Form 5

[See Rule 15(1) ]

Notice of Withdrawal

Election of Councillors to the Corporation of the City of ………………………….. from the ………………………………….*ward reserved for Backward Classes (A) or (B)**/ Scheduled Castes/ Scheduled Tribes/ Women

To:
The Returning Officer,
.………………………………
.………………………………
.………………………………

I, ………………………………………………a Candidate validly nominated at the above election do hereby give notice that I withdraw my candidature.

Place	:
Date	:	Signature of the Candidate

 

This notice was delivered to me at my office at ………….(hour) on …………….. (date) by ………………………………………(name)

Place	:
Date	:	Returning Officer

Receipt of Notice of withdrawal
(To be handed over to the person delivering the notice)

The notice of withdrawal of candidature by ……………………….a validly nominated candidate at the election to the ………………………*ward was delivered to me by the + …………………….at my office …………………………(hour) on ……………..(date).

Place	:
Date	:	Returning Officer

* Appropriate particulars of the election to be inserted.
** Strike off the inappropriate alternative
+ Here insert one of the following alternatives as may be appropriate

(1) Candidate
(2) Candidate's proposer who has been authorised in writing by the Candidate to deliver it
(3) Candidate's election agent who has been authorized in writing by the Candidate to deliver it.