FORM 14

[See rule 25 (4) ]

Revocation of Appointment of Polling Agent


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


To:

The Presiding Officer:

………………………

………………………


I, ……………………………. a Candidate / the Election Agent of ………… at the above election hereby revoke the appointment of ………………………. Polling Agent ……………………………………………………………. at the Polling Station No………………………. at ………………………………(place)


 
Place :
 

Date
Signature of the Candidate
** /Election Agent

 * Appropriate particulars of the election to be inserted here.
** Strike off the inappropriate alternative.