FORM 11

(See rule 24 (1))

 Appointment of Election Agent

Election to the * ……………Grama ** / Taluk / Zilla Panchayat from the *…………..Constituency

To:

 
The Returning Officer,

 
I, …………………..of ………………….a candidate at the above election do hereby appoint Sri ………. (Name and Address) as my election agent from this day at the above election.

 
Place : 

I accept the above appointment 

Place :

                                                                                                                                                  

* Appropriate particulars of the election to be indicate here.

** Strike off the inappropriate alternative.