FORM 12

[See rule 24 (3) ]

Revocation of Appointment of Election Agent


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


To:

The Returning Officer,


I, .. a candidate at the above election hereby revoke the appointment of . my election agent.

 
Place :
 

Date
Signature of the Candidate



* Appropriate particulars of the election to be indicate here.

** Strike off the inappropriate alternative.