rule 24 (1))
of Election Agent
Election to the *
Grama ** / Taluk / Zilla Panchayat from the
The Returning Officer,
.a candidate at the above
election do hereby appoint Sri
. (Name and Address) as my election
agent from this day at the above election.
Signature of the Candidate
I accept the above appointment
Signature of Election
* Appropriate particulars of the election to be indicate here.
Strike off the inappropriate alternative.