[See Rule 58 (4) ]

Revocation of Appointment of Counting Agent

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

The Returning Officer,

I, ... a candidate** / the Election Agent of ...who is a candidate at the above election hereby revoke the appointment of . My**/his counting Agent.

Place :  
Date :
Signature of person Revoking

* Appropriate particulars of the election to be inserted.

** Score off the inappropriate alternative