Page 1 of 1

FORM NO. VI

{See Rule 20(3)}

CERTIFICATE OF ELECTION

I declare that...........................................................................................................................(Name)

of ....................................................................................................................................................(Address)

Registration No. ....................................................................................................has been duly elected to fill

the

seat of .....................................................................................................

Place:......................................................................................................

Returning Officer

Date:..........................................

http://coa.gov.in/home/frm6.asp 8/23/2013