[See Rule 21(4) ]
Revocation of Appointment of Polling Agent
Election of Councillors to the Corporation of the City of
.. from the
...*ward
To:
The Presiding Officer,
..
..
..
..
I,
.
. a Candidate / ** Election Agent of
..at
the above election hereby revoke the appointment of Polling Agent
.
At the Polling Station No
at
..(Place)
| Place |
: |
|
| Date |
: |
Signature of Candidate
/ Election Agent
|
* Appropriate particulars of the Election
to be inserted.
** Score off the inappropriate
alternative
