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 :
 

Date
Signature of the Candidate


I accept the above appointment 


Place :

Date
Signature of Election Agent

                                                                                                                                                  

* Appropriate particulars of the election to be indicate here.

** Strike off the inappropriate alternative.