[See rule 25 (4) ]
Revocation of Appointment of Polling
Election to the *
.Grama ** /Taluk/Zilla Panchayat
from the *
The Presiding Officer:
. a Candidate / the Election Agent of
above election hereby revoke the appointment of
. at the Polling Station No
Signature of the Candidate
** /Election Agent
* Appropriate particulars of the election to be inserted here.
** Strike off the inappropriate alternative.