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:………………………………