FORM 30

[See rule 63 (4) ]

Revocation of the appointment for Counting Agent


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


To:

Returning Officer:


I, . a candidate ** / the Election Agent .. of .who is a candidate at the above election hereby revoke the appointment of .my ** / his counting Agent.


Place :
 

Date
Signature of the Candidate
** /Election Agent

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