Form 10

[See Rule 21(2) ]

Appointment of Polling Agent*

Election of Councillors to the Corporation of the City of ……………………….. from the ………………………………….*ward

I, ………………………….a Candidate/*** the Election Agent of ………………………. who is a candidate t 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) ………………

Place :  
Date :
  Signature of Candidate / ***Election Agent

I agree to act as Polling Agent.

Place :  
Date :
  Signature of the Polling Agent


Declaration of Polling Agent to be signed before the Presiding Officer

I hereby declare that at the above election, I will not do anything forbidden by section 44 of the Karnataka Municipal Corporation Act, 1976 which I have read/has been read over to me.

 

Place :  
Date :
  Signature of Polling Agent
Signed before me

Presiding Officer


* 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 44 of the Karnataka Municipal Corporation Act, 1976
"Maintenance of secrecy of voting - (1) Every Officer, 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 authorized by or under any law, communicate to any person any information calculated to violate such secrecy.
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."