Appointment of polling/counting agent

Election to the Managing Committee (Guardian Category) of Hardamnagar

Uday Chand High School, Hardamnagar, Malda.

I ,………………………………………………………………………………….(name of the candidate) do hereby

appoint ……………………………………………………………………………………………. (name of the agent)
………………………………………………………………………………………...
……………………………………………………………………………………………………………(address) as a
polling/counting agent to attend polling station at Hardamnagar UC High School fixed for the
poll on 24th September 2023 at 9 a.m. His name is entered in the Final Voters’ List (Guardian
Category) in serial no………………………. ………..

Signature of the candidate

Place:
Date:
I agree to act as polling /counting agent
Signature of the polling/ counting agent
Place:
Date:

DECLARATION
I do hereby declare that at the above election I will not do anything forbidden by The
Management of Recognised Non—Govt. Institutions (Aided and Unaided) Rules 1969 and
necessary amendments thereafter which I have read/has been read over to me.

Signature of the polling/counting agent (to be signed before Election Officer)

Date:

Place:

Signed before me.

Signature of the Election Officer

Place: Date: