PS No. C.

U No
B.U No
PS NAME:
VVPAT No.
S.No Name of the candidate Symbol Votes Polled TOTAL Tallied/NOT

1 1 2 3 4 5 6 7 8 9 10
2 1 2 3 4 5 6 7 8 9 10
3 1 2 3 4 5 6 7 8 9 10
4 1 2 3 4 5 6 7 8 9 10
5 1 2 3 4 5 6 7 8 9 10
6 1 2 3 4 5 6 7 8 9 10
7 1 2 3 4 5 6 7 8 9 10
8 1 2 3 4 5 6 7 8 9 10
9 1 2 3 4 5 6 7 8 9 10
10 1 2 3 4 5 6 7 8 9 10
11 1 2 3 4 5 6 7 8 9 10
12 1 2 3 4 5 6 7 8 9 10
13 1 2 3 4 5 6 7 8 9 10
14 1 2 3 4 5 6 7 8 9 10
15 1 2 3 4 5 6 7 8 9 10
16 1 2 3 4 5 6 7 8 9 10
Time:5.30 to 5.45 am
No.of polling agents present: ( )
Signiture of the polling agents Name of the cadidate In case thre is no polling agents present by 5.45 am
1 Name of the polling Offiocer Signiture of the polling Offiocer
2
3
4
5
6

Sector officer sign Micro abserver sign presiding officer sign