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Election to the Managing Committee members of................................................... Cooperative
Society Ltd.,....................................... Tahsil ............................, ..........................., District ........................
from................................................ constituency.
To
The Returning Officer,
I........................................... , a candidate for the present election do hereby
request you that I have appointed :-
1. Shri., ......................................... Address............................................
2. Shri., ......................................... Address............................................
as Counting Agents to attend the counting work on........... (date) at................
(place) at................. (time).
Date:
Signature of the Candidate
I agree to act as Counting Agent
Signature of the Counting Agent.
N.B.
(1) Not more than two counting agents shall be appointed.
(2) This form duly filled in and signed by the candidate shall be
presented to the Returning Officer in duplicate.
Declaration of Polling/Counting Agent to be signed before the Returning/Polling Officer
I hereby declare that I will not do anything forbidden by the Act or
these Rules or by-laws thereunder at this election for......................................... (name of
constituency)
of................................. (name of society).
Signature of the Polling/Counting Agent
Signed before me
Returning/Polling Officer