me at the following address:
..
..
..
Yours faithfully,
Place ..
Date ..
..]
155[Form 12-A
[See Rule 20(2)]
Application for Election Duty Certificate
To
The Returning Officer,
Assembly
constituency.
Paliamentary
Sir,
Legislative Assemble
I intend to cast my vote in person at the ensuing election to the from the..
House of the People
. constituency.
I have been posted on election duty within the constituency at .. (No. and name of the polling station) but my name is entered at Serial No . Part No .. of the electoral rolls for assembly constituency comprised within . Parliamentary constituency.
I request that an Election Duty Certificate in Form 12-B may be issued to enable me to vote at the polling station where I may be on duty on the polling day.
It may be sent to me at the following address:
.
.
.
Yours faithfully,
Form 12-B
[See Rules 20(2) and 35-A]
Election Duty Certificate
Certified that is an elector in the .
Assembly
constituency, his electoral roll number being that by reason of his
Parliamentary
being on election duty he is unable to vote at the polling station where he is entitled to vote and that he is therefore hereby authorised to vote at any polling station 156[in the said constituency where] may be on duty on the date of poll.
| Place |
|
| Date .. |
Signature .. |
Returning Officer.
157[Form 12-C
[See Rule 27-C]
Part I
Letter of intimation to Assistant Returning Officer for notified class of electors:
To,
The Assistant Returning Officer,
(for the notified class of electors)
| .. .. |
Parliamentary/Assembly constituency (Designation & address of ARO) |
Sir,
I, .. son/daughter/wife of . resident of . of . village/mohalla . of . Town/city/tehsil .. District .. of .. (State) belong to the class of notified electors and wish to cast my vote by post at the election to the House of the People/Legislative Assembly from the .
My complete present postal address is as under:
house/dwelling unit/tent number ..
camp/mohalla/village .
ward/town/tehsil .
district .
State PIN CODE
My name is entered at serial number .. in Part No of the electoral roll for . parliamentary/assembly constituency.
*I am registered as a migrant with .. (designation of officer) Government of .. under registration No .. as a head/member of the family of self/Shri/Smt
*I am not registrered as a migrant.
*I am the head of my family and am serving as a Government employee as (designation) . in the office of .. (full address).
*I am the head of my family and am a pensioner and drawing pension under account No .. from Government Treasury/Branch of Bank, located at . (full address)
Yours faithfully,
Part II
Certificate by the officer-in-charge of the migrant camp/office/area or by head of the office where the applicant is serving as a migrant employee or by a treasury officer/bank manager from where the migrant is drawing his pension as a pensioner or by any gazetted officer.
It is hereby certified that the particulars given by the applicant in Part I are correct as per our record to the best of my knowledge and understanding.
. (Full signature)
of the Attesting Officer)
(Name)
.. (Address)
. (Rubber stamp)
*(Strike off whichever is not applicable and tick the relevant statement)
Note. Notified elector means the elector who belongs to the class of persons notified by the Election Commission under clause (c) of Section 60 of the Representation of the People Act, 1951. (A copy of the notification issued by the Election Commission of India is enclosed in this regard).]
158[Form 12-D
[See Rule 27-C]
Part I
Letter of intimation to Assistant Returning Officer
(for absentee voters)
To
The Assistant Returning Officer,
(for the notified class of electors)
..Parliamentary/Assembly constituency
..(designation and address of ARO)
Sir,
I, son/daughter/wife of ..... .resident of .. village/ mohalla ..Town/city/tehsil ..District (State) belong to the class of absentee voter and wish to cast my vote by post at the election to the House of the People/Legislative Assembly from the Parliamentary/ Assembly constituency.
My complete present postal address is as under
House/dwelling unit/tent number ..
Camp/mohalla/tent number ..
Ward/town/tehsil ..
District ..
State ..Pin Code
Mobile Phone No. (if available)
My name is entered at serial number .in Part No ..of the electoral roll for Parliamentary/Assembly constituency.
I am working as .. (designation of the office held) in
(Name and full address of organisation).
I will be on duty in the abovementioned office on the day of poll for the abovementioned election.
*On account of my official duties on the date of poll, I will not be in a position to be present in the polling station assigned to me on the day of poll.
OR
*I am ..years of age/am a person with disability, and am not in a position to go to the polling station to cast vote.
It is requested that postal ballot paper may be issued to me as absentee voter for the above election.
Yours faithfully,
(Full name and signature)
Part II
(for absentee voter other than senior citizen or persons with disability)
Certificate by the nodal officer appointed by the Organisation concerned.
It is hereby certified that the particulars given by the applicant in Part I are correct, and it is further certified that the applicant will be on official duty on the day of poll, and he/she will not be in a position to be present in the polling station on the day of poll.
.
(Full Signature of the attesting Officer)
(Name)
(Address)
..(Rubber Stamp)
Strike off whichever is not applicable and tick the relevant statement.
Note. This Application must reach RO within 5 days following the date of notification of election.]
Form 13-A
[See Rule 23(1)(a)]
Declaration by Elector
Election to the* ..
(This side is to be used only when the elector signs the declaration himself)
I hereby declare that I am the elector to whom the postal ballot paper bearing serial number . has been issued at the above election.
Signature of elector.
Attestation of signature
The above has been signed in my presence by (elector) who** is personally known to me/has been identified to my satisfaction by . (identifier) who is personally known to me.
Signature of Attesting Officer.
| Signature of identifier, if any .. |
Designation .. |
| Address . |
Address . |
| |
Date .. |
(This side is to be used when the elector cannot sign himself)
I hereby declare that I am the elector to whom the postal ballot paper bearing serial number .. has been issued at the above election.
Signature of Attesting Officer on behalf of elector.
| Date .. |
Address of Elector .. |
CERTIFICATE
I hereby certify that
(1) the above named elector** is personally known to me/has been identified to my satisfaction by (identifier) who is personally known to me;
(2) I am satisfied that the elector** is illiterate/suffers from (infirmity) and is unable to record his vote himself or sign his declaration;
(3) I was requested by him to mark the ballot paper and to sign the above declaration on his behalf; and
(4) the ballot paper was marked and the declaration signed by me on his behalf in his presence and in accordance with his wishes.
| |
Signature of Attesting Officer |
| Signature of identifier, if any |
Designation |
| Address .. |
Address .. |
Date
*Here insert one of the following alternatives as may be appropriate:
(1) House of the People from the constituency.
(2) Legislative Assembly from the .. constituency.
(3) Council of States by the elected members of the Legislative Assembly of .. (State).
(4) Council of States by the members of the electoral college of .. (Union territory).
(5) Legislative Council by the members of the Legislative Assembly.
(6) Legislative Council from the .. constituency.
**Strike off the inappropriate alternative.
Form 13-B
[See Rule 23(1)(b)]
159[Cover A]
| COVER A |
|
| NOT TO BE OPENED BEFORE COUNTING ELECTION to the *. . . . . . . . . . . . . . . . . . POSTAL BALLOT PAPER Serial number of ballot paper. . . . . . . . . . . . . . . . . |
*Appropriate particulars of the election to be inserted here.
Form 13-C
[See Rule 23(1)(c)]
160[Cover B]
(To be used at an election to the House of the People for the Legislative Assembly of a State)
| COVER B |
[ Every officer under whose care or through whom a postal ballot paper is sent shall ensure its delivery to the addressee without delay-Rule 23(4) of the Conduct of Elections Rules, 1961 ] |
SERVICE UNPAID |
| |
|
|
| ELECTION-IMMEDIATE POSTAL BALLOT PAPER For*. . . . . . . . . . . . . . . . Constituency (NOT TO BE OPENED BEFORE COUNTING) To The Returning Officer Signature** . . . . . . . . . . . . . . . . . of sender. . . . . . . . . . . . . . . . . . . |
*Returning Officer to insert here the name of the appropriate Parliamentary/Assembly Constituency.
**Returning Officer to mention here his full postal address.
***Strike off in the case of an elector who is employed under the Government of India in a post outside India.
Form 13-C
[See Rule 23(1)(c)]
161[Cover B]
(To be used at an election to the Council of States or to the Legislative Council of a State)
| COVER B |
NOT TO BE OPENED BEFORE COUNTING |
| |
ELECTION - IMMEDIATE |
| POSTAL BALLOT PAPER |
*. . . . . . . . . . . . . . . . . . . . . . . . |
| The Returning Officer **. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
*Insert here Council of States or name of the Legislative Council or the appropriate Electoral College.
**Full postal address of the Returning Officer to be inserted here.
162[Form 13-D
[See Rule 23(1)(d)]
Instructions for Guidance of Electors
(To be used at an election to the House of the People or to the Legislative Assembly of a State)
Election to the* . from the ..
The persons whose names are printed on the ballot paper sent herewith are candidates at the above election. Record your vote by placing clearly a mark opposite the name of the candidate to whom you wish to give your vote. The mark should be so placed as to indicate clearly and beyond doubt to which candidate you are giving your vote. If the mark is so placed as to make it doubtful to which candidate you have given your vote, your vote will be invalid.
The number of members to be elected is one. Please remember that you have only one vote. Accordingly you should not vote for more than one candidate. If you do so, your ballot paper will be rejected.
Do not put your signature or write any word or mark any mark, sign or writing whatsoever on the ballot paper other than the mark required to record your vote.
After you have recorded your vote on the ballot paper place the ballot paper in the smaller cover marked A sent herewith. Close the cover and secure it by seal or otherwise.
(1) You may then sign the declaration in Form 13-A also sent herewith in the presence of a stipendiary magistrate and obtain the attestation of your signature by such stipendiary magistrate.
(2) If you are a member of the armed forces of the Union or of an armed police force of a State but serving outside that State, the attestation may be obtained by such officer as may be appointed in this behalf by the Commanding Officer of the Unit, ship or establishment in which you or your husband, as the case may be, are employed.
(3) If you are employed under the Government of India in a post outside India the attestation may be obtained by such officer as may be appointed in this behalf by the diplomatic or consular representative of India in the country in which you are resident.
(4) If you hold an office like the office of the (i) President, (ii) Vice-President, (iii) Governors of States, (iv) Cabinet Ministers of the Union or of any State, (v) The Deputy Chairman and Members of the Planning Commission, (vi) The Ministers of State of the Union or of any State, (vii) Deputy Ministers of the Union, of any State, (viii) The Speaker of the House of the People or of any State Legislative Assembly, (ix) The Chairman of any State Legislative Council, (x) Lieutenant Governors of Union Territories, (xi) The Deputy Speaker of the House of the People or of any State Legislative Assembly, (xii) The Deputy Chairman of the Council of States or of any State Legislative Council, (xiii) Parliamentary Secretaries of the Union or of any State, the attestation may be obtained by an officer not below the rank of a Deputy Secretary to the Government of the Union or the State, as the case may be.
(5) If you are on an election duty, attestation may be obtained by any gazetted officer or by the Presiding Officer of the polling station in which you are on election duty.
(6) If you are under preventive detention, the attestation may be obtained by the Superintendent of the jail or the Commandant of the detention camp in which you are under detention.
In all the above cases you may take the declaration to the authorised officer and sign it in his presence after he has satisfied himself about your identity. The officer will attest your signature and return the declaration to you. You must not show your ballot paper to the attesting officer nor tell him how you have voted.
If you are unable to mark the ballot paper and sign the declaration yourself in the manner indicated above by reason of illiteracy, blindness or other infirmity, you are entitled to have your vote marked and declaration signed on your behalf by any of the authorised officer mentioned above. Such an officer will, at your request mark the ballot paper in your presence and in accordance with your wishes. He will also complete the necessary certificate in this behalf.
After your declaration has been signed and your signature has been attested, place the declaration in Form 13-A as also the smaller cover marked A containing the ballot paper in the larger cover marked B . After closing the larger cover, send it to the returning officer by post or by messenger. You have to give your full signature in the space provided on the cover marked B . No postage stamp need to be affixed by you, if the cover is posted in India. If, however, you are an elector employed under the Government of India in a post outside India, you should return the cover to the returning officer concerned, direct by air mail service after the requisite postage stamp is duly affixed thereon by the office in which you are serving except where it is sent by diplomatic bag.
You must ensure that the cover reaches the Returning Officer before .. on Please note that:
(i) if you fail to get your declaration attested or certified in the manner indicated above, your ballot paper will be rejected; and
(ii) if the cover reaches the returning officer after
on the . your vote will not be counted.
*Appropriate particulars of the election to be inserted here.
( Here specify the hour and date fixed for the commencement of counting of votes).
Form 13-D
[See Rule 23(1)(d)]
Instructions for the Guidance of Electors
(To be used at an election to the Council of States or to the Legislative Council of a State)
Election to the Council of States . Legislative Council.
The persons whose names are printed on the ballot paper sent herewith are candidates at the above election. Record your vote by placing the figure 1 in the space opposite the name of the candidate to whom you want to vote. Place the figure 1 opposite the name of one candidate only (although there are more members than one to be elected). You may indicate your relative preference for the other candidates by placing in the spaces opposite their names the figures 2, 3, 4, etc. in order of such preference. Do not place more than one figure opposite the name of any candidate and do not place the same figure opposite the names of more candidates than one.
The number of members to be elected is ..
After you have recorded your vote on the ballot paper, place the ballot paper in the smaller cover marked A sent herewith. Close the cover and secure it by seal or otherwise.
You have then to sign the declaration in Form 13-A also sent herewith in the presence of an officer competent to attest your signature. If you are under preventive detention the attestation of your signature on the declaration in Form 13-A shall be obtained by the Superintendent of the jail or the Commandant of the detention camp in which you are under such detention. If you are not under preventive detention, the attestation may be obtained by a stipendiary magistrate to whom you are personally known or to whose satisfaction you have been identified, or in the case of an election to a Council Constituency by any of the following categories of officers who have been notified in this behalf by the Election Commission, namely:
Take the declaration to any such officer and sign it in his presence after he has been satisfied about your identity. The officer will attest your signature and return the declaration to you. You must not show your ballot paper to the attesting officer nor tell him how you have voted.
If you are unable to mark the ballot paper and sign the declaration yourself in the manner indicated above by reason of illiteracy, blindness or other infirmity, you are entitled to have your vote marked and the declaration signed on your behalf by an officer competent to attest your signature. Such an officer will, at your request, mark the ballot paper in your presence and in accordance with your wishes. He will also complete the necessary certificate in this behalf.
After the declaration has been signed and your signature has been attested, place the declaration in Form 13-A as also the smaller cover marked A containing the ballot paper in the larger cover marked B . After closing the larger cover, send it to the Returning Officer by registered post or by messenger.
You must ensure that the cover reaches the returning officer before* .. on the .*.
Please note that
(i) If you fail to get your declaration attested or certified in the manner indicated above your ballot paper will be rejected; and
(ii) if the cover reaches the returning officer after* on the ..*your vote will not be counted.
Any ballot paper on which the figure 1 is not marked or on which the figure 1 is set opposite the name of more than one candidate, or is so placed as to render it doubtful to which candidate it is intended to apply, or on which the figure 1 and some other figures are set opposite the name of the same candidate or on which the same figure is set opposite the names of more candidates than one or on which the signature of the elector is not duly attested or the number of which does not agree with the number of the ballot paper entered on the cover in which it is placed, will be rejected.]
To be deleted when only one member is to be elected.
*Here specify the hour and date fixed for the commencement of counting of votes.
163[Form 13-E
[See Rule 27-F]
INSTRUCTIONS FOR GUIDANCE OF NOTIFIED CLASS OF ELECTORS
(To be used at an election to the House of the People/State Legislative Assembly)
Election to the House of the People/Legislative Assembly of from the ..
The persons whose names are printed on the ballot paper sent herewith are candidates at the above election. Record your vote by placing clearly a mark opposite the name of the candidate to whom you wish to give your vote. The mark should be so placed as to indicate clearly and beyond doubt to which candidate you are giving your vote. If the mark is so placed as to make it doubtful to which candidate you have given your vote, your vote will be invalid.
The number of members to be elected is one. Accordingly you should not vote for more than one candidate, if you do so, your ballot paper will be rejected.
Do not put your signature or write any word or mark any mark, sign or writing whatsoever on the ballot paper other than the mark required to record your vote.
After you have recorded your vote on the ballot paper, place the ballot paper in the smaller cover marked A sent herewith. Close the cover and secure it by seal or otherwise.
You may then sign the declaration in Form 13-A which is sent herewith in the presence of the officer as defined in Rule 27-J of the Conduct of Elections Rules, 1961 and obtain the attestation of your signature by such authorised officer. Extracts of Rule 27-J of the Conduct of Elections Rules, 1961 are enclosed herewith.
If you are unable to mark the ballot paper and sign the declaration yourself in the manner indicated above by reason of illiteracy, blindness or other infirmity, you are entitled to have your vote marked and declaration signed on your behalf by any of the authorised officers as mentioned above. Such an Officer will, at your request, mark the ballot paper in your presence and in accordance with your wishes. He will also complete the necessary certificate in this behalf.
After your declaration has been signed and your signature has been attested, place the declaration in Form 13-A, as also the smaller cover marked A contained the ballot paper in the larger cover marked B. After closing the larger cover, send it to the Returning Officer by post or by messenger. You have to give your full signature in the space provided on the cover marked B. No postage stamp need be affixed by you, if the cover is posted in India. If, however, you are a elector employed under the Government of India on a post outside India, you should return the cover to the Returning Officer concerned direct by air mail service after the requisite postage stamp is fully affixed thereon by the office in which you are serving except where it is sent by diplomatic bag. You must ensure that the cover reaches the Returning Officer before .. (hour) on (date).
Please note that:
(i) if you fail to get your declaration attested or certified in the manner indicated above, your ballot paper will be rejected; and
(ii) if the cover reaches the Returning Officer after (hour) on .. (date) your vote will not be counted.]
164[Form 13-F
[See Rule 27-N(3)]
Serial No. ..
Appointment of Proxy by Classified Service Voter to give Vote
I (Name of the classified service voter) aged about s/o, d/o, w/o r/o presently working as and posted at am entitled to appoint proxy under sub-rule (2) of Rule 27-N of the Conduct of Election Rules, 1961. I hereby appoint (Name of the proxy) aged about s/o, d/o, w/o r/o as my proxy to give vote on my behalf and in my name in Assembly constituency and/or Parliamentary constituency of the State/Union Territory of in which I am entitled to give vote under the Representation of the People Act, 1951 (43 of 1951) and the rules made thereunder.
| (Signature of Proxy) |
(Signature of Classified Service Voter) |
| Serial number of his name and part no. of electoral roll of the concerned constituency |
Serial number of his name in the last part of electoral roll of the concerned constituency Service Identity Card No Name of the Force to which he belongs |
Note. (1) The person to be appointed as proxy shall be an ordinary resident in the constituency concerned and of not less than eighteen years of age and shall not be a person disqualified for registration as an elector in an electoral roll under Section 16 of the Representation of the People Act, 1950 (43 of 1950).
(2) The signature of the classified service voter and the proxy shall be made before a First Class Magistrate or Notary or the Commanding Officer of the Unit concerned who shall verify the signatures under his hand and seal. In case of First Class Magistrate or Notary verifying the signature, he shall personally check the service identity card of the classified service voter to authenticate veracity of the classified service voter.
(3) Score out the word(s) which are not applicable.
Receipt of Form 13-F for the appointment of proxy by classified service voter (To be handed over to the person depositing the said form)
| Serial No. |
|
| Received Form 13-F of Shri/Smt/Km .. |
| Date |
|
| |
Returning Officer |
Form 13-G
[See Rule 27-N(4)]
Serial No. .
Revocation of Appointment of Proxy or Revocation of Appointment of Proxy and Appointment of Substitute Proxy by Classified Service Voter to give Vote
I .. .. (Name of the classified service voter) aged about s/o, d/o, w/o .. r/o .. presently working as and posted at .. had appointed . . (Name of the proxy) aged about . s/o, d/o, w/o .. .. r/o as my proxy to give vote on my behalf and in my name in Assembly constituency and/or . Parliamentary constituency of the State/Union Territory of ..
2. I hereby revoke the appointment of my said proxy and do not wish to appoint any substitute proxy.
OR
Whereas such proxy has died/I hereby revoke appointment of the said proxy and being entitled to appoint substitute proxy under sub-rule (4) of Rule 27-N of the Conduct of Elections Rules, 1961, hereby appoint (Name of the substitute proxy) aged about . s/o, d/o, w/o r/o .. as substitute proxy who shall hereafter give vote on my behalf and in my name in .. Assembly constituency and/or . Parliamentary constituency .. of the State/Union territory of .. in which I am entitled to give vote under the Representation of the People Act, 1951 (43 of 1951) and the rules made thereunder.
| .. (Signature of Proxy) |
. (Signature of Classified Service Voter) |
| Serial number of his name and part no. of electoral roll of the concerned constituency |
Serial number of his name in last part of electoral roll of the concerned constituency Service Identity Card No. .. Name of the Force to which he belongs |
Note. (1) The person to be appointed as proxy shall be an ordinary resident in the constituency concerned and of not less than eighteen years of age and shall not be a person disqualified for registration as an elector in an electoral roll under Section 16 of the Representation of the People Act, 1950 (43 of 1950).
(2) The signature of the classified service voter and the proxy shall be made before a First Class Magistrate or Notary or the Commanding Officer of the Unit concerned who shall verify the signatures under his hand and seal. In case of First Class Magistrate or Notary verifying the signature, he shall personally check the service identity card of the classified service voter to authenticate veracity of the classified service voter.
(3) Score out the word(s) which are not applicable.
Receipt of Form 13-G for revocation of appointment of proxy or revocation of appointment of proxy and appointment of substitute proxy by classified service voter to give vote
(To be handed over to the person depositing the said form)
Serial No ..
Received Form 13-G of Shri/Smt/Km .. r/o
| Date .. |
(Signature and Seal) |
Returning Officer.
Form 14
List of Challenged Votes
[See Rule 36(2)(e)]
Election to the* . from the . constituency
165[Polling Station Number and Name of the Polling Station . in . Assembly constituency/Name of place of poll .]
| Serial Number of entry |
Name of electoral |
Serial Number of |
Signature or thumb impression of the person challenged |
Address of the person challenged |
Name of identifier, if any, |
Name of challenger |
Order of Presiding Officer |
Signature of challenger on receiving refund of deposit |
| Part of roll |
Elector's name in that part |
| 1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
| 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. |
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| Date . |
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. Signature of Presiding Officer |
| *Appropriate particulars of the election to be inserted here |
|
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|
Form 14-A
[See Rule 40(2) and Rule 40-A(2)]
List of Illiterate, Blind and Infirm Voters
Election to the .. ** ..*from the .. constituency*/by the elected members**/members of the Legislative Assembly of .(State).
166[Number and Name of Polling Station . in . Assembly constituency/Name of place of poll ..]
| Part No. & Serial No. of elector |
Full name of elector |
Full name of companion |
Address of companion |
Signature of companion |
| |
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| Date .. |
Signature of Presiding Officer. |
The word illiterate not applicable in the case of election from Assembly/Parliamentary constituency.
*Strike off whichever is inapplicable.
**Strike off whichever is inapplicable.]
Form 15
[See Rule 42(2)]
List of Tendered Votes
Election to the* .. from the constituency.
167[Number and Name of Polling Station in Assembly constituency/Name of place of poll .]
| Part number, serial number and name of elector |
Address of elector |
Serial number of tendered ballot paper |
Serial number of ballot paper issued to the person who has already voted |
Signature or thumb impression of person tendering vote |
| 1 |
2 |
3 |
4 |
5 |
| |
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| |
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|
| Date .. |
Signature of Presiding Officer |
*Appropriate particulars of the election to be inserted here.
168[Form 16
[See Rules 45, 56(7) and 56-A(7)]
Part I
BALLOT PAPER ACCOUNT
Election to the ..from the ..constituency.
Name of Assembly Segment (in the case of election from a Parliamentary constituency)
No. and Name of Polling Station
| |
Serial Nos. |
Total No. |
| |
From |
To |
|
| 1. |
Ballot papers received |
|
| 2. |
Ballot papers unused (i.e. not issued to voters) |
|
| |
(a) With the signature of Presiding Officer |
|
| |
(b) Without the signature of Presiding Officer |
____________________________ |
| |
*Total: (a+b) |
____________________________ |
| 3. |
*Ballot papers used at the Polling Station |
____________________________ |
| |
(1 2=3) .. |
____________________________ |
| 4. |
*Ballot papers used at the polling station but |
|
| |
NOT INSERTED INTO THE BALLOT BOX: |
|
| |
(a) Ballot papers cancelled for violation of voting procedure under Rule 39. |
|
| |
(b) Ballot papers cancelled for other reasons. |
|
| |
(c) Ballot papers used as tendered ballot papers |
____________________________ |
| |
*Total: (a+b+c) |
____________________________ |
| 5. |
*Ballot papers to be found in the ballot box (3 4 = 5) |
|
|
| |
*(Serial numbers need not be given) |
|
| Date .. |
|
|
Signature of the Presiding Officer. |
Part II
RESULT OF COUNTING
| Sl. No. |
Name of candidate |
Number of valid votes cast. |
| 1. 2. 3. 4. 5. etc. |
|
|
| II. Rejected Ballot Papers |
|
| III. TOTAL |
|
| Whether the total number of ballot papers shown against item No. III above tallies with the total shown against item No. 5 of Part I or any discrepancy noticed between these two totals. |
| Place |
|
| Date .. |
Signature of the Counting Supervisor. |
| Place |
|
| Date .. |
Signature of the Returning Officer.] |
169[Form 16-A
[See Rules 45 and 55-B(1)]
(To be used in constituencies specified under Rule 59-A)
Election to the from the .constituency
Name of Assembly Segment .. (in the case of election from a Parliamentary constituency)
No. and Name of Polling Station ..
| |
Serial Nos. |
Total No. |
| |
From |
To |
|
| 1. |
Ballot papers received |
|
| 2. |
Ballot papers unused (i.e. not issued to voters) |
|
| |
(a) With the signature of Presiding Officer |
|
| |
(b) Without the signature of Presiding Officer |
____________________________ |
| |
*Total: (a+b) |
____________________________ |
| 3. |
*Ballot papers used at the Polling Station |
____________________________ |
| |
(1 2=3) .. |
____________________________ |
| 4. |
*Ballot papers used at the polling station but |
|
| |
NOT INSERTED INTO THE BALLOT BOX: |
|
| |
(a) Ballot papers cancelled for violation of voting procedure under Rule 39. |
|
| |
(b) Ballot papers cancelled for other reasons. |
|
| |
(c) Ballot papers used as tendered ballot papers |
____________________________ |
| |
*Total: (a+b+c) |
____________________________ |
| 5. |
*Ballot papers to be found in the ballot box (3 4 = 5) |
|
| |
*(Serial numbers need not be given) |
|
| Date .. |
|
Signature of the Presiding Officer. |
Part II
RESULT OF INITIAL COUNTING
1. Total number of ballot papers found in the ballot box(es) used at the polling station .
2. Discrepancy, if any, between the total number as shown against item 1 in this Part and the total number of ballot papers to be found in the ballot box(es) shown in item 5 of Part I ..
| Date .. |
Signature of Counting Supervisor Signature of the Returning Officer] |
Form 17
[See Rule 49(3)(f)]
Tendered Ballot Paper
Election to the* from the constituency Serial number of Ballot paper .
Polling Station
Name of election
Serial number of elector .. in Part number . of the electoral roll.
Address of elector ..
Name of candidate in whose favour vote is tendered .
Date ..
*Appropriate particulars of the election to be inserted here.
170[Form 17-A
[See Rule 49-L]
Register of Voters
Election to the House of the People/Legislative Assembly of the State/Union Territory from .. Constituency No. and Name of Polling Station Part No. of Electoral Roll
| Sl. No. |
Sl. No. of elector in the electoral roll |
Details of the document produce by the elector in proof of his/her identification |
Signature/Thumb impression of elector |
Remarks |
| (1) |
(2) |
(3) |
(4) |
(5) |
| 1. |
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| 2. |
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| 3. |
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| 4. |
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| etc.] |
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|
Form 17-B
(See Rule 49-P)
List of Tendered Votes
Election to the House of the People/Legislative Assembly of the State/Union Territory from .. Constituency.
No. and Name of Polling Station ..
Part No. of Electoral Roll .
| Sl. No. |
Name of elector |
Sl. No. of elector in electoral roll |
Sl. No. in Register of voters (Form 17-A) of the person who has already voted in place of elector |
Signature/Thumb impression of elector |
| 1. |
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| 2. |
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| 3. |
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| 4. |
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| 5. |
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| 6. |
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| 7. |
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| 8. |
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| 9. |
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| 10. |
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| Date |
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Signature of the Presiding Officer |
171[Form 17-C
[See Rules 49-S and 56-C(2)]
Part I
Account of Votes Recorded
Election to House of the People/Legislative Assembly of the State/Union territory from . Constituency.
| Number and Name of Polling Station: |
|
| Identification Number of voting |
control unit .. |
| Machine used at the Polling Station: |
balloting unit .. |
| |
Printer (if used) .. |
1. Total number of electors assigned to the Polling Station
2. Total number of voters as entered in the Register for Voters (Form 17-A)
3. Number of voters deciding not to record votes under Rule 49-0
4. Number of voters not allowed to vote under Rule 49-M
5. Test votes recorded under Rule 49-MA (d) required to be deducted
| (a) total number of test votes to be deducted: |
Total No. |
Sl. No.(s) of elector(s) in Form 17-A |
| |
|
|
| (b) candidate(s) for whom test vote(s) cast: |
Sl. No |
Name of candidate |
No. of votes |
| |
. |
|
|
| |
. |
|
.. |
6. Total number of votes recorded as per voting machine:
7. Whether the total number of votes as shown against Item 6 tallies with the total number of votes as shown against Item 2 minus numbers of voters deciding not to record votes as against Item 3 minus number of voters as against Item 4 (i.e. 2-3-4) or any discrepancy noticed:
8. Number of voters to whom tendered ballot papers were issued under Rule 49-P: ..
9. Number of tendered ballot papers.Sl. No.
(a) received for use
(b) issued to electors
(c) not used and returned
10. Account of papers seals
Signature of polling agents.
| 1. |
Paper seals supplied for use: |
Total No. |
1. |
| |
|
Sl. No. from ..to . |
|
| 2. |
Paper seals used: |
Total No. . |
2. |
| |
|
Sl. No.(s) . |
|
| 3. |
Unused paper seals returned to Returning Officer: |
Total No. . |
3. |
| |
|
Sl. No.(s) . |
|
| 4. |
Damaged paper seal, if any: |
Total No. . |
4. |
| |
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Sl. No.(s) . |
5. |
| |
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6. |
| Date .. |
Signature of Presiding Officer |
| Place .. |
Polling Station No. . |
Part II
Result of Counting
| Sl. No. of candidate |
Name of candidate |
Number of votes as displayed on control unit |
Number of test votes to be deducted as per Item 5 of Part I |
Number of valid votes. (3-4) |
| (1) |
(2) |
(3) |
(4) |
(5) |
| 1. |
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| 2. |
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| 3. |
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| 4. |
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| 5. |
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| 6. |
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| Total |
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| Whether the total number of votes shown above tallies with the total number of votes shown against Item 6 of Part I or any discrepancy noticed between the two totals. |
| Place |
| Date . |
| |
Signature of Counting Supervisor |
| Name of candidate/election agent/counting agent |
Full Signature |
| 1. |
| 2. |
| 3. |
| 4. |
| 5 |
| 6. |
| 7. |
| Place .. |
| Date |
Signature of Returning Officer.] |
Form 18
[See Rule 52(2)]
Appointment of Counting Agents
Election to the . from the .. constituency.
To
The Returning Officer,
I .. *a candidate/the election agent of .. who is a candidate at the above election, do hereby appoint the following persons as my counting agents to attend the counting of votes at : Addresses of the counting agents
Names of the counting agents
1.
2.
3.
etc.
| We agree to act as such counting agents |
Signature of *candidate/election agent. |
1.
2.
3.
etc.
| Place .. |
Signature of Returning Officer. |
| Date .. |
|
Declaration of Counting Agents
(To be signed before the Returning Officer)
We hereby declare that at the above election we will not do anything forbidden by Section 128 of the Representation of the People Act, 1951, which *we have read/has been read over to us.
1.
2.
3.
etc.
| Date .. |
Signature of counting agents. |
| Signed before me. |
|
| Date .. |
Returning Officer. |
*Strike off the inappropriate alternative.
Section 128 of the Representation of the People Act, 1951:
128. Maintenance of secrecy of voting. (1) Every officer, clerk, agent or other person who performs any duty in connection with the recording or counting of votes at an election shall maintain and aid in maintaining, the secrecy of the voting and shall not (except for some purpose authorised by or under any law) communicate to any person any information calculated to violate such secrecy.
(2) Any person who contravenes the provisions of sub-section (1) shall be punishable with imprisonment for a term which may extend to three months or with fine or with both.
Form 19
[See Rule 52(4)]
Revocation of Appointment of Counting Agent
Election to the
To
The Returning Officer,
I, . [the election agent of ..] a candidate at the above election hereby revoke the appointment of . my/his counting agent.
| Place |
|
| Date .. |
Signature of person revoking. |
*Here insert one of the following alternatives as may be appropriate:
(1) House of the People from the . constituency.
(2) Legislative Assembly from the constituency.
(3) Council of States by the elected members of the Legislative Assembly of .. (State).
(4) Council of States by the members of the electoral college of . (Union Territory).
(5) Legislative Council by the members of the Legislative Assembly.
(6) Legislative Council from the .. constituency.
N.B. Omit the words [] as necessary.
172[Form 20
[See Rule 56(7)]
Final Result Sheet
(To be used for recording the result of voting at polling stations other than notified polling stations)
Election to the from the . constituency.
Part I
(To be used both for Parliamentary and Assembly elections)
Name of the Assembly segment (in the case of election from a
Parliamentary constituency)
Total No. of
electors in Assembly
constituency/segment ..
| Serial No. of Polling Station |
No. of valid votes cast in favour of |
Total of valid votes |
No. of rejected votes |
Total No. of tendered votes |
| |
A |
B |
C |
|
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|
| 1. |
|
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| 2. |
|
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| 3. etc. |
|
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|
| Total No. of votes recorded at Polling Stations. |
| No. of votes recorded on postal ballot papers. (To be filled in the case of election from an Assembly constituency.) |
Total votes polled.
| Place |
|
| Date .. |
Returning Officer. |
Part II
(To be used for a Parliamentary election only)
| Name of Assembly Segment |
No. of valid votes cast in favour of |
Total of valid votes |
No. of rejected votes |
Total No. of tendered votes |
| |
A |
B |
C |
|
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|
| 1. |
|
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| 2. |
|
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| 3. etc. |
|
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| Total |
| No. of votes recorded on Postal ballot papers. GRAND TOTAL |
| Place |
|
| Date .. |
Returning Officer. |
Form 20
[See Rule 59]
Final Result Sheet
(To be used for recording the result of voting at notified polling stations)
Election to the* . from the .constituency
| Polling Station |
Number of the ballot papers found in the ballot box of |
Total for polling station |
Number of tendered votes |
| Serial No. |
Name |
A |
B |
C |
D |
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| Valid |
Rejected |
Valid |
Rejected |
Valid |
Rejected |
Valid |
Rejected |
Valid |
Rejected |
Total |
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| 1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
11 |
12 |
13 |
14 |
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| TOTAL |
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Number of valid votes polled by |
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A |
B |
C |
D |
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Total |
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| Recorded at polling stations |
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| Recorded on postal ballot papers |
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| Total Votes polled |
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| Place .. Date .. |
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Returning Officer |
| *Appropriate particulars of the election to be inserted here. |
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173[Form 20-A
[See Rule 56-A(7)]
Final Result Sheet
(To be used for recording the result of voting at polling stations in constituencies specified under Rule 59-A)
Election to the from the . constituency.
| Polling Station No. |
Total votes found in the ballot box(es) |
No. of tendered votes |
| (1) .. |
. |
. |
| (2) .. |
. |
. |
| (3) .. |
. |
. |
| |
. |
. |
| |
. |
. |
| |
. |
. |
| |
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| Total |
|
|
| 1. Total number of valid votes recorded for candidates and of rejected ballot papers |
Candidate's valid votes |
Valid Votes Total |
Number of rejected ballot papers |
Valid and rejected votes Total |
| A |
B |
C |
D |
| 1st round |
. |
. |
. |
. |
. |
. |
. |
| 2nd round |
. |
. |
. |
. |
. |
. |
. |
| 3rd round |
. |
. |
. |
. |
. |
. |
. |
| 4th round |
. |
. |
. |
. |
. |
. |
. |
| 5th round |
. |
. |
. |
. |
. |
. |
. |
| |
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| TOTAL |
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| 2. Total number of valid votes recorded on postal ballot papers for candidates and of rejected postal ballot papers |
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| GRAND TOTAL |
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Place
Date .
Returning Officer
(For Parliamentary elections only)
| Name of assembly constituency |
Candidates' valid votes |
Valid Votes Total |
Number of rejected ballot papers |
Valid and rejected votes Total |
| A |
B |
C |
D |
| I.1. |
.. |
.. |
.. |
.. |
.. |
.. |
.. |
| 2. |
.. |
.. |
.. |
.. |
.. |
.. |
.. |
| 3. etc. |
.. |
.. |
.. |
.. |
.. |
.. |
.. |
| TOTAL |
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| II. Total number of valid votes recorded on postal ballot papers for candidates and of rejected postal ballot papers |
.. |
.. |
.. |
.. |
.. |
.. |
.. |
| GRAND TOTAL |
|
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| Place |
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| Date .. |
Returning Officer.] |
Form 21
[See Rule 11(1)]
(For Use in General Election when seat is uncontested)
Declaration of the result of Election under sub-section (2)*/sub-section (3)* of Section 53 of the Representation of the People Act, 1951.
Election to the**:
In pursuance of the provisions contained in sub-section (2)*/sub-section (3)*of Section 53 of the Representation of the People Act, 1951, read with sub-rule (1) of Rule 11 of the Conduct of Elections Rules, 1961, I declare that
| (Name) (Address) |
174[sponsored by (name of the recognised/registered political party)] |
| has been duly elected to fill the seat in that House from the above constituency. |
| Place .. |
Signature . |
| Date .. |
Returning Officer |
*Score out, if inappropriate.
**Here insert one of the following alternatives as may be appropriate:
(1) House of the People from the Parliamentary constituency in the State/Union Territory of
(2) Legislative Assembly of the State/Union Territory of from the .. Assembly constituency.
(3) Metropolitan Council of the Union Territory of Delhi from the Metropolitan Council constituency.
Form 21-A
[See Rule 11(1)]
(For use in General Election when seat is uncontested)
Declaration of the result of Election under sub-section (2)*/sub-section (3)* of Section 53 of the Representation of the People Act, 1951
Election to the
In pursuance of the provisions contained in sub-section (2)*/sub-section (3)* of Section 53 of the Representation of the People Act, 1951, read with sub-rule (1) of Rule 11 of the Conduct of Elections Rules, 1961, I declare that
| .. (Name) |
175[sponsored by (name of the recognised/registered political party)] |
| .. (Adress) |
|
| (Name) |
176[Sponsored by . |
| .. (Address) |
(name of the recognised/registered political party)] |
has been/have been duly elected to fill the seat(s) in that House of ** .. member(s) retiring on . (date, month and year) on the expiration of their term of office.
| Place .. |
Signature .. |
| Date .. |
Returning Officer. |
*Score out, if inappropriate.
Here insert one of the following alternatives as may be appropriate:
(1) Council of States by the elected members of the Legislative Assembly of . (State).
(2) Council of States by the members of the electoral college of . (Union Territory).
(3) Legislative Council of (State) by the members of the Legislative Assembly.
(4) Legislative Council of .. (State) from the . (Local Authorities/Graduates'/Teachers') constituency.
**Fill up the number of members retiring.
Form 21-B
[See Rule 11(1)]
(For use in Election to fill a casual vacancy when seat is uncontested)
Declaration of the result of Election under sub-section (2)*/sub-section (3)* of Section 53 of the Representation of the People Act, 1951.
Election to the
In pursuance of the provisions contained in sub-section (2)*/sub-section (3)* of Section 53 of the Representation of the People Act, 1951, read with sub-rule (1) of Rule 11 of the Conduct of Elections Rules, 1961, I declare that
| (Name) |
177[sponsored by .. |
| (name of the recognised/registered political party)] (Address) |
|
has been duly elected to fill the vacancy caused in that House by the
*resignation of
*death of .
*election of . having been declared void
*seat of *having become vacant.
*having been declared
| Place .. |
Signature |
| Date .. |
Returning Officer. |
*Score out, if inappropriate.
Here insert one of the following alternatives as may be appropriate:
(1) House of the People from the .. Parliamentary constituency in the State/Union Territory of .
(2) Legislative Assembly of the State/Union Territory of . from the . Assembly constituency.
(3) Metropolitan Council of Delhi from the Metropolitan Council constituency.
(4) Council of States by the elected members of the Legislative Assembly (State).
(5) Council of States by the members of the electoral college of .. (Union Territory)
(6) Legislative Council of . (State) by the members of the Legislative Assembly.
(7) Legislative Council of .. (State) from the (Local Authorities'/Graduates'/Teachers') constituency.
Form 21-C
(See Rule 64)
(For use in General Election when seat is contested)
Declaration of the result of Election under Section 66 of the Representation of the People Act, 1951.
*Election to the House of the People from the Parliamentary constituency in (State/Union Territory).
*Election to the Legislative Assembly of . (State/Union Territory) from . Assembly constituency.
*Election to the Metropolitan Council of Delhi from . Metropolitan Council constituency.
In pursuance of the provisions contained in Section 66 of the Representation of the People Act, 1951, read with Rule 64 of the Conduct of Elections Rules, 1961, I declare that
. (Name)
. (Address) 178[sponsored by .(name of the recognised/registered political party) has been duly elected to fill the seat in that House from the above constituency.
| Place .. |
Signature . |
| Date .. |
Returning Officer. |
*Score out, if inappropriate.
Form 21-D
(See Rule 64)
(For use in Election to fill a casual vacancy when seat is contested)
Declaration of the result of Election under Section 66 of the Representation of the People Act, 1951. *Election to the House of the People from the Parliamentary constituency in .. (State/Union Territory).
*Election to the Legislative Assembly of . (State/Union Territory) from .. Assembly constituency.
*Election to the Metropolitan Council of Delhi from .. Metropolitan Council constituency.
In pursuance of the provisions contained in Section 66 of the Representation of the People Act, 1951, read with Rule 64 of the Conduct of Elections Rules, 1961, I declare that
. (Name)
. (Address) 179[sponsored by .. (name of the recognised/registered political party] has been duly elected to fill the vacancy caused in that House by the
*resignation of ..
*death of
*election of .. having been declared void.
*having become
*seat of vacant.
*having been declared
| Place .. |
Signature .. |
| Date .. |
Returning Officer. |
*Score out, if inappropriate
Form 21-E
(See Rule 64)
Return of Election
Election to the from the .constituency
Return of Election
| 180[Serial No. |
Name of candidate |
Party affiliation |
Number of votes polled] |
| |
|
|
|
| |
|
|
|
181[Total number of electors .]
Total number of valid votes polled .
Total number of rejected votes .
Total number of tendered votes
I declare that
(name)
of .. (address)
has been duly elected to fill the seat.
| Place |
|
| Date .. |
Returning Officer. |
Form 22
(See Rule 66)
Certificate of Election
I, Returning Officer for the .. Parliamentary/Assembly constituency in the State of .. hereby certify that I have on the . day of 19 . declared Shri . of .. 182[Sponsored by (name of the recognised/registered political party)] to have been duly elected by the said]
constituency 183[in the General Election/Bye-election] to be a member of
House of the People
the and that in token thereof I have granted to him this certificate of election.
Legislative Assembly
| Place .. |
.. |
| Date .. |
Returning Officer, |
for the .. Parliamentary/
Assembly constituency.
SEAL
184[Form 22-A
[See Rule 39-AA(2)]
Appointment Letter
Election of the ..
I .. *President/General Secretary of .. Party do hereby appoint the following persons as the authorised agents of the Party to verify under Rule *39-AA/Rule 42/Rule 42-A/Rule 84 as to whom the electors who are the members of the said political party have cast their votes. Photographs of the aforesaid authorised agents are pasted hereunder and is attested under my hand and seal.
| Name of the authorised agents 1 2 |
Address of the authorised agents Signature of *President/ General Secretary of the Party (Seal) |
| We agree to act as such authorised agents 1 2 |
Signature of the authorised agents |
Space for the photographs
* Strike off the inappropriate alternative.]
185[Form 23
[See Rule 84(1)(a)]
(For use in Biennial Election when seat is contested)
Declaration of the result of Election under Section 66 of the Representation of the People Act, 1951.
Election to the * ..
In pursuance of the provisions contained in Section 66 of the Representation of the People Act, 1951, read with clause (a) of sub-rule (1) of Rule 84 of the Conduct of Elections Rules, 1961, I declare that
(Name) 186[sponsored by . (name of the recognised/registered
.. (Address) political party)
.. (Name) 187[sponsored by (name of the recognised/registered
..(Address) political party)]
**has been
duly elected to fill the seat(s) in that House of a member(s)
**have been
retiring on ..(date, month and year) on the expiration of their term of office.
| Place .. |
Signature .. |
| Date .. |
Returning Officer] |
*Here insert one of the following alternatives as may be appropriate:
(1) Council of States by the elected members of the Legislative Assembly of (State).
(2) Council of States by the members of the electoral college of .. (Union Territory).
(3) Legislative Council of (State) by the members of the Legislative Assembly.
(4) Legislative Council of .. (State) from the (Local Authorities'/Graduates'/Teachers') constituency.
**Score out, if inappropriate.
Fill up the number of members retiring.
Form 23-A
[See Rule 84(1)(a)]
(For use in Election to fill a casual vacancy when seat is contested)
Declaration of the result of Election under Section 66 of the Representation of the People Act, 1951
Election to the .
In pursuance of the provisions contained in Section 66 of the Representation of the People Act, 1951, read with clause (a) of sub-rule (1) of Rule 84 of the Conduct of Elections Rules, 1961, I declare that
. (Name)
. (Address) 188[sponsored by . (name of the recognised/registered political party)] has been duly elected to fill the vacancy caused in that House by the
*resignation of ..
*death of
*election of ..having been declared void.
*having become
*seat of vacant.
*having been declared
| Place .. |
Signature . |
| Date .. |
Returning Officer. |
Here insert one of the following alternatives as may be appropriate:
(1) Council of States by the elected members of the Legislative Assembly of .. (State).
(2) Council of States by the members of the electoral college of . (Union Territory).
(3) Legislative Council of . (State) by the members of the Legislative Assembly.
(4) Legislative Council of . (State) from the (Local Authorities'/Graduates'/Teachers') constituency.
*Score out, if inappropriate.]
189[Form 23-B
[See Rule 84 of (1) 190(b)]
Return of Election
Election to the Council of States.
Election to the Legislative Council by Members of Assembly/ constituency.
The result of the poll and of the transfer of votes is as follows:
Number of valid votes
Number of members to be elected .
Quota (number of votes sufficient to secure the election of a candidate)
| Names of candidates |
First Count |
Second Count |
Third Count |
Fourth Count |
Name of elected candidates and order of election |
| |
Votes polled by each candidate |
Transfer of |
Result |
Transfer of |
Result |
Transfer of |
Re- sult |
|
| Non-transferable papers |
|
|
|
|
|
|
|
|
| Loss due to fractions |
|
|
|
|
|
|
|
|
| TOTAL |
|
|
|
|
|
|
|
|
I declare that
(1) (Name)
(Address) ..
(2) (Name) ..
(Address)
191[Sponsored by (name of the recognised/registered political party)] etc has/have been duly elected.
(Signature)
Returning Officer.
Dated the ..day of .. 20..
Form 24
(See Rule 85)
Certificate of Election
I, Returning Officer for the election to the . Council of States
Legislative Council
by the elected members of the .. Legislative Assembly
Local Authorities'
constituency/members of the Legislative Assembly
Graduates'
Teachers'
hereby certify that I have on the ..day of .. 20 .. declared Shri 192[Sponsored by . (name of the recognised/registered political party)] to have been duly elected to be a member of the
Council of States
and that in token thereof I have granted to him this certificate of election.
Legislative Council
| Place .. |
. |
| Date .. |
Returning Officer. |
for the election to the Council of States/
Legislative Council.
SEAL
193[Form 24-A
[See Rule 85-B]
This Form should be filed with the Election Commission before the due date for furnishing a return of the political party's income of the concerned financial year under Section 139 of the Income Tax Act, 1961 (43 of 1961) and a certificate to this effect should be attached with the income tax return to claim exemption under the Income Tax Act, 1961 (43 of 1961).
1. Name of political party:
2. Status of the political party:
(recognised/unrecognised)
3. Address of the headquarters of the political party:
4. Date of registration of political party with Election Commission:
5. Permanent Account Number (PAN) and Income Tax Ward/Circle where return of the political party is filed:
6. Details of the contributions received, in excess of Rupees Twenty thousand, during the Financial Year: 200 . 200 .
| SI. No. |
Name and complete address of the contributing person/company |
PAN (if any) and Income Tax Ward/Circle |
Amount of contribution (Rs) |
Mode of contribution *(cheque/demand draft/cash) |
Remarks |
| |
|
|
|
|
|
* In case of payment by cheque/demand draft, indicate name of the bank and branch of the bank on which the cheque/demand draft has been drawn.
7. In case the contributor is a company, whether the conditions laid down under Section 293-A of the Companies Act, 1956 (1 of 1956) have been complied with (A copy of the certificate of this effect obtained from the company should be attached).
VERIFICATION
I, . (Full name in Block letters), son/daughter of . solemnly declare that to the best of my knowledge and belief, the information given in this Form is correct, complete and truly stated. I further declare that I am verifying this Form in my capacity as . on behalf of the political party abovenamed and I am also competent to do so.
| Date .. |
(Signature and name of the Treasurer/Authorised person) |
| Place: .] |
|
Form 25
[See Rule 94-A]
Affidavit
I, .., the petitioner in the accompanying election petition calling in question the election of Shri/Smt . (respondent No . in the said petition) make solemn affirmation/oath and say
(a) that the statements made in paragraphs of the accompanying election petition about the commission of the corrupt practice of* .. and the particulars of such corrupt practice mentioned in paragraphs of the same petition and in paragraphs of the Schedule annexed thereto are true to my knowledge;
(b) that the statements made in paragraphs of the said petition about the commission of the corrupt practice of* .. and the particulars of such corrupt practice given in paragraphs .. of the said petition and in paragraphs .. of the Schedule annexed thereto are true to my information;
(c)
(d)
etc.
Signature of deponent.
Solemnly affirmed/sworn by Shri/Smt before me, at this day of 20.
Magistrate of the first class/Notary/Commissioner of Oaths.
*Here specify the name of the corrupt practice.]
194[Form 26
(See Rule 4-A)
| |
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| |
|
Please affix your recent passport size photograph here |
Affidavit to be filed by the candidate along with nomination paper before the returning officer for election to .(name of the House) from constituency (Name of the constituency)
Part A
I ., **son/daughter/wife of Aged years, resident of (mention full postal address), a candidate at the above election, do hereby solemnly affirm and state on oath as under
(1) I am a candidate set up by .(**name of the political party)/**am contesting as an Independent candidate.
(**Strike out whichever is not applicable)
(2) My name is enrolled in .(Name of the constituency and the State), at Serial No. in Part No. .
195[(3) My contact telephone number(s) is/are and my E-mail ID (if any) is and my social media account(s) (if any) is/are (i) . . . (ii) .. (iii) .]
196[(4) Details of Permanent Account Number (PAN) and status of filing of income tax return:
| Sl. No. |
Names |
PAN |
The financial year for which the last income-tax return has been filed. |
Total income shown in income tax return (in Rupees) for the last five Financial Years (as on the 31st March). |
| 1. |
Self |
|
|
(i) |
| (ii) |
| (iii) |
| (iv) |
| (v) |
| 2 |
Spouse |
|
|
(i) |
| (ii) |
| (iii) |
| (iv) |
| (v) |
| 3. |
HUF (If the Candidate is Karta or Coparcener) |
|
|
(i) |
| (ii) |
| (iii) |
| (iv) |
| (v) |
| 4. |
Dependent-1 |
|
|
(i) |
| (ii) |
| (iii) |
| (iv) |
| (v) |
| 5. |
Dependent-2 |
|
|
(i) |
| (ii) |
| (iii) |
| (iv) |
| (v) |
| 6. |
Dependent-3 |
|
|
(i) |
| (ii) |
| (iii) |
| (iv) |
| (v) |
Note: It is mandatory for PAN holder to mention PAN and in case of no PAN, it should be clearly stated No PAN allotted .
197[(5) Pending criminal cases.
(i) I declare that there is no pending criminal case against me.
(Tick this alternative, if there is no criminal case pending against the Candidate and write NOT APPLICABLE against alternative (ii) below)
OR
(ii) The following criminal cases are pending against me:
(If there are pending criminal cases against the candidate, then tick this alternative and score off alternative (i) above, and give details of all pending cases in the Table below)
TABLE
| (a) |
FIR No. with name and address of Police Station concerned |
|
|
|
| (b) |
Case No. with Name of the Court |
|
|
|
| (i) |
Sections of concerned Acts/Codes involved (give no. of the section, e.g. Section .of IPC, etc.). |
|
|
|
| (d) |
Brief description of offence |
|
|
|
| (e) |
Whether charges have been framed (mention YES or NO) |
|
|
|
| (f) |
If answer against item (e) above is YES, then give the date on which charges were framed |
|
|
|
| (g) |
Whether any Appeal/Application for revision has been filed against the proceedings (Mention YES or NO) |
|
|
|
(6) Cases of conviction.
(i) I declare that I have not been convicted for any criminal offence.
(Tick this alternative, if the candidate has not been convicted and write NOT APPLICABLE against alternative (ii) below)
OR
(ii) I have been convicted for the offences mentioned below:
(If the candidate has been convicted, then tick this alternative and score off alternative (i) above, and give details in the Table given below)
TABLE
| (a) |
Case No. |
|
|
|
| (b) |
Name of the Court |
|
|
|
| (c) |
Sections of Acts/Codes involved (give no. of the Section, e.g. Section .of IPC, etc.) |
|
|
|
| (d) |
Brief description of offence for which convicted |
|
|
|
| (e) |
Dates of orders of conviction |
|
|
|
| (f) |
Punishment imposed |
|
|
|
| (g) |
Whether any Appeal has been filed against conviction order (Mention YES or No) |
|
|
|
| (h) |
If answer to item (g) above is YES, give details and present status of appeal |
|
|
|
(6-A) I have given full and up-to-date information to my political party about all pending criminal cases against me and about all cases of conviction as given in paragraphs (5) and (6).
[candidates to whom this item is not applicable should clearly write NOT APPLICABLE IN VIEW OF ENTRIES IN PARAGRAPHS 5(i) and 6(i) above.]
Note:
1. Details should be entered clearly and legibly in BOLD letters
2. Details to be given separately for each case under different columns against each item.
3. Details should be given in reverse chronological order, i.e., the latest case to be mentioned first and backwards in the order of dates for the other cases.
4. Additional sheet may be added if required.
5. Candidate is responsible for supplying all information in compliance of the Hon'ble Supreme Court's judgment in W.P. (C) No. 536 of 2011.]
(7) That I give hereinbelow the details of the assets (movable and immovable etc.) of myself, my spouse and all dependents:
A. Details of movable assets:
| Note: 1. |
Assets in joint name indicating the extent of joint ownership will also have to be given. |
| Note: 2. |
In case of deposit/Investment, the details including serial number, amount, date of deposit, the scheme, name of the Bank/Institution and Branch are to be given. |
| Note: 3. |
Value of Bonds/Share Debentures as per current market value in Stock exchange in respect of listed companies and as per books in case of non-listed companies should be given. |
| Note: 4. |
198[ Dependent means parents, son(s), daughter(s) of the candidate or spouse and any other person related to the candidate whether by blood or marriage, who have no separate means of income and who are dependent on the candidate for their livelihood.] |
| Note: 5. |
Details including amount is to be given separately in respect of each investment. |
| 199[Note: 6. |
Details should include the interest in or ownership of offshore assets. Explanation. For the purpose of this Form, the expression offshore assets includes, details of all deposits or investments in Foreign banks and any other body or institution abroad, and details of all assets and liabilities in foreign countries.] |
| Sl. No. |
Description |
Self |
Spouse |
200[HUF] |
Dependent-1 |
Dependent-2 |
Dependent-3 |
| (i) |
Cash in hand |
|
|
|
|
|
|
| (ii) |
Details of deposit in Bank accounts (FDRs, Term Deposits and all other types of deposits including saving accounts), Deposits with Financial Institutions, Non-Banking Financial Companies and Cooperative societies and the amount in each such deposit |
|
|
|
|
|
|
| (iii) |
Details of investment in Bonds, debentures/shares and units in companies/Mutual funds and others and the amount |
|
|
|
|
|
|
| (iv) |
Details of investment in NSS, Postal Saving, Insurance policies and investment in any Financial instruments in Post Office or Insurance Company and the amount |
|
|
|
|
|
|
| (v) |
Personal loans/advance given to any person or entity including firm, company, Trust etc., and other receivables from debtors and the amount |
|
|
|
|
|
|
| (vi) |
Motor Vehicles/Aircrafts/Yach-ts/Ships (Details of Make, registration number etc. year of purchase and amount) |
|
|
|
|
|
|
| (vii) |
Jewellery, bullion and valuable thing(s) (give details of weight and value) |
|
|
|
|
|
|
| (viii) |
Any other assets such as value of claims/interest |
|
|
|
|
|
|
| (ix) |
Gross Total Value |
|
|
|
|
|
|
B. Details of Immovable Assets:
Note:1. Properties in joint ownership indicating the extent of joint ownership will also have to be indicated.
Note:2. Each land or building or apartment should be mentioned separately in this format.
201[Note:3. Details should include the interest in or ownership of offshore assets.]
| Sl. No. |
Description |
Self |
Spouse |
202[HUF] |
| (i) |
Agricultural Land Location(s) Survey number(s) |
|
|
|
| Area (total measurement in acres) |
|
|
|
| Whether inherited property (Yes or No) |
|
|
|
| Date of Purchase in case of self-acquired property |
|
|
|
| Cost of Land (in case of purchase) at the time of purchase |
|
|
|
| Any investment on the land by way of development, construction etc. |
|
|
|
| Approximate current market value |
|
|
|
| (ii) |
Non-Agricultural Land: Location(s) Survey number(s) |
|
|
|
| Area (total measurement in sq. ft.) |
|
|
|
| Whether inherited property (Yes or No) |
|
|
|
| Date of Purchase in case of self-acquired property |
|
|
|
| Cost of Land (in case of purchase) at the time of purchase |
|
|
|
| Any investment on the land by way of development, construction etc. |
|
|
|
| Approximate current market value |
|
|
|
| (iii) |
Commercial Buildings (including apartments) Location(s) Survey number(s) |
|
|
|
| Area (total measurement in sq.ft.) |
|
|
|
| Built-up Area (total measurement in sq.ft.) |
|
|
|
| Whether inherited property (Yes or No) |
|
|
|
| Date of purchase in case of self-acquired property |
|
|
|
| Cost of property (in case of purchase) at the time of purchase |
|
|
|
| Any investment on the property by way of development, construction etc. |
|
|
|
| Approximate current market value |
|
|
|
| (iv) |
Residential Buildings (including apartments): Location(s) Survey number(s) |
|
|
|
| Area (total measurement in sq.ft.) |
|
|
|
| Built-up area (total measurement in sq.ft.) |
|
|
|
| Whether inherited property (Yes or No) |
|
|
|
| Date of purchase in case of self-acquired property |
|
|
|
| Cost of property (in case of purchase) at the time of purchase |
|
|
|
| Any investment on the land by way of development, construction etc. |
|
|
|
| Appropriate current market value |
|
|
|
| (v) |
Others (such as interest in property) |
|
|
|
| (vi) |
Total of current market value of (i) to (v) above |
|
|
|
(8) I give herein below the details of liabilities/dues to public financial institutions and government
(Note. Please give separate details of name of bank, institutions, entity or individual and amount before each item)
| Sl. No. |
Description |
Self |
Spouse |
203[HUF] |
Dependent-1 |
Dependent-2 |
Dependent-3 |
| (i) |
Loan or dues to Bank/financial institution(s) Name of the Bank or financial institution, Amount outstanding, Nature of Loan |
|
|
|
|
|
|
| Loan or dues to any other individuals/entity other than mentioned above Name(s), Amount outstanding, nature of loan |
|
|
|
|
|
|
| Any other liability |
|
|
|
|
|
|
| Grand total of liabilities |
|
|
|
|
|
|
| 204[(ii) |
Government dues: Dues to Departments dealing with Government accommodation |
(A) Has the Deponent been in occupation of accommodation provided by the Government at any time during the last ten years before the date of notification of the current election? (B) If answer to (A) above is YES, the following declaration may be furnished, namely (i) The address of the Government accommodation: (ii) There is no dues payable in respect of above Government accommodation, towards (a) rent; (b) electricity charges; (c) water charges; and (d) telephone charges as on . (date) |
|
| [the date should be the last date of the third month prior to the month in which the election is notified or any date thereafter]. |
| Note: No Dues Certificate from the agencies concerned in respect of rent, electricity charges, water charges and telephone charges for the above Government accommodation should be submitted. |
| (iii) |
Dues to Department dealing with Government transport (including aircrafts and helicopters) |
|
|
|
|
|
|
| (iv) |
Income tax dues |
|
|
|
|
|
|
| Sl. No. |
Description |
Self |
Spouse |
205[HUF] |
Dependent-1 |
Dependent-2 |
Dependent-3 |
| (v) |
GST Dues |
|
|
|
|
|
|
| (vi) |
Municipal/Property tax dues |
|
|
|
|
|
|
| (vii) |
Any other dues |
|
|
|
|
|
|
| (viii) |
Grand total of all Government dues |
|
|
|
|
|
|
| (ix) |
Whether any other liabilities are in dispute, if so, mention the amount involved and the authority before which it is pending.] |
|
|
|
|
|
|
(9) Details of profession or occupation:
(a) Self .
(b) Spouse ..
206[(9-A) Details of sources of income:
(a) Self
(b) Spouse .
(c) Source of income, if any, of dependents,
(9-B) Contracts with appropriate Government and any public company or companies
(a) details of contracts entered by the candidate
(b) details of contracts entered into by spouse
(c) details of contracts entered into by dependents ..
(d) details of contracts entered into by Hindu undivided family or trust in which the candidate or spouse or dependents have interest
(e) details of contracts, entered into by Partnership Firms in which candidate or spouse or dependents are partners ..
(f) details of contracts entered into by private companies in which candidate or spouse or dependants have share ]
(10) My educational qualification is as under
..
(Give details of highest School/University education mentioning the full form of the certificate/diploma/degree course, name of the School/College/University and the year in which the course was completed.)
Part B
(11) Abstract of the details given in (1) to (10) of Part A:
| 1. |
Name of the candidate |
Sh./Smt./Kum. |
| 2. |
Full postal address |
|
| 3. |
Number and name of the constituency and State |
|
| 4. |
Name of the political party which set up the candidate (otherwise write Independent ) |
|
| 207[5. |
Total number of pending criminal cases |
|
| 6. |
Total number of cases in which convicted.]. |
|
| 7. |
|
PAN of |
Year for which last income tax return filed |
Total income shown |
| |
(a) Candidate |
|
|
|
|
|
| |
(b) Spouse |
|
|
|
|
|
| |
208[(c) HUF |
|
|
|
|
|
| |
(d) Dependents] |
|
|
|
|
|
| 8. |
209[Details of Assets and Liabilities (including offshore assets) in Rupees] |
| |
Description |
Self |
Spouse |
210[HUF] |
Dependent-I |
Dependent-II |
Dependent-III |
| A. |
Movable Assets (Total Value) |
|
|
|
|
|
|
| B |
|
Immovable Asset |
|
|
|
|
|
|
| |
I. |
Purchase Price of self-acquired immovable property |
|
|
|
|
|
|
| II. |
Development/Construction cost of immovable property after purchase (if applicable) |
|
|
|
|
|
|
| III. |
Approximate Current market price of |
|
|
|
|
|
|
| |
(a) self-acquired assets (Total Value) |
|
|
|
|
|
|
| |
(b) inherited assets (Total Value) |
|
|
|
|
|
|
| 9. |
|
Liabilities |
|
|
|
|
|
|
| (i) |
Government dues (Total) |
|
|
|
|
|
|
| (ii) |
Loans from Bank, Financial Institutions and others (Total) |
|
|
|
|
|
|
| 10. |
|
Liabilities that are under dispute |
|
|
|
|
|
|
| |
(i) |
Government dues (Total) |
|
|
|
|
|
|
| |
(ii) |
Loans from Bank, Financial Institutions and others (Total) |
|
|
|
|
|
|
| 11. |
(Give details of highest School/University education mentioning the full form of the certificate/diploma/degree course, name of the School/College/University and the year in which the course was completed.) |
VERIFICATION
I, the deponent, abovenamed, do hereby verify and declare that the contents of this affidavit are true and correct to the best of my knowledge and belief and no part of it is false and nothing material has been concealed therefrom. I further declare that
(a) there is no case of conviction or pending case against me other than those mentioned in Items 5 and 6 of Part A and B above;
(b) I, my spouse, or my dependents do not have any asset or liability, other than those mentioned in Items 7 and 8 of Part A and Items 8, 9 and 10 of Part B above.
Verified at this the day of
DEPONENT
| Note: 1. |
Affidavit should be filed latest by 3.00 PM on the last day of filing nominations. |
| Note: 2. |
Affidavit should be sworn before an Oath Commissioner or Magistrate of the First Class or before a Notary Public. |
| Note: 3. |
All column should be filled up and no column to be left blank. If there is no information to furnish in respect of any item, either Nil or Not applicable , as the case may be, should be mentioned. |
| Note: 4. |
The Affidavit should be either typed or written legibly and neatly.] |
| 211[Note: 5. |
Each page of the Affidavit should be signed by the deponent and the Affidavit should bear on each page the stamp of the Notary or Oath Commissioner or Magistrate before whom the Affidavit is sworn.] |
(See Rule 83)
Illustration of the procedure as to the counting of votes at an election on the single transferable vote system when more than one seat is to be filled.
Assume that there are seven members to be elected, sixteen candidates, and one hundred and forty electors.
The valid ballot papers are arranged in separate parcels according to the first preference recorded for each candidate, and the papers in each parcel counted.
Let it be assumed that the result is as follows:
| A |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
12 |
| B |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
8 |
| C |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
6 |
| D |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
9 |
| E |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
10 |
| F |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
7 |
| G |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
4 |
| H |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
19 |
| I |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
13 |
| J |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
5 |
| K |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
14 |
| L |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
8 |
| M |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
10 |
| N |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
6 |
| O |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
4 |
| P |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
5 |
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
140 |
Each valid ballot paper is deemed to be of the value of one hundred and the values of the votes obtained by the respective candidates are as shown in the first column of the result sheet.
The values of all the papers are added together and the total 14,000 is divided by eight (i.e. the number which exceeds by one the number of vacancies to be filled) and 1,751 (i.e. the quotient 1,750 increased by one) is the number sufficient to secure the return of a member and is called the quota.
The operation may be shown thus:
14,000
Quota +1 1,750 + 1 = 1,751
The candidate H, the value of whose votes exceeds the quota, is declared elected.
As the value of the papers in H's parcel exceeds the quota, his surplus must be transferred. His surplus is 149, i.e., 1,900 less 1,751.
The surplus arises from original votes, and therefore, the whole, of H's papers are divided into sub-parcels according to the next preferences recorded thereon, a separate parcel of the exhausted papers being also made. Let it be assumed that the result is as follows:
Papers
| B is marked as next available preference on |
. |
. |
. |
. |
. |
. |
. |
7 |
| D is marked as next available preference on |
. |
. |
. |
. |
. |
. |
. |
4 |
| E is marked as next available preference on |
. |
. |
. |
. |
. |
. |
. |
4 |
| F is marked as next available preference on |
. |
. |
. |
. |
. |
. |
. |
3 |
| Total of unexhausted papers |
|
|
18 |
| No. of exhausted papers |
|
|
1 |
| Total papers |
|
|
19 |
The values of the papers in the sub-parcels are as follows:
| B |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
|
700 |
| D |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
|
400 |
| E |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
|
400 |
| F |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
. |
|
300 |
| Total value of unexhausted papers |
|
|
1,800 |
| Value of exhausted papers |
|
|
100 |
| TOTAL VALUE |
|
|
1,900 |
The value of the unexhausted papers is 1,800 and is greater than the surplus. This surplus is, therefore, transferred as follows:
All the unexhausted papers are transferred, but at a reduced value, which is ascertained by dividing the surplus by the number of unexhausted papers.
The reduced value of all the papers, when added together, with the addition of any value lost as the result of the neglect of fractions, equals the surplus. In this case the new value of each paper transferred is
149 (the surplus)
18 (the number of unexhausted papers)
the residue of the value of each paper (100 8=92), being required by H for the purpose of constituting his quota, i.e., one exhausted paper value (100) plus the value (1,656) of 18 unexhausted papers.
These values of the sub-parcels transferred are:
B=56 (i.e., seven papers at the value of 8);
D=32 (i.e., four papers at the value of 8);
E=32 (i.e., four papers at the value of 8);
F=24 (i.e., three papers at the value of 8);
These operations can be shown on a transfer sheet as follows:
Transfer Sheet
| Value of surplus (H's) to be transferred |
. |
. |
. |
. |
. |
. |
|
149 |
| Number of papers in H's parcel |
. |
. |
. |
. |
. |
. |
|
19 |
| Value of each paper in parcel |
. |
. |
. |
. |
. |
. |
|
100 |
| Number of unexhausted papers |
. |
. |
. |
. |
. |
. |
|
18 |
| Value of unexhausted papers |
. |
. |
. |
. |
. |
. |
|
1,800 |
| New value of each paper transferred |
|
|
|
|
|
|
|
|
| Surplus |
|
149 |
= 8 |
| number of unexhausted paper |
|
18 |
|
| |
Names of Candidates marked as the next available preference |
Number of papers to be transferred |
Value of sub-parcels to be transferred |
| B |
. |
7 |
|
| D |
.. |
4 |
|
| E |
.. |
4 |
|
| F |
.. |
3 |
|
| |
TOTAL |
18 |
144 |
| Number of exhausted papers . |
1 |
.. |
| Loss of value owing to neglect of fractions . |
.. |
5 |
| TOTAL |
19 |
149 |
The values of the sub-parcels are added to the values of the votes already credited to the candidates B, D, E and F. This operation is shown on the result sheet.
There being no further surplus the candidate lowest on the poll has now to be excluded. G and O both have 400.
The Returning Officer casts lots and G is chosen to be excluded.
Being original votes, G's papers are transferred at the value of 100 each. A who was marked as next preference on two papers receives 200, while D and E were each next preference on one paper and receiving 100 each. O now being lowest is next excluded and his 400 is similarly transferred to I, B and K, I receiving 200 and B and K 100 each.
This leaves J and P lowest with 500 each and J is chosen by lot for exclusion first. His papers are transferred at the value of 100 each to A, B, D and I, the three first named receiving 100 each, and I who had the next preference on two papers receiving 200. P is then excluded and his papers are transferred to E, L and K, the two first named receiving 100 each, and K, who had the next preference on three papers, receiving 300.
K now exceeds the quota and is declared elected.
Prior to further exclusion, K's surplus of 49 has to be distributed.
The sub-parcel last transferred to K consisted of 3 votes transferred at the value of 100 each. This sub-parcel is examined; there are no exhausted papers and B, F and I are each next preference on one paper and one paper is transferred to each of them at a reduced value determined by dividing the surplus (49) by the number of unexhausted papers (3), B, F and I accordingly receive 16 each.
The process of exclusion is now proceeded with.
C and N have 600 each, and C is chosen by lot for exclusion first. He has 6 original votes; B, D and E are each next preference on two papers, and each receives 200. N is then excluded, A is next preference on 3 of his papers, and receives 300; F, I and L are each next preference on one paper and receive 100 each.
This brings A and I above the quota and they are declared elected. Their surplus have now to be distributed and I's surplus which is the larger, 65, is dealt with first.
The last sub-parcel transferred to I consisted of one paper transferred at the value of 100, D is next preference on this paper, and receives, the whole surplus of 65.
A's surplus of 49 is then dealt with. The last sub-parcel transferred to him consisted of 3 papers transferred at the value of 100 each. B was next preference on two of these papers and E on one, and the papers are transferred accordingly. The value to be transferred is 16 per paper, i.e., the surplus (49), divided by the number of the unexhausted (3). B accordingly receives 32 and E 16.
No other candidate having reached the quota, the process of exclusions is proceeded with, and F who is now lowest with 840, is excluded.
His seven original votes are transferred first. B, D and E are next preference on three, two and two papers, respectively, and receive respectively 300, 200 and 200.
The transferred votes are next transferred in the order of their transfers to F. The 3 votes received at the value of eight each at the distribution of H's surplus are transferred at the same value to L who was next preference on all 3 papers.
The vote valued at sixteen received by F at the distribution of K's surplus, goes at the same value to M, who was next preference on that paper. The vote transferred at the value of 100 on the exclusion of N is then transferred at the same value to D, who thus received a total of 300.
No continuing candidate having reached the surplus, N, who is now lowest with 1016 is excluded.
His ten original votes are transferred first. B and D are first preference on three papers each and E and L on two each. B and D accordingly receive 300 each, and E and L 200 each. This brings B, D and E above the quota and they are declared elected. The requisite number of candidates having now been elected, the election is at an end, and it is unnecessary to proceed to the transfer of M's transferred votes.
Full details are shown in the result sheet:
| Value of votes: 14,000 |
RESULT SHEET |
14,000 Quota = + 1 = 1,751 8 |
| Name of candidates |
Value of votes at first count |
Distribution of H S surplus |
Result |
Distribution of votes of G and O |
Result |
Distribution of votes of J and P |
Result |
Distribution of K's surplus |
| 1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
| A . . . . . . . |
1,200 |
.. |
1,200 |
+200 |
1,400 |
+100 |
1,500 |
.. |
| B . . . . . . . |
800 |
+56 |
856 |
+100 |
956 |
+100 |
1,056 |
+16 |
| C . . . . . . . |
600 |
.. |
600 |
.. |
600 |
.. |
600 |
.. |
| D . . . . . . . |
900 |
+32 |
932 |
+100 |
1,032 |
+100 |
1,132 |
.. |
| E . . . . . . . |
1,000 |
+32 |
1,032 |
+100 |
1,132 |
+100 |
1,232 |
.. |
| F . . . . . . . |
700 |
+24 |
724 |
.. |
724 |
.. |
724 |
+16 |
| G . . . . . . . |
400 |
.. |
400 |
-400 |
.. |
.. |
.. |
.. |
| H . . . . . . . |
1,900 |
149 |
1,751 |
.. |
1,751 |
.. |
1,751 |
.. |
| I . . . . . . . |
1,300 |
.. |
1,300 |
+200 |
1,500 |
+200 |
1,700 |
+16 |
| J . . . . . . |
500 |
.. |
500 |
.. |
-500 |
500 |
.. |
.. |
| K . . . . . . . |
1,400 |
.. |
1,400 |
+100 |
1,500 |
+300 |
1,800 |
49 |
| L . . . . . . . |
800 |
.. |
800 |
.. |
800 |
+100 |
900 |
.. |
| M . . . . . . . |
1,000 |
.. |
1,000 |
.. |
1,000 |
.. |
1,000 |
.. |
| N . . . . . . . |
600 |
.. |
600 |
.. |
600 |
.. |
600 |
.. |
| O . . . . . . . |
400 |
.. |
400 |
400 |
.. |
.. |
.. |
.. |
| P . . . . . . . |
500 |
|
500 |
.. |
-500 |
500 |
.. |
.. |
| Loss of value by neglect of fraction |
.. |
+5 |
5 |
.. |
5 |
.. |
5 |
+1 |
| TOTAL .. |
14,000 |
.. |
14,000 |
.. |
14,000 |
.. |
14,000 |
.. |
| Value of votes: 14,000 |
RESULT SHEET |
14,000 Quota = + 1 = 1,751 8 |
| Result |
Distribution of votes of C and N |
Result |
Distribution of surplus of I and A |
Result |
Distribution of F's votes |
Result |
Distribution of M's votes |
Result |
Result of Election |
| 10 |
11 |
12 |
13 |
14 |
15 |
16 |
17 |
18 |
19 |
| 1,500 |
+300 |
1,800 |
+49 |
1,751 |
.. |
1,751 |
.. |
1,751 |
Elected |
| 1,072 |
+200 |
1,272 |
+32 |
1,304 |
+300 |
1,604 |
+300 |
1,904 |
Elected |
| 600 |
-600 |
.. |
.. |
.. |
.. |
.. |
.. |
.. |
Not elected |
| 1,132 |
+200 |
1,332 |
+65 |
1,397 |
+300 |
1,697 |
+ 00 |
1.99 |
Elected |
| 1,232 |
+200 |
1,432 |
+16 |
1,448 |
+200 |
1,648 |
+200 |
1,848 |
Elected |
| 740 |
+100 |
840 |
.. |
840 |
-840 |
.. |
.. |
.. |
Not Elected |
| .. |
.. |
.. |
.. |
.. |
.. |
.. |
.. |
.. |
Not Elected |
| 1,751 |
.. |
1,751 |
.. |
1,751 |
.. |
1,751 |
.. |
1,751 |
Elected |
| 1,716 |
+100 |
1,816 |
-65 |
1,751 |
.. |
1,751 |
.. |
1,751 |
Elected |
| .. |
.. |
.. |
.. |
.. |
.. |
.. |
.. |
.. |
Not Elected |
| 1,751 |
.. |
1,751 |
.. |
1,751 |
.. |
1,751 |
.. |
1,751 |
Elected |
| 900 |
+100 |
1,000 |
.. |
1,000 |
+24 |
1,024 |
+200 |
1,224 |
Not Elected |
| 1,000 |
.. |
1,000 |
.. |
1,000 |
+16 |
1,016 |
1,000 |
+16 |
Not Elected |
| 600 |
-600 |
.. |
.. |
.. |
.. |
.. |
.. |
.. |
Not Elected |
| .. |
.. |
.. |
.. |
.. |
.. |
.. |
.. |
.. |
Not Elected |
| .. |
.. |
.. |
.. |
.. |
.. |
.. |
.. |
.. |
Not Elected |
| 6 |
.. |
6 |
+1 |
7 |
.. |
7 |
.. |
7 |
|
| 14,000 |
.. |
14,000 |
.. |
14,000 |
.. |
14,000 |
.. |
14,000 |
|