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STATEMENT SHOWING THE LIST OF X CLASS STUDENTS TO BE GOING TO WORK AS VOLUNTEER TO ASSIST OLD PEO

DISTRICT
Name of name of School
Name of the Name of the Boy
S.No the the UDISE Name of the School
Constituency Student /Girl
Mandal Village Code

Note : - For each polling station 4 Childeren (@ 2 Boys and 2 Girls) data has to be furnished
WORK AS VOLUNTEER TO ASSIST OLD PEOPLE AT POLLING STATIONS(GENERAL ELECTIONS) IN THE

Name of Contact Cell


Native
the Native place of Native Mandal No of the
Constituency of Remarks
Father/gu the Student of the Student Student/Fathe
the Student
ardian r/Guardian

Signature of the DYEO with seal

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