[See Rule 22(2) ]

Revocation of Appointment of Election Agent

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

The Returning Officer,

I, .... a candidate at the above election hereby revoke the appointment of . my Election Agent.

Place :  
Date :
Signature of the Candidate

* Appropriate particulars of the election to be inserted here