Form 10

[See Rule 23(1) ]

Appointment of Polling Agent*

Election of Councillors to the City Municipal Council/Town Municipal Council/Town Panchayat of the City/Town of ……………………….. from the ………………………………….*ward.

I, …………………………………………..………….a Candidate/*** the Election Agent of …………..……………………. who is a candidate at the above election do hereby appoint ……………………………...…………………….(Name and address) as a Polling Agent to attend Polling Station No………………..…………….at (Place)….………….…fixed for poll at (time) ………………

I agree to act as Polling Agent.

Declaration of Polling Agent to be signedbefore the Presiding Officer

I hereby declare that at the above election, I will not do anything forbidden by section 30 of the Karnataka Municipalities Act, 1964 which I have read/has been read over to me.

* To be handed over to the Polling Agent for production at the Polling station or at the place fixed for the poll.
** Appropriate particulars of the election to be inserted.
** Score off the inappropriate alternative

Section 30 of the Karnataka Municipalities Act, 1964

"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 under this Act 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 provision of sub-section(1) shall be punishable with imprisonment for a term which may extend to three months or with fine or with both."