The Maharashtra Cooperative Societies Rule 1961

MCS Rule Forms

Form 'M-12' Form of declaration by companion of blind or infirm voter

[See Rule 56A-11(1)]

Download the Word or PDF Format of form M-12 from here.

 


Election to the .....................................(name of society) Co-operative Society Ltd .......................

Tahsil ................... (name of constituency) District .................. from the ....................... constituency.

No. and name of Polling Station :

I ................................................................... aged ............................ residing at ................................................................ hereby declare that:-
(a) I wish to act as companion of Shri/Smt ............................ who is a blind /infirm voter at the above election and whose name is in the voters list at Sr. No .............................

(b) I have not already acted as the companion of any other voter at my polling station on this day.

(c) I will keep secret the vote recorded by me on behalf of the voter aforesaid.

Place:
Date:

Signature of the companion

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