[See Rule 25(1) ]
Revocation of Appointment of Polling
Election of Councillors to the City Municipal Council/Town Municipal
Council/Town Panchayat of the City/Town of
The Presiding Officer,
. a Candidate/Election Agent** of
at the above election hereby revoke the appointment of
.at the polling
Signature of the Candidate
* Appropriate particulars of the
election to be inserted.
** Score off the inappropriate altenative.