2. Subs. by Notifn. No. S.O.124(E), dated the 24th February, 1993, for certain words.

121

Whether the candidate—
(i) has been convicted—

Conduct of Elections Rules, 1961
(Statutory Rules and Order)

1[PART II
(To be filled by the Candidate)

(a) of any offence(s) under sub-section (1); or
(b) for contravention of any law specified in sub-section (2), of section 8 of the Representation of the People

Act, 1951 (43 of 1951); or

(ii) has been convicted for any other offence(s) for which he has been sentenced to imprisonment for two years or
more.

If the answer is “Yes”, the candidate shall furnish the following information:

(i) Case/First information report No./Nos. …………………………………………………………………..

(ii) Police station(s)………………………District(s)……………………………State(s)…………………..

(iii) Section(s) of the concerned Act(s) and brief description of the offence(s) for which he has been
convicted ……………………………………………………………………………………………………..

(iv) Date(s) of conviction(s)……………………………………………………………………………………
(v) Court(s) which convicted the candidate…………………………………………………………………..
(vi) Punishment(s) imposed [indicate period of imprisonment(s) and/or quantam of fine(s)]………………………..
(vii) Date(s) of release from prison………………………………………………………………………………
(viii) Was/were any appeal(s)/revision(s) filed against above conviction(s)…………..Yes/No
(ix) Date and particulars of appeal(s)/application(s) for revision filed……………………………….
(x) Name of the court(s) before which the appeal(s)/application(s) for revision filed………………………………..
(xi) Whether the said appeal(s)/application(s) for revision has/have been disposed of or is/are pending…………….
(xii) If the said appeal(s)/application(s) for revision has/have been disposed of—

(a) Date(s) of disposal……………………..

(b) Nature of order(s) passed………………………….
Place:

Date:

(Signature of the candidate)].

________________________________________________________________________________________________
1. Ins. by Notifn. No. S.O. 935(E), dated the 3rd September, 2002.

Yes/No

122

Serial No. of Nomination Paper…………..

Conduct of Elections Rules, 1961
(Statutory Rules and Order)

1[PART III]
(To be filled by the Returning Officer)

This nomination was delivered to me at my office at……………….(hour) on……………….(date) by the
candidate/proposer……….(Name).

Date……………

1[PART IV]
Decision of Returning Officer accepting or rejecting the Nomination Paper

Returning Officer.

I have examined this nomination paper in accordance with section 36 of the Representation of the People Act,
1951, and decide as follows:—

Date…….

Returning Officer.
________________________________________________________________________________________________

(perforation)…………………….
________________________________________________________________________________________________

1[PART V]

Receipt for Nomination Paper and Notice of Scrutiny

(To be handed over to the person presenting the nomination paper)
Serial No. nomination paper………….

The nomination paper of…..a candidate for election to the Legislative Council of……(State) by the Members
of Legislative Assembly was delivered to me at my office at……(hour) on…..(date) by the
candidate/proposer……(Name). All nomination papers will be taken up for scrutiny at …..(hour) on……..(date)
at……(place).

Date……..

Returning Officer.

________________________________________________________________________________________________
Note:—Wherever alternative is provided score out the word(s) not applicable.

_______________________________________________________________________________________________
1. Ins. by S.O. 935(E), dated 3-9-2002.

123

Conduct of Elections Rules, 1961
(Statutory Rules and Order)

1[FORM 2E
(See rule 4)
NOMINATION PAPER

Election to the Legislative Council of ……………..(State) from a Council constituency………………….

2[PART I]
We hereby nominate as a candidate for election to the Legislative Council of………………..(State) from the

constituency. Candidate’s name…………………….(Father’s/Mother’s/Husband’s name)………………..His Postal
address…………………….His name is entered at Sl. No……………………….in Part No. ……………..of the
electoral roll for ……………………..Assembly Constituency.

We declare that we are electorals and our name entered in the electoral roll
for……………………………..(Council) constituency as indicated below and we append our signatures below in token
of subscribing to this nomination:–

Particulars of the proposers and their signatures.

________________________________________________________________________________________________
Sl.No. Electroral Roll No. of proposer Full Name Signature Date

_______________________________________________
Part No. of electoral roll Sl. No. in that Part

________________________________________________________________________________________________
123456
________________________________________________________________________________________________
1.

2.
3.
4.
5.
6.
7.
8.
9.
*10.
________________________________________________________________________________________________
*There should be ten per cent. of the electors of the constituency or ten such electors whichever is less, as proposers.

I, the above-mentioned candidate, assent to this a nomination and hereby declare:—

(a) that I have completed ……………………….years of age;
(b) that I am set up at this election by the …………………..party;
(c) that my name and my (father’s/mother’s/husband’s name) has been correctly spelt out above in
…………………….(name of the language);
(d) that to the best of my knowledge and belief, I am qualified and not also disqualified for being chosen to fill
the seat in the Legislative Council of……………………………………………………(State) from
………………………………………………………………….Council constituency.

I also declare that I have not been and shall not be, nominated as a candidate at the present biennial
election/bye-elections being held simultaneously, to the Legislative Council of ……………………….(State) from
more than two Council constituencies in the State.

Date……………………..

*Score out the words not applicable

(Signature of the Candidate).

_______________________________________________________________________________________________
1. Subs. by Notifn. No. S.O. 558(E), dated the 9th August, 1996.
2. Ins. by Notifn. No. S.O. 935(E), dated the 3rd September, 2002.
.

124

Whether the candidate—
(i) has been convicted—

Place:

Date:

(Signature of the candidate)].

(a) Date(s) of disposal……………………..
(b) Nature of order(s) passed………………………….

Conduct of Elections Rules, 1961
(Statutory Rules and Order)

1[PART II
(To be filled by the candidate)

(a) of any offence(s) under sub-section (1); or
(b) for contravention of any law specified in sub-section (2), of section 8 of the Representation of the

People Act, 1951 (43 of 1951); or

(ii) has been convicted for any other offence(s) for which he has been sentenced to imprisonment for two years or
more.

If the answer is “Yes”, the candidate shall furnish the following information:

(i) Case/First information report No./Nos. …………………………………………………………………..

(ii) Police station(s)………………………District(s)……………………………State(s)…………………..

(iii) section(s) of the concerned Act(s) and brief description of the offence(s) for which he has been
convicted ……………………………………………………………………………………………………..

(iv) date(s) of conviction(s)……………………………………………………………………………………
(v) Court(s) which convicted the candidate…………………………………………………………………..
(vi) Punishment(s) imposed [indicate period of imprisonment(s) and/or quantam of fine(s)]………………………..
(vii) Date(s) of release from prison………………………………………………………………………………
(viii) Was/were any appeal(s)/revision(s) filed against above conviction(s)…………..Yes/No
(ix) Date and particulars of appeal(s)/application(s) for revision filed……………………………….
(x) Name of the court(s) before which the appeal(s)/application(s) for revision filed………………………………..
(xi) Whether the said appeal(s)/application(s) for revision has/have been disposed of or is/are pending…………….
(xii) If the said appeal(s)/application(s) for revision has/have been disposed of—

_______________________________________________________________________________________________
1. Ins. by Notifn. No. S.O. 935(E), dated the 3rd September, 2002.

Yes/No

125

Conduct of Elections Rules, 1961
(Statutory Rules and Order)

1[PART III]
(To be filled by the Returning Officer)

Serial No. of Nomination Paper ……………………

This nomination was delivered to me at my office at ………………………… (hour) on ………… (date)
by the candidate/proposer …………………………….(Name).

Date…………..

Returning Officer.
________________________________________________________________________________________________

1[PART IV]
Decision of Returning Officer accepting or rejecting the Nomination Paper

I have examined this nomination paper in accordance with section 36 of the Representation of the People Act,
1951 and decide as follows:—

Date………

Returning Officer.

________________________________________________________________________________________________
1[PART V]

Receipt for Nomination Paper and Notice of Scrutiny

(To be handed over to the person presenting the nomination paper)
Serial No. of nomination paper …………………………

The
nomination paper of …………………………………………a
candidate for election to the Legislative Council
of …………………………………………….(State) from
the………..Graduates’/(Teachers’/Local Authorities’) constituency was
delivered to me at my office at
………………………………(hour)
on……………………………………………. (date) by the
candidate/proposer…………………. (Name). All nomination papers
will be taken up for scrutiny at ………………….(hour)
on ……………………(date) at ……………………(Place).

Date………..

Note:—Wherever alternative is provided score out the word(s) not applicable.

________________________________________________________________________________________________
1. Ins. by Notifn. No. S.O. 935(E), dated the 3rd September, 2002.

Returning Officer.

126

Conduct of Elections Rules, 1961
(Statutory Rules and Order)

1[FORM 3A
(See rule 7)
NOTICE OF NOMINATIONS

Election to the *House of the People/Legislative Assembly from the ………………………. constituency.

Notice is hereby given that the following nominations in respect of the above election have been received up to
3 P .M. today:—
______________________________________________________________________________________________
Sl. No. of Name of candidate Name of Father/mother/husband Age of candidate Address
Nomination

paper
______________________________________________________________________________________________
12345
______________________________________________________________________________________________

______________________________________________________________________________________________

Party Particulars
affiliation of castes,

or tribes
for candidates
belonging to
scheduled
castes or
scheduled
tribes

Electoral
roll of
number of
candidate

Names
of proposers

Electoral roll No.
of proposers

_______________________________________________________________________________________________
6 7 8 9 10
_______________________________________________________________________________________________

Place:……………….
Date:……………….. Returning Officer]

________________________________________________________________________________________________

*Strike off the inappropriate alternative.

________________________________________________________________________________________________
1. Subs. by Notifn. No. S.O. 558 (E), dated the 9th August, 1996.

127

Conduct of Elections Rules, 1961
(Statutory Rules and Order)

1[FORM 3B
(See rule 7)

NOTICE OF NOMINATION

Election to the the Council of States/Legislative Council by the elected members of the Legislative
Assembly/Electoral College of.

Notice is hereby given that the following nominations in respect of the above election have been received up to 3
P.M. today: —

________________________________________________________________________________________________

Serial Name of
Number candi-
of date
nomina-

Name of 2[father/mother Age
husband] of

candidate

Address

Party
Affiliation

tion
paper
________________________________________________________________________________________________
123456
________________________________________________________________________________________________

________________________________________________________________________________________________

Electoral
roll number
of candidate

Names of proposers

Serial numbers of
proposers in the
list maintained
under section 152

________________________________________________________________________________________________
789

________________________________________________________________________________________________

Place
Date

Returning Officer.

Note:—Wherever alternative is provided score out the word(s) not applicable.
________________________________________________________________________________________________
1. Subs. by Notifn. No. S.O. 364(E), dated the 18th May, 1989, for Forms 3B and 3C.
2. Subs. by Notifn. No. S.O.124(E), dated the 24th February, 1993, for certain words.

128

Conduct of Elections Rules, 1961
(Statutory Rules and Order)

FORM 3C
(See rule 7)

NOTICE OF NOMINATION
Election to the Legislative Council of ………………………….(State) from the……………………..constituency.

Notice is hereby given that the following nominations in respect of the above election have been received up to 3
P.M. today: —

________________________________________________________________________________________________

Serial Name of
Number candi-
of date
nomina-

Name of 1[father/mother/ Age
husband] of

candidate

Address

Party
Affiliation

tion
paper
________________________________________________________________________________________________
123456
________________________________________________________________________________________________

________________________________________________________________________________________________

Electoral
roll numbers
of candidate
in assembly constituency
________________________________________________________________________________________________

789
________________________________________________________________________________________________

Names of proposers

Electrol roll numbers of
proposers in the
council constituency

Place……………………
Date…………………… Returning Officer.]

Note:—Wherever alternative is provided score out the word(s) not applicable.

________________________________________________________________________________________________
1. Subs. by Notifn. No. S.O.124(E), dated the 24th February, 1993, for certain words.

129

Conduct of Elections Rules, 1961
(Statutory Rules and Order)

1[FORM 4
(See rule

LIST OF VALIDLY NOMINATED CANDIDATES

Election to the* ……………………….

________________________________________________________________________________________________
Sl. Name of candidate Name of **Father/mother/husband Address of candidates @Party affiliation
No.
________________________________________________________________________________________________
12345
________________________________________________________________________________________________

________________________________________________________________________________________________
(i) Candidates of recognised National and State Political Parties.

(ii) Candidates of registered political parties (other than recognised National and State Political Parties).

(iii) Other candidates.
_______________________________________________________________________________________________

Place……………………
Date ……………………

Returning Officer.]
________________________________________________________________________________________________

*Appropriate particulars of the election to be inserted here.
**Strike off the inappropriate alternative.
@Applicable in the case of candidates mentioned under categories (i) and (ii) above.

N.B.—Under Col. 1 above, the serial numbers of candidates of all the three categories shall be given consecutively
and not separately for each category.

________________________________________________________________________________________________
1. Subs. by Notifn. No. S.O. 558(E), dated the 9th August, 1996, for Form 4.

130

The Returning Officer,

Conduct of Elections Rules, 1961
(Statutory Rules and Order)

FORM 5
[See rule 9(1)]

NOTICE OF WITHDRAWAL OF CANDIDATURE

Election to the* …………………………………

I,………………………, a 1[candidate validly nominated] at the above election do hereby give notice that I withdraw my
candidature.

Place ……………
Date …………….

Signature of 1[validly nominated candidate].
This notice was delivered to me at my office at ……………………………………………..(hour) on………………

(date) by…………………………..(name), the+……………………………….
Date…………………..
________________________________________________________________________________________________

Receipt for Notice of Withdrawal

(To be handed over to the person delivering the notice)

The notice of withdrawal of candidature by ……………………………a 1[validly nominated candidate] at the
election to the*……………………………………was delivered to me by the+…………………….at my office
at……………………………….(hour) on ………………………………….. (date).

Returning Officer.
________________________________________________________________________________________________

*Here insert one of the following alternatives as may be appropriate:—
(1) House of the People from the ……………….. constituency.
(2) Legislative Assembly from the………………….constituency.
(3) Council of States by the elected members of the Legislative Assembly of……………………………(State).
(4) Council of States by the members of the electoral college of……………………………… (Union territory).
(5) Legislative Council by the members of the Legislative Assembly.

(6) Legislative Council from the………………… constituency.

+Here insert one of the following alternatives as may be appropriate:—

(1) Candidate.

(2) Candidate’s proposer who has been authorised in writing by the candidate to deliver it.

(3) Candidate’s election agent who has been authorized in writing by the candidate to deliver it.

________________________________________________________________________________________________
1. Subs. by Notifn. No. S.O. 565(E), dated the 4th August, 1984.

Returning Officer.

131

election

Conduct of Elections Rules, 1961
(Statutory Rules and Order)

FORM 6
[See rule 9(2)]

NOTICE OF WITHDRAWAL OF CANDIDATURES

Election to the* …………………………………

Notice is hereby given that the following 1[validly nominated +candidate]/candidates at the above
withdraw +his candidature/their candidatures today.

_______________________________________________________________________________________________
Name of 1[validly Address of Remarks
nominated candidate] 1[validly

nominated
candidate]

_______________________________________________________________________________________________
1.

2.
3.

etc.
_______________________________________________________________________________________________

Date……….

Returning Officer.

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

________________________________________________________________________________________________
1. Subs. by Notifn. No. S.O. 565(E), dated the 4th August, 1984.

132

Conduct of Elections Rules, 1961
(Statutory Rules and Order)

1[FORM 7A
[See rule 10(1)]
LIST OF CONTESTING CANDIDATES

Election to the House of the People/Legislative Assembly from the ……………………………… constituency.

_______________________________________________________________________________________________
Sl. Name of candidate Address of candidate *Party affiliation Symbol allotted

No.
_______________________________________________________________________________________________
12345
_______________________________________________________________________________________________

________________________________________________________________________________________________

(i) Candidates of recognised National and State Political Parties.
(ii) Candidates of registered political parties (other than recognised National and State Political Parties).
(iii) Other candidates.
________________________________________________________________________________________________
Place ………
Date ……….

Returning Officer.]
________________________________________________________________________________________________

*Applicable in the case of candidates mentioned under categories (i) and (ii) above.

N.B.—Under Col. 1 above, the serial numbers of candidates of all the three categories shall be given consecutively
and not separately for each category.]

________________________________________________________________________________________________
1. Subs. by Notifn. No. S.O. 558(E), dated the 9th August, 1996, for Form 7A.

133

Conduct of Elections Rules, 1961
(Statutory Rules and Order)

1[FORM 7B
[See rule 10(1)]
LIST OF CONTESTING CANDIDATES
Election to the*……………………..

________________________________________________________________________________________________
Sl. No Name of candidate Address of candidate **Party affiliation
________________________________________________________________________________________________
1234
________________________________________________________________________________________________

(i) Candidates of recognised National and State Political Parties.
(ii) Candidates of registered political parties (other than recognised National and State Political Parties).

(iii) Other candidates.
________________________________________________________________________________________________

Place………..
Date………..

Returning Officer.]
________________________________________________________________________________________________

*Here insert one of the following alternatives as may be appropriate:—
(1) Council of States by the elected members of the Legislative Assembly of………………………….(State).
(2) Council of States by the members of the electoral college……………..(Union Territory).
(3) Legislative Council of………….(State), by the members of the Legislative Assembly.
(4) Legislative Council of………….(State), from the……………….Constituency.

**Applicable in the case of candidates mentioned under categories (i) and (ii) above.
N.B.—Under Col. 1 above, the serial numbers of candidates of all the three categories shall be given consecutively

and not separately for each category.]

________________________________________________________________________________________________
1. Subs. by Notifn. No. S.O. 558(E), dated the 9th August, 1996, for Form 7B.

134

To
The Returning Officer,

Conduct of Elections Rules, 1961
(Statutory Rules and Order)

FORM 8
[See rule 12(1)]
APPOINTMENT OF ELECTION AGENT
(To be filled by the Returning Officer)
Election to the* …………………………………

I,……………………,of………………..
a candidate at the above election do hereby
appoint……………of………as my
election agent from this day at the above election.

Place…………

Signature of candidate.

Date…………
________________________________________________________________________________________________
I accept the above appointment.

Place………….
Date…………..

Signature of election agent
1[Approved. Signature and Seal of the Returning officer.]

________________________________________________________________________________________________
*Here insert one of the following alternatives as may be appropriate:—

(1) House of the People from the……………constituency.
(2) Legislative Assembly from the…………..constituency.
(3) Council of States by the elected members of the Legislative Assembly of………(State).
(4) Council of States by the members of the electoral college of…….(Union territory).
(5) Legislative Council by the members of the Legislative Assembly.
(6) Legislative Council from the …………….constituency.

________________________________________________________________________________________________
1. Ins.by Notifn. No. S.O. 565(E), dated the 4th August, 1984.

135

To
The Returning Officer,

Conduct of Elections Rules, 1961
(Statutory Rules and Order)

FORM 9
[See rule 12(2)]

REVOCATION OF APPOINTMENT OF ELECTION AGENT

Election to the* …………………………………

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

Place……….
Date ……….

Signature of candidate.

________________________________________________________________________________________________
*Here insert one of the following alternatives as may be appropriate:—

(1) House of the People from the………………. constituency.
(2) Legislative Assembly from the……………… constituency.
(3) Council of States by the elected members of the Legislative Assembly of ……………….. (State).
(4) Council of States by the members of the electoral college of……………….. (Union territory).
(5) Legislative Council by the members of the Legislative Assembly.
(6) Legislative Council from the ……………. constituency.

136

Place………..
Date ………..

Conduct of Elections Rules, 1961
(Statutory Rules and Order)

FORM 10
[See rule 13(2)]
*APPOINTMENT OF ELECTION AGENT

Election to the** …………………………………

I, …………… †
hereby 1[appoint………………….(Name and address)]………………………as a polling agent to attend† polling station
No………………….. at/place fixed for the poll………. at………

Place ………..
Date………….

I agree to act as such polling agent.

Signature of †candidate/election agent.

a candidate/the

election agent of ……………….who is a candidate at the above election do

Declaration of polling agent to be signed before Presiding Officer

I hereby declare that at the above election I will not do anything forbidden by section 128†† of the Representation
of the People Act, 1951, which† I have read/has been read over to me.

Date ………..

Signed before me.
Date……………

Signature of polling agent.

Presiding Officer.
________________________________________________________________________________________________

*To be handed over to the polling agent for production at the polling station or at the place fixed for the poll.
**Here insert one of the following alternatives as may be appropriate:—

(1) House of the People from the ………….constituency.
(2) Legislative Assembly from the…………….constituency.
(3) Council of States by the elected members of the Legislative Assembly of ………(State).
(4) Council of States by the members of the electoral college of………… (Union territory).
(5) Legislative Council by the members of the Legislative Assembly.
(6) Legislative Council from the ……………………constituency.

†Strike off the inappropriate alternative.
††Section 128 of the Representation of the People Act, 1951:—

“128. Maintenance of secrecy of voting.—(1) Every officer, clerk, agent or other person who performs any duty in
connection with the recording or counting of votes at an election shall maintain, and aid in maintaining, the secrecy
of the voting and shall not (except for some purpose authorised by or under any law) communicate to any person any
information calculated to violate such secrecy.

(2) Any person who contravenes the provisions of sub-section (1) shall be punishable with imprisonment for a term

which may extend to three months or with fine or with both.”.

________________________________________________________________________________________________
1. Subs. by Notifn. No. S.O. 565(E), dated the 4th August, 1984.

Signature of polling agent.

137

To
The Presiding Officer,

The Returning Officer for
Assembly/Parliamentary constituency.

Conduct of Elections Rules, 1961
(Statutory Rules and Order)

FORM 11
[See rule 14(1)]
REVOCATION OF APPOINTMENT OF POLLING AGENT
Election to the* …………………….

I, …………………[the election agent of………………] a candidate at the above election, hereby revoke the
appointment of……………… my/his polling agent.

Place ………………………
Date ………………………

Signature of person revoking.
________________________________________________________________________________________________

*Here insert one of the following alternatives as may be appropriate:—

(1) House of the People from the…………… constituency.
(2) Legislative Assembly from the………………….. constituency.
(3) Council of States by the elected members of the Legislative Assembly of …………………….(State).
(4) Council of States by the elected members of the electoral college of…………………….. (Union territory).
(5) Legislative Council by the members of the Legislative Assembly.
(6) Legislative Council from the…………………… constituency.

N.B.-Omit the words marked [ ] as necessary.
________________________________________________________________________________________________

1[FORM 12
(See rules 19 and 20)
LETTER OF INTIMATION TO RETURNING OFFICER

To

Sir,

I intend to cast my vote by post at the ensuing election to the Legislative Assembly/House of the People from
the ……………..Assembly/Parliamentary constituency.

My name is entered at S.No……..in Part No…………. of the electoral role for …………… assembly constituency
comprised within………………….Parliamentary constituency.

The ballot paper may be sent to me at the following address:—

……………………………
……………………………
……………………………

Place ………………………
Date ……………………….
________________________________________________________________________________________________
1. Subs. by Notifn. No. S.O. 3662, dated the 12th October, 1964, for Form 12.

Yours faithfully,
………………….]

138

To
The Returning Officer,

……….Assembly/Parliamentary constituency.
Sir,

People

Conduct of Elections Rules, 1961
(Statutory Rules and Order)

1[FORM 12A
[See rule 20(2)]

APPLICATION FOR ELECTION DUTY CERTIFICATE

I intend to cast my vote in person at the ensuing election to the Legislative
from the ………constituency.

Assembly/House

of the

I
have been posted on election duty within the constituency at
………….. (No. and name of the polling
station) but my name is entered at Serial No………….. Part No.
……………. of the electoral rolls for………….. assembly
constituency comprised within…………………… Parliamentary
constituency.

I request that an Election Duty Certificate in Form 12B may be issued to enable me to vote at the polling
station where I may be on duty on the polling day. It may be sent to me at the following address:—

……………………………
……………………………
……………………………
……………………………
……………………………
……………………………

Place ………….
Date …………..
________________________________________________________________________________________________

FORM 12B
[See rules 20(2) and 35A]
ELECTION DUTY CERTIFICATE

Certified that……….is an elector in the……………………Assembly/Parliamentary constituency, his electoral roll
number being …………..that by reason of his being on election duty he is unable to vote at the polling station where
he is entitled to vote and that he is therefore hereby authorised to vote at any polling station 2[in the said
constituency where] he may be on duty on the date of poll.

Place……………… Signature…………
Date ………………

SEAL Returning Officer.
________________________________________________________________________________________________

1. Subs. by Notifn. No. S.O. 565(E), dated the 4th August, 1984.
2. Ins., ibid.

Yours faithfully,
………….].

139

Conduct of Elections Rules, 1961
(Statutory Rules and Order)

1[FORM 12C
[See rule 27-C]

PART I
Letter of intimation to Assistant Returning Officer for notified class of electors:

To
The Assistant Returning Officer,
(for the notified class of electors)

………………………….
Parliamentary/Assembly constituency …………………………..
(designation & address of ARO)
Sir,

I,……son/daughter/wife
of…..resident of….of……village/Mohalla….of
Town/city/tehsil…….District……….of………(State)
belong to the class of notfied electors and wish to cast my vote by post
at the election to the House of the
People/Legislative Assembly from the………..Parliamentary/Assembly
constituency.

My complete present postal address is as under:—

House/dwelling unit/tent number………………………
Camp/mohalla/village……………………………………
ward/town/tehsil………………………………………….
district………………………………………………………
State……………………………….PIN CODE…………..

My name is entered at serial number……………in Part No………………of the electrol roll
for………..Parliamentary/Assembly constituency.

*I am registered as a migrant with……………..(designation of officer) Government of…………under
registration no………..as a head/member of the family of self/Shri/Shrimati…………….. .

*I am not registered as a migrant.

*I am the head of my family is serving as a Government employee as (designation)……………………..in the
office of…………. (full address).

*I am/the head of my family is a pensioner and drawing pension under account No……..from Government
Treasury/Branch of Bank, located at………………(full address).

Yours faithfully,

PART II

Certificate by the officer incharge of the migrant camp/office/area or by head of the office where the
applicant is serving as a migrant employee or by a treasury officer/bank manager from where the migrant is drawing
his pension as a pensioner or by any gazetted officer.

It is hereby certified that the particulars given by the applicant in Part I are correct as per our record/to the
best of my knowledge and understanding.

………….(full signature of the attesting Officer)
……………….(Name)
……………….(address)
……………….(rubber stamp).

* Strike off whichever is not applicable and tick the relevant statement.

________________________________________________________________________________________________
1. Subs. by Notifn. No. S.O. 628(E), dated 4th August, 1999.

140

Conduct of Elections Rules, 1961
(Statutory Rules and Order)

FORM 13A
[See rule 23(1)(a)]

DECLARATION BY ELECTOR

Election to the*……….
(This side is to be used only when the elector signs the declaration himself)

I hereby declare that I am the elector to whom the postal ballot paper bearing serial number…………has been issued at the
above election.

Date………….

Signature of identifier, if any…..
Address………….

Signature of Attesting Officer.
Designation…………….

Address………………..
Date…………………..

Date……….

I hereby certify that—

Signature of Attesting Officer on behalf of elector.
Address of Elector…………..

__________

Attestation of signature

The above has been signed in my presence by……………(elector) who** is personally known to me/has been identified to
my satisfaction by……….(identifier) who is personally known to me.

(This side is to be used when the elector cannot sign himself)

I hereby declare that I am the elector to whom the postal ballot paper bearing serial number………….has been issued at the
above election.

__________
CERTIFICATE

(1) the above named elector** is personally known to me/has been identified to my satisfaction by……..(identifier) who
is personally known to me;

(2) I am satisfied that the elector** is illiterate/suffers from……………..(infirmity) and is unable to record his vote
himself or sign his declaration;

(3) I was requested by him to mark the ballot paper and to sign the above declaration on his behalf; and
(4) the ballot paper was marked and the declaration signed by me on his behalf in his presence and in accordance with

his wishes.

Signature of Attesting Officer…………………….
Signature of identifier, if any………….. Designation………..

Address………….. Address……………
Date………………

__________________________________________________________________________________________________________
*Here insert one of the following alternatives as may be appropriate:—

(1) House of the People from the………….. constituency.
(2) Legislative Assembly from the…………. constituency.
(3) Council of States by the elected members of the Legislative Assembly of …………………….(State).
(4) Council of States by the members of the electoral college of…………………….. (Union territory).
(5) Legislative Council by the members of the Legislative Assembly.
(6) Legislative Council from the…………. constituency.

**Strike off the inappropriate alternative.

Signature of elector.
Address……………

141

Conduct of Elections Rules, 1961
(Statutory Rules and Order)

FORM 13B
[See rule 23(1)(b)]
1[Cover A]

*Appropriate particulars of the election to be inserted here.
________________________________________________________________________________________________

FORM 13C
[See rule 23(1)(c)]

1[Cover B]
(To be used at an election to the House of People for the Legislative Assembly of a State)

*Returning Officer to insert here the name of the appropriate Parliamentary/Assembly Constituency.
**Returning Officer to mention here his full postal address.
2[***Strike off in the case of an elector who is employed under the Government of India in a post outside India.]
________________________________________________________________________________________________

1. Subs. by Notifn. No. S.O. 565(E), dated the 4th August, 1984.
2. Subs. by Notifn. No. S.O. 2362 (E), dated the 3rd July, 1970.

142

Conduct of Elections Rules, 1961
(Statutory Rules and Order)

FORM 13C
[See rule 23(1)(c)]
1[Cover B]

(TO BE USED AT AN ELECTION TO THE COUNCIL OF STATES OR TO THE LEGISLATIVE
COUNCIL OF A STATE)

*Insert here Council of States or name of the Legislative Council or the appropriate Electoral College.
**Full postal address of the Returning Officer to be inserted here.

________________________________________________________________________________________________
1. Subs. by Notifn. No. S.O. 565(E), dated the 4th August, 1984.

143

Conduct of Elections Rules, 1961
(Statutory Rules and Order)

1[FORM 13D
[See rule 23(1)(d)]
INSTRUCTIONS FOR GUIDANCE OF ELECTORS

(To be used at an election to the House of the People or to the Legislative Assembly of a State)

Election
to the*………..from
the………………………………………………………………………………………………………………

The
persons whose names are printed on the ballot paper sent herewith are
candidates at the above election. Record your
vote by placing clearly a mark opposite the name of the candidate to
whom you wish to give your vote. The mark should be so
placed as to indicate clearly and beyond doubt to which candidate you
are giving your vote. If the mark is so placed as to make it
doubtful to which candidate you have given your vote, your vote will be
invalid.

The number of members to be elected is one. Please remember that you have only one vote. Accordingly you should not
vote for more than one candidate. If you do so, your ballot paper will be rejected.

Do not put your signature or write any word or mark any mark, sign or writing whatsoever on the ballot paper other than the
mark required to record your vote.

After you have recorded your vote on the ballot paper, place the ballot paper in the smaller cover marked ‘A’ sent
herewith. Close the cover and secure it by seal or otherwise.

(1) You may then sign the declaration in Form 13A also sent herewith in the presence of a stipendiary magistrate and obtain
the attestation of your signature by such stipendiary magistrate.

(2) If you are a member of the armed forces of the Union or of an armed police force of a State but is serving outside that
State, the attestation may be obtained by such officer as may be appointed in this behalf by the Commanding Officer of the
Unit, ship or establishment in which you or your husband, as the case may be, are employed.

(3) If you are employed under the Government of India in a post outside India the attestation may be obtained by such
officer as may be appointed in this behalf by the diplomatic or consular representative of India in the country in which you
are resident.

(4)
If you hold an office like the office of the (i) President, (ii)
Vice-President, (iii) Governors of States, (iv) Cabinet
Ministers of the Union or of any State, (v) The Deputy Chairman and
Members of the Planning Commission, (vi) The Ministers of
State of the Union or of any State, (vii) Deputy Minister of the Union
of any State, (viii) The Speaker of the House of the People
or of any State Legislative Assembly, (ix) The Chairman of any State
Legislative Council, (x) Lieutenant Governors of Union
territories, (xi) The Deputy Speaker of the House of the People or of
any State Legislative Assembly, (xii) The Deputy Chairman
of the Council of States or of any State Legislative Council, (xiii)
Parliamentary Secretaries of the Union or of any State, the
attestation may be obtained by an officer not below the rank of a Deputy
Secretary to the Government of the Union or the State, as
the case may be.

(5)
If you are on an election duty, attestation may be obtained by any
gazetted officer or by the Presiding Officer of the polling
station in which you are on election duty.

(6) If you are under preventive detention, the attestation may be obtained by the Superintendent of the jail or the
Commandant of the detention camp in which you are under detention.

In all the above cases you may take the declaration to the authorised officer and sign it in his presence after he has satisfied
himself about your identity. The officer will attest your signature and return the declaration to you. You must not show your
ballot paper to the attesting officer nor tell him how you have voted.

If
you are unable to mark the ballot paper and sign the declaration
yourself in the manner indicated above by reason of
illiteracy, blindness or other infirmity, you are entitled to have your
vote marked and declaration signed on your behalf by any of
the authorised officer mentioned above. Such an officer will, at your
request mark the ballot paper in your presence and in
accordance with your wishes. He will also complete the necessary
certificate in this behalf.

After
your declaration has been signed and your signature has been attested,
place the declaration in Form 13A as also the
smaller cover marked ‘A’ containing the ballot paper in the larger cover
marked ‘B’. After closing the larger cover, send it to the
returning officer by post or by messenger. You have to give full
signature in the space provided on the cover marked `B’.

* Appropriate particulars of the election, to be inserted here.

________________________________________________________________________________________________
1. Subs. by Notifn. No. S.O. 961 (E), dated the 29th December, 1986, for Form 13D.

144

Conduct of Elections Rules, 1961
(Statutory Rules and Order)

No postage stamp need be affixed by you, if the cover is posted in India. If, however, you are an elector employed
under the Government of India in a post outside India, you should return the cover to the returning officer concerned
direct by air mail service after the requisite postage stamp is duly affixed thereon by the office in which you are
serving except where it is sent by diplomatic bag.

You
must ensure that the cover reaches the Returning Officer before**
………………..**on………………………………….
Please note that :—

(i) if you fail to get your declaration attested or certified in the manner indicated above, your ballot paper will
be rejected; and

(ii) if the cover reaches the returning officer after**……………………………………………on the**………..
………………….your vote will not be counted.

________________________________________________________________________________________________
**(Here specify the hour and date fixed for the commencement of counting of votes).

FORM 13D
[See rule 23(1) (d)]
INSTRUCTIONS FOR GUIDANCE OF ELECTORS

(To be used at an election to the Council of States or to the Legislative Council of a State)

Election to the Council of States …………………….Legislative Council.

The
persons whose names are printed on the ballot paper sent herewith are
candidates at the above election. Record your vote
by placing the figure 1 in the space opposite the name of the candidate
to whom you want to vote. Place the figure 1 opposite the
name of one candidate only *(although there are more members than one to
be elected). You may indicate your relative
preference for the other candidates by placing in the spaces opposite
their names the figures 2, 3, 4, etc., in order of such
preference. Do not place more than one figure opposite the name of any
candidate and do not place the same figure opposite the
names of more candidates than one.

The
number of members to be elected is
………………………………………………………………………………………….

After you have recorded your vote on the ballot paper, place the ballot paper in the smaller cover marked `A’ sent herewith.
Close the cover and secure it by seal or otherwise.

You
have then to sign the declaration in Form 13A also sent herewith in the
presence of an officer competent to attest your
signature. If you are under preventive detention the attestation of your
signature on the declaration in Form 13A shall be obtained
by the Superintendent of the jail or the Commandant of the detention
camp in which you are under such detention. If you are not
under preventive detention, the attestation may be obtained by a
stipendiary magistrate to whom you are personally known or to
whose satisfaction you have been identified, or in the case of an
election to a Council Constituency by any of the following
categories of officers who have been notified in this behalf by the
Election Commission, namely:—

………………………………..
………………………………..

Take
the declaration to any such officer and sign it in his presence after
he has been satisfied about your identity. The
officer will attest your signature and return the declaration to you.
You must not show your ballot paper to the attesting officer nor
tell him how you have voted.

If
you are unable to mark the ballot paper and sign the declaration
yourself in the manner indicated above by reason of
illiteracy, blindness or other infirmity, you are entitled to have your
vote marked and the declaration signed on your behalf by
an officer competent to attest your signature. Such an officer will, at
your request, mark the ballot paper in your presence and in
accordance with your wishes. He will also complete the necessary
certificate in this behalf.

After
the declaration has been signed and your signature has been attested,
place the declaration in Form 13A as also the
smaller cover marked `A’ containing the ballot paper in the larger cover
marked `B’. After closing the larger cover, send it to the
Returning Officer by registered post or by messenger.

__________________________________________________________________________________________________________
* To be deleted when only one member is to be elected.

145

You must ensure that
the……………………………………**.

Please note that—

Conduct of Elections Rules, 1961
(Statutory Rules and Order)

the cover reaches the returning officer before**……………..on

(i) If you fail to get your declaration attested or certified in the manner indicated above your ballot paper
will be rejected; and

(ii) if the cover reaches the returning officer after** ………………on the…………..**your vote will not
be counted.

Any ballot paper on which the figure 1 is not marked or on which the figure 1 is set opposite the name of more
than one candidate, or is so placed as to render it doubtful to which candidate it is intended to apply, or on which
the figure 1 and some other figures are set opposite the name of the same candidate or on which the same figure is set
opposite the name of more candidates than one or on which the signature of the elector is not duly attested or the
number of which does not agree with the number of the ballot paper entered on the cover in which it is placed, will
be rejected.]

________________________________________________________________________________________________
**Here specify the hour and date fixed for the commencement of counting of votes.

146

Conduct of Elections Rules, 1961
(Statutory Rules and Order)

1[FORM 13E
(See rule 27F)
INSTRUCTIONS FOR GUIDANCE OF NOTIFIED CLASS OF ELECTORS

(To be used at an election to the House of the People/State Legislative Assembly)

Election to the House of the People/Legislative Assembly of……………… .from the………………………….. .

The persons whose names are printed on the ballot paper sent herewith are candidates at the above election.
Record your vote by placing clearly a mark opposite the name of the candidate to whom you wish to give your vote.
The mark should be so placed as to indicate clearly and beyond doubt to which candidate you are giving your vote. If
the mark is so placed as to make it doubtful to which candidate you have given your vote, your vote will be invalid.

The number of members to be elected is one. Accordingly, you should not vote for more than one candidate, if
you do so, your ballot paper will be rejected.

Do not put your signature or write any word or mark any mark, sign or writing whatsoever on the ballot paper
other than the mark required to record your vote.

After you have recorded your vote on the ballot paper, place the ballot paper in the smaller cover marked A
sent herewith. Close the cover and secure it by seal or otherwise.

You may then sign the declaration in Form 13A which is sent herewith in the presence of the officer (as defined
in Rule 27J) of the Conduct of Elections Rules, 1961 and obtain the attestation of your signature by such authorised
officer. Extracts of Rule 27J of the Conduct of Elections Rules, 1961 are enclosed herewith.

If you are unable to mark the ballot paper and sign the declaration yourself in the manner indicated above by
reason of illiteracy, blindness or other infirmity, you are entitled to have your vote marked and declaration signed
on your behalf by any of the authorised officers as mentioned above. Such an Officer will, at your request mark the
ballot paper in your presence and in accordance with your wishes. He will also complete the necessary certificate
in this behalf.

After your declaration has been signed and your signature has been attested, place the declaration in Form 13A
as also the smaller cover marked A containing the ballot paper in the larger cover marked B. After closing the larger
cover, send it to the Returning Officer by post or by messenger. You have to give your full signature in the space
provided on the cover marked B. No postage stamp need be affixed by you if the cover is posted in India. If,
however, you are an elector employed under the Government of India on a post outside India, you should return the
cover to the Returning Officer concerned direct by air mail service after the requisite postage stamp is fully affixed
thereon by the office in which you are serving except where it is sent by diplomatic bag. You must ensure that the
cover reaches the Returning Officer before…………..(hour) on………..(date).

Please note that:—

(i) if you fail to get your declaration attested or certified in the manner indicated above, your ballot paper will
be rejected; and

(ii) if the cover reaches the Returning Officer after………………(hour) on ……………(date) your vote will
not be counted.]

________________________________________________________________________________________________
1. Form 13E, which was ins. by Notifn. No. S.O. 321 (E), dated the 1st May, 1996, subs. by Notifn. No. S.O. 628(E), dated 4th August, 1999.

147

Conduct of Elections Rules, 1961
(Statutory Rules and Order)

1[FORM 13F
[See rule 27N(3)]

Appointment of proxy by classified service voter to give vote.

I………….(name
…………….r/o…………presently working as…………….and posted at……………am entitled to appoint proxy
under sub-rule (2) of rule 27N of the Conduct of Election Rules, 1961. I hereby appoint……………(name of the
proxy) aged about…………………..s/o, d/o, w/o………………..r/o…………………as my proxy to give vote on my
behalf and in my name in………………Assembly constituency and/or……………Parliamentary constituency of the
State/Union territory of…………..in which I am entitled to give vote under the Representation of the People Act, 1951
(43 of 1951) and the rules made thereunder.

Serial No……………..

……………………….
(Signature of proxy)

Serial number of his name
and part no. of electoral roll of the
concerned constituency…………

……………………………………..
(Signature of classified service voter)

Serial number of his name in the last
part of electoral roll of the concerned
constituency…………………………
Service Identity Card No……….
Name of the Force to which he
belongs……………………………..

of the classified service voter) aged about…….s/o, d/o, w/o

Note: (1) The person to be appointed as proxy shall be an ordinary resident in the constituency concerned and of
not less than eighteen years of age and shall not be a person disqualified for registration as an elector in an
electoral roll under section 16 of the Representation of the People Act, 1950 (43 of 1950).

(2) The signature of the classified service voter and the proxy shall be made before a First Class Magistrate or
Notary or the Commanding Officer of the Unit concerned who shall verify the signatures under his hand and
seal. In case of First Class Magistrate or Notary verifying the signature, he shall personally check the service
identity card of the classified service voter to authenticate veracity of the classified service voter.

(3) Score out the word (s) which are not applicable.

Receipt of Form 13F for the appointment of proxy by classified service voter
(To be handed over to the person depositing the said form)

Serial No…………………..
Received Form 13F of Shri/Smt./Kum…………………………….
Date…………………. …………………..

Returning Officer

_______________________________________________________________________________________________
1. Ins. by Notifn. No. S.O. 903(E), dated the 5th August, 2003.

148

Serial No……………..

……………………….
(Signature of proxy)

Serial number of his name
and part no. of electoral roll of the
concerned constituency…………

……………………………………..
(Signature of classified service voter)

Serial number of his name in the last
part of electoral roll of the concerned
constituency…………………………
Service Identity Card No……….
Name of the Force to which he
belongs……………………………..

Conduct of Elections Rules, 1961
(Statutory Rules and Order)

FORM 13G
[See rule 27N(4)]

Revocation of appointment of proxy or revocation of appointment of proxy and appointment of substitute proxy by
classified service voter to give vote

I…………………….(name of the classified service voter) aged about…….s/o, d/o, w/o
……………….r/o……………presently working as…………….and posted at……………had
appointed……………(name of the proxy) aged about…………………..s/o, d/o,
w/o………………..r/o…………………as my proxy to give vote on my behalf and in my name
in………………Assembly constituency and/or……………Parliamentary constituency of the State/Union territory
of…………..

2. I hereby revoke the appointment of my said proxy and do not wish to appoint any substitute proxy.
OR

Whereas such proxy has died/I hereby revoke appointment of the said proxy and being entitled to appoint
substitute proxy under sub-rule (4) of rule 27N of the Conduct of Election Rules, 1961, hereby
appoint………………(name of the substitute proxy) aged about…………………..s/o, d/o,
w/o……………………r/o………………….as substitute proxy who shall hereafter give vote on my behalf and in my
name in………………….Assembly constituency and/or………………..Parliamentary constituency……………..of the
State/Union territory of…………………………..in which I am entitled to give vote under the Representation of the
People Act, 1951 (43 of 1951) and the rules made thereunder.

Note: (1) The person to be appointed as proxy shall be an ordinary resident in the constituency concerned and of
not less than eighteen years of age and shall not be a person disqualified for registration as an elector in an
electoral roll under section 16 of the Representation of the People Act, 1950 (43 of 1950).

(2) The signature of the classified service voter and the proxy shall be made before a First Class Magistrate or
Notary or the Commanding Officer of the Unit concerned who shall verify the signatures under his hand and
seal. In case of First Class Magistrate or Notary verifying the signature, he shall personally check the service
identity card of the classified service voter to authenticate veracity of the classified service voter.

(3) Score out the word (s) which are not applicable.
Receipt of Form 13G for revocation of appointment of proxy or revocation of appointment of proxy and

appointment of substitute proxy by classified service voter to give vote.

(To be handed over to the person depositing the said form)
Serial No…………………..

Received Form 13G of Shri/Smt./Kum…………………………….
Date…………………. …………………..

Signature and Seal
Returning Officer.]

________________________________________________________________________________________

149

Serial
number
of entry

Name of electoral Part Elector’s
of name in
roll that part

Signature or
thumb impression
of the person
challenged

Conduct /of Elections Rules, 1961
(Statutory Rules and Order)

FORM 14
[See rule 36(2)(c)]
LIST OF CHALLENGED VOTES

Election to the*………………..from the……………….constituency.

1[Polling
________________________________________________________________________________________________

Station Number and Name of Polling Station……………in……………..Assembly
constituency/Name of place of poll ……………]

________________________________________________________________________________________________
12345
________________________________________________________________________________________________
1.

2.
3.
4.
5.
6.
7.
8.
9.
10.
________________________________________________________________________________________________

Address of
the person
challenged

Name of
identifier,
if any

Name of
challenger

Order of Presiding
Officer

Signature of
challenger on
receiving
refund of
deposit

________________________________________________________________________________________________
6 7 8 9 10

________________________________________________________________________________________________

________________________________________________________________________________________________

………………………………
Date………………. Signature of Presiding Officer.

*Appropriate particulars of the election to be inserted here.

________________________________________________________________________________________________
1. Subs. by Notifn. No. S.O. 565(E), dated the 4th August, 1984.

150

Conduct of Elections Rules, 1961
(Statutory Rules and Order)

1[FORM 14A
[See rules 40(2) and 40A(2)]
LIST OF †ILLITERATE, BLIND AND INFIRM VOTERS

Election to the ………….**………….*from the…….constituency*/by the elected members**/members
of the Legislative Assembly of ……………..(State).

2[Number and Name of Polling Station………..in…………Assembly constituency/Name of place of poll……………..]

________________________________________________________________________________________________
Part No. Full name Full name Address of Signature of
& Sl.No. of elector of companion companion companion
of elector
________________________________________________________________________________________________

________________________________________________________________________________________________
Date…………..

Signature of Presiding Officer.]

†The word “illiterate” not applicable in the case of election from Assembly/Parliamentary constituency.
*Strike off whichever is inapplicable.
** Strike off whichever is inapplicable.]

________________________________________________________________________________________________
1. Subs. by Notifn. No. S.O. 2362, dated the 3rd July, 1970, for Form 14A.
2. Subs. by Notifn. No. S.O. 563(E), dated the 4th August, 1984, for certain words.