FORM 12

(See rules 19 and 20)

Letter of intimation to Returning Officer

(Application for Postal Ballot)

To

The Returning Officer for

…………………………Assembly/Parliamentary Constituency.

Sir,

I……………………………………………...s/o…………….…………………………………………...
intend to cast my vote by post at the ensuing election to the Legislative Assembly/ House of the People
from the…………………………………….. Assembly Constituency.

My name is entered at Serial. No.……………in Section No………….. & Name………………….

under Part No……………….of the Electoral roll for…………………………………………………
Assembly Constituency. My Electoral Photo Identity card No. is ……………...

The Ballot Paper may be sent to me at the following address:-

………………………………………………….…………………….

…………………………………………………………………………

…………………………………………………………………………

Contact No…………...................

Place: Yours faithfully,

(Signature of the Applicant)

Date:
Name:………………………………