Appointment of counting agents

FORM 34 [See Rule 76(2)] Election to the Municipal Corporaton/Council/Nagar Panchayat from ______________constituency. To The Returning officer. I, _______________a candidate/the election agent of _________________________ who is a candidate at the above election, do hereby appoint the following persons as my counting agents to attend the counting of votes at _____________________ SR NO. Name of counting Agent Address of the Counting Agents 1 2 3 4

We agree to act as such counting agents Signature of candidate/Section agents. 1. 2. 3. 4, Place______________ Date _______________

Signture of counting agents. DECLARATION OF COUNTING AGENTS (To be signed before the Returning Officer) We hereby declare that at the above election we will not do anything forbidden by Section 113 which we have read/has been read over to us. 1, 2. 3. etc. Date____________________

Signature of Counting agent. Signed before the Date____________ Returning Officer