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)]
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:
Date:
Signature of the companion
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