FORM 13

[See rule 25 (2) ]

Revocation of Appointment of Counting Agent


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


To:

The Returning Officer,

……………………….

……………………….


I, …………….…………………………………………….………. a candidate / ** the Election Agent of …………………………………………….a candidate at the election hereby revoke the appointment of ………………………. my / ** his/her Counting Agent.

Place :
Date:
Signature of person revoking


* Appropriate particulars of the election to be inserted.
** Score off the inappropriate alternative.