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 : 

                                                                                                                                                  

* Appropriate particulars of the election to be indicate here.

** Strike off the inappropriate alternative.