FORM 10

ISee Rule 13(7) I

* /vppointtrurnt: or Pollinfj /vqcnt
ttcctron to the**. ...
I,. .; a candidate/the election aqent: of who is a candidate at the above election do hereby 1.:,.1
I appoint... . (Name and address) I .as a polling agent to attend I polling station No ....
at./ptacc fixed for the poll .. at.
r)laC(~..
Date. Signat.ure oft candidate/election aqnnt..
r agree to act as such polling aqc.nt.
1)lace.
Si qrtat.urc of pollinq aqcru..
Date.

Declaration or polling afjent. to be signed betorc Presiding Officer

I hereby declare that at t.ho above election I will not. do anything forbidden by Section 1781 I of HIe
Representation of the I)eople Act, 19~;1, which : I have read/has been read over t.o me.
Dat.e . Signat.ure of polling accnt.
Siq ncd before me.
Prcsrdinq Officer
Date

*To be handed over t.o the pollin q aqcnt for production at. the pollinq st.at.ion or at. the place fixed for the
poll.
**I-lere insert. one of the followinq altcrn ativcs as may be appropriate:
(1) lIouse of the People from t.he.... .. constituency.
(7.) tcqistativc Assembly from HIe.. .. constituency.
(3) Council of St.atcs by the elected members of t.hc legislative Assembly of . (State).
(1\) Council of Stat.cs by the members of the electoral college of .. (Union t.errit.ory).
e» I eqis+at.vc Council by the members of the lcqistauvc Assembly.
(6) t.cqistat.rvc Council from the . constituency.
I St.rike off the inappropriate alternative.
I lScction 178 of the Representation of the People Act, 19S1:
"128. r-teint.enemcc or secrecy or votinq . (1) lvcrv officer, clerk, agent or other person who performs any
duty in connection with the recording or countinq of votes at. an election shall rnaintain , and aid In
mamtaininq, t.hc secrecy of the vot.i n q and shall not. (except. for some purpose autho ns cd by or under any law)
cornrnurur.atr: to any person any inforrnat.ion calculated t.o violate such secrecy.
(/.) Any person who co nt.ravcrie s the provisions of sub-scctron (1) shall be punishable with imprisonment. for
il t.crrn which rnav ext.eric to t.hr cc months or wit.h fine or with both."