General Elections to HoP & APLA-2024

Application for Pamphlet Distribution

To,
The Returning Officer / Asst. Returning Officer
Assembly Constituency/Assembly Segment ________________________
District _________________________________

Parliamentary Constituency________________________________

Sub: Application for Pamphlet Distribution

Sir/ Madam,

I hereby inform you that I, Shri/Smt. ________________________ am an election agent of/

an Independent candidate/ a candidate of the _________________________________________

Party.

I request you to kindly issue necessary permission for Pamphlet Distribution for election campaign for

General-Elections to the Assembly Constituency/ Assembly segment(s) of the Parliamentary

Constituency______________________________________, 2024

Pamphlet Distribution Details:

Areas / Locality Name: _________________________________________________

Date: From ____________________ To________________________

Duration of Time: from ______________________ to ____________________

Enclosed

Tentative Expenditure (YES / NO)


Venue owner permission (YES / NO)

 DECLARATION

I hereby declare that the facts and particulars mentioned above are true to the best of my
knowledge and belief.

Signature: __________________________ Mobile No registered with RO: ____________________

Name: _____________________________ E-mail: ________________________________________

Address: _____________________________ Date of submission: _____________________________

_______________________________

________________________________