[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
.a Candidate/*** the Election
. who is a candidate at the above election
do hereby appoint
.(Name and address) as a
Polling Agent to attend Polling Station No
for poll at (time)
Signature of the Candidate
I agree to act as Polling Agent.
Signature of the Polling
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.
Signature of Polling Agent
Signed before 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."