FORM 21

[See rule 58 (2) ]

Appointment of Counting Agent

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

To:
The Returning Officer
………………………
………………………

I …………………………..a Candidate**/the Election Agent of……………who is a candidate at the above election do hereby appoint the following persons as my **/his counting Agents to attend the counting of votes at …………………………….

Name of the Counting Agent

Address of the Counting Agent

1.

2.

3.

etc.

Place	:
Date	:	Signature of the Candidate/Election Agent

We agree to act as such Counting Agents.

1.

2.

3.

etc.

Place	:
Date	:	Signature of the Counting Agents

Declaration of the Counting Agents

(To be signed before the Returning Officer)

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

1.

2.

3.

etc.

Place	:
Date	:	Signature of the Counting Agents Signed before me

Date	:	Signature of the Returning Officer

* Appropriate particulars of the Election to be inserted.
** Strike off the inappropriate alternative

Section 44 of the Karnataka Municipal Corporation Act, 1976-
"44. Maintenance of secrecy of voting

1. Every Officer, Clerk, Agent or other person who performs any duty in connection with the recording or counting of votes at any Election under this act shall maintain and aid in maintaining the Secrecy of 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.

2. Any person who contravenes the provision of sub-section (1) shall on conviction be punished with imprisonment for a term which may extend to three months or with fine or with both.