1

074 VILLUPURAM CONSTITUENCY

PARLIAMENTARY ELECTION – 2024
MODEL FORMS
FORM–17C
[See Rule 49S and 56C (2)]
PART - I - ACCOUNT OF VOTES RECORDED
Election to the House of the People / Legislative Assembly of the State / Union
Territory........TAMILNADU....from....VILLUPURAM....... Constituency.
No. and Name of Polling Station. 275 PUES -KUMULAM.............
‘‘Identification No. of Voting Machine used at the Polling Station : 03
Balloting unit : (i) BU A20025 (ii) BU Z20034
Control unit : CU 53650

1. Total No. of electors assigned to the polling station : 950

2. Total No. of voters as entered in the Register for Voters (Form 17A) : 752

3. No. of voters deciding not to record votes under rule 49 - O : 01

4. No. of voters not allowed to vote under rule 49M. : NIL

5.Test votes recorded under rule 49MA (d) required to be deducted : NIL
(a) Total number of test votes to be detucted : Total no. Sl.No (s) of electrol (s) in form 17A
……NIL……… ……………… NIL ……………………

(b) Candidates (s) for whom test vote (s) cast : S.no Name of the candidate No .of votes

…… ………… NIL ………………… ….…………………

…… …………………………………… …. …………………

6. Total No. of votes recorded as per voting machine . : 751

7. Whether the total No. of votes as shown against item 6 tallies with the total
No. of voters as shown against item 2 minus Nos. of voters deciding not to
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record votes as against item 3 minus No. of Voters as against item 4 (ie 2 – 3 - 4 )
or any discrepancy noticed. : 752 – 1 - 0 = 751

8. No. of voters to whom tendered ballot papers were issued under rule 49P. : NIL

9. No. of tendered ballot papers. : 20

Sl .No
Total From to
(a) received for use : ………20…………………1001………………………1020………

(b) issued to electors : ………………………………NIL………………………………………..

(c) not used and returned : ………20…………………1001………………………1020………

10. Account of papers seals :
1. Paper seals supplied for use Total No…03….. Signature of polling agents

Sl.No.from…3211 to 3213 1…………………………

2. Paper seals used Total No…01….. 2…………………………

Sl.No. 3211 3…………………………

3. Unused Paper seals returned to Total No…02….. 4…………………………
returning officer Sl.No. 3212 to 3213 5…………………………
4. Damaged paper seal if any Total No…NIL…..
Sl.No……NIL……. 6…………………………
7………………………
Date : 19.04.2024

Place : KUMULAM Signature of Presiding officer

Polling Station No......275...

PART II - RESULT OF COUNTING

Sl. No. Name of Candidate No of Votes recorded

☻ Do not filled this form

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ANNEXURE XIV
(CHAPTER XXXIII, Para 1)
PRESIDING OFFICER’S DIARY
1. Name of the constituency (in block letters) : 74 VILLUPURAM
2. Date of poll : 19.04.2024
3. Number & Name of the polling station : 275 - KUMULAM
Whether located in -
(i) Government or quasi-government building : GOVERNMENT
(ii) Private building : ___
(iii) Temporary structure : ___
4. Number of polling officers recruited locally, if any : NIL
5. Appointment of polling officer made in the absence of duly appointed polling officer, if any,
and the reasons for such appointment : NIL
6. Electronic Voting Machine -
(i) Number of Control Units used : 01
(ii) S. No. (s) of Control Units used : CU 53650
(iii) Number of balloting units used : 02
(iv) S. No. of balloting units used : (i) BU A20025 (ii) BU Z20034
7. (i) Number of paper seals used : 01
(ii) Sl. Nos. of paper seals used : 3211
7A.
(i) Number of special tags supplied : 03
(ii) S.No.(s) of special tags supplied : C1205 – C1207
(iii) Number of special tags used : 01
(iv) S.No.(s) of special tags used : C1205
(v) S.No.(s) of special tags returned as unused : 02 ( C1206 – C1207 )

7B.
(i) Applicable in the polling stations where VVPAT system is used
(ii) No.of printers used : NIL
(iii) Sl.no of printer : __
8. Number of candidates who had appointed polling agents at the polling stations : 10
9. (i) Number of polling agents present at the commencement of poll : 09
(ii). Number of polling agents and the number who arrived late : 01
(iii). Number of polling agents present at the close of poll : 10

10. (i) Total no. of voters assigned to the polling station : 950
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(ii) Number of electors allowed to vote according to marked copy of electoral roll : 752
(iii) Number of electors who actually voted as per Register of Voters (Form 17– A) : 752
(iv) Number of votes recorded as per the voting machine : 751
(v) Number of votes deciding not to record vote if any : 01

Signature of first Polling Officer Signature of Polling Officer

in-charge of Register of Voters

11. Number of electors who voted -

Men.............. 350.......
Women …….. 401......
Third Gender NIL.....
Total ............751......
12. Challenged vote -
Number allowed ......... NIL............
Number rejected .........NIL...........
Amount forfeited Rs. . NIL..........
13. Number of persons who have voted on production of Election Duty Certificate (EDC) : 03
13A. Number of overseas electors who voted
14. Number of electors who voted with the help of companions : 02
15. Number of votes cast through proxy : NIL
16. Number of tendered votes : NIL
17. No. of electors -
(a) From whom declarations as to their age obtained .... NIL............
(b) Who refused to give such declaration ..... NIL............
18. Whether it was necessary to adjourn the poll and if so, the reasons for such adjournment :
NIL
19. Number of votes cast -
from 7 a.m. to 8 a.m. : 90
from 8 a.m. to 9 a.m. : 159
from 9 a.m. to 10 p.m. : 260
from 10 p.m. to 11 p.m. : 310
from 11 p.m. to 12 p.m. : 379
from 12 p.m. to 1p.m. : 424
from 1 p.m. to 2 p.m. : 490
from 2 p.m. to 3 p.m. : 538
from 3 p.m. to 4 p.m. : 578
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from 4 p.m. to 5 p.m. : 632

from 5 p.m. to 6 p.m. : 698
from 6 p.m. to 7 p.m. : 751
( Necessary changes may be made depending on the hours fixed for commencement and close
of poll )
20. (a) Number of slips issued at the closing hour of the poll to electoral standing in the queue : 10
(b) Time at which poll finally closed after the last such elector cast his/her vote : 6.15 PM
21. Electoral offences with details :
Number of cases of -
(a) Canvassing within one hundred metre of the polling station : NO
(b) Impersonation of voters : NO
(c) Fraudulent defacing, destroying or removal of the list of notice or other document
at the polling station : NO
(d) Bribing of voters : NO
(e) Intimidation of voters and other persons : NO
(f) Booth capturing : NO
22. Was the poll interrupted or obstructed by -
(1) riot : NO
(2) open violence : NO
(3) natural calamity : NO
(4) booth capturing : NO
(5) failure of voting machine : NO
(6) any other cause : NO
Please give details of the above.
23. Was the poll vitiated by any voting machine used at the polling station having been -
(a) unlawfully taken out of the custody of the Presiding Officer :– NO
(b) accidentally or intentionally lost or destroyed : NO
(c) damaged or tampered with : NO
Please give details
24. Serious complaints, if any, made by the candidate/agents : NO
25. Number of cases of breach of law and order : NO
26. Report of mistakes and irregularities committed, if any, at the polling Station : NO
27. Whether the declarations have been made before the commencement of the poll and
if necessary during the course of poll when a new voting machine is used and
at the end of poll as necessary : YES
Place : KUMULAM
Date : 19.04.2024
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Presiding Officer signature

This diary should be forwarded to the Returning Officer along with the voting machine,.
Visit Sheet, 14-Point Observer’s Report and other sealed papers
PRESIDING OFFICER’S REPORT
PART – 1 MOCK POLL
(TO BE FILLED BEFORE COMMENCEMENT OF ACTUAL POLL)
1. Name of the constituency (in block letters) : 74 VILLUPURAM

2. Date of poll : 19.04.2024

3. Number and name of the polling station : 275 PUES - KUMULAM

4. (a) Details of electronic voting machine and VVPAT used :

(BU – Balloting Unnit , CU – Control Unit and VVPAT – Voter verifiable paper Audit Trail)

Signature of
sector officers
S.NO Particulars BU CU VVPAT
in case of
replacement
Unique ID of units
(i) BUA20025
1 given at the time of CU 53650 BVTAK2234
(ii) BU Z20034
dispersal
(a) Tick ( ) which one
found non – functional __ __ __
during mock poll
2 (b) Reason for non-
functioning (mention
error m code noticed
__
in CU)
Unique ID of units
3 given as replacement __ __ __
during mock poll
(b) Following polling agents witness the replacement process :

S.No Name of polling Name of party Name of Signature of

Agent candidate polling agent
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If any replacement of EVM made before commencement of poll this table is to be filled up
Signature of presiding officer

Mock poll details :

(a) Conduct of mock poll and verification of mock poll data

Result
displayed in
Number of Number of Signature
CU &
Number of votes VVPAT of polling
printed
Name of the votes cast displayed in printed agents
S.No paper slips
candidate during CU on paper slips with party
count
mock poll checking against abbreviati
tallied with
the result candidates on
each other
(YES/NO)
1 AAA 3 3 3 YES
2 BBB 3 3 3 YES
3 CCC 3 3 3 YES
4 DDD 3 3 3 YES
5 EEE 3 3 3 YES
6 FFF 3 3 3 YES
7 GGG 3 3 3 YES
8 HHH 3 3 3 YES
9 III 3 3 3 YES
10 JJJ 3 3 3 YES
11 KKK 3 3 3 YES
12 LLL 3 3 3 YES
13 MMM 3 3 3 YES
14 NNN 3 3 3 YES
15 OOO 2 2 2 YES
16 PPP 2 2 2 YES
17 QQQ 2 2 2 YES
NOTA 2 2 2 YES
TOTAL 50 50 50
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Repeat the above information in same format , if number of candidates more than 16

(b) ‘CLEAR’ button on the control Unit has been pressed to clear mock poll data (Yes/No)
if Yes , then write the above sentence in ink .

Yes, “CLEAR” button on the control unit has been pressed to clear Mock poll data .

(c) All paper slips taken out from VVPAT after mock poll (YES/No) .

(d) Empty VVPAT shown to all polling agents (YES /No).

(e) Before actual poll ensure that no printed paper slip is in VVPAT Drop box and shown to
polling agents (YES /No).

(f) “TOTAL’” button on the Control Unit has been pressed to shown total vote ‘0’ to polling agents
(YES /No).

(g) Mock poll VVPAT slips stamped with ‘MOCK POLL SLIP’ and sealed in black envelope and
than sealed in plastic box with pink paper slip (YES /No).

(h) Following witness Mock poll and certify that mock votes tallied and that the mock votes
erased from CU and VVPAT after mock poll .

Signature of the
S.No Name of polling Agent Name of party Name of the candidate
polling agent
1 Aaa A1 AAA
2 Bbb A2 BBB
3 Ccc A3 CCC
4 Ddd A4 DDD

Signature of Micro-observer
(if posted at the polling station) Signature and signature of the presiding officer

(i) It is hereby , certify that before commencement of actual poll .“TOTAL” button of the control
Unit has been pressed in the presence of all polling officials to ensure that Total Vote is “0”
. Tick the appropriate observation.
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(ii) Control Unit shown total vote “0” 

(or)

(ii) Control Unit shows total vote more than ‘0’ (means mock poll votes not cleared .Hence ,
clear mock poll data)

Signature of presiding officers

Following witness the above process and certify that mock votes erased from the Control
Unit and mock poll VVPAT slips removed from the VVPAT before start of actual poll .

S.No Name of pollig officer Signature

1 PO1
2 PO2
3 PO3

PRESIDING OFFICER’S REPORT

PART – II EVM/VVPAT REPLACEMENT
(TO BE FILLED DURING POLL & AFTER COMPLETION OF POLL DEPENDING ON CASE/SITUATION)

{IT CAN BE USED INCASE OF EVM/VVPAT REPLACEMENT}

NIL

PART – II POWER PACK REPLACEMENT IN CU

(TO BE FILLED DURING MOCK POLL,POLL & AFTER COMPLETIONO OF POLL DEPENDING
ON CASE/SITUATION)

{IT CAN BE USED INCASE OF POWER PACK REPLACEMENT}

NIL
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DECLARARION BY THE PRESIDING OFFICER

PART - I

DECLARATION BY THE PRESIDING OFFICER BEFORE THE COMMENCEMENT OF THE POLL

Election to VILLUPURAM parliamentary constituency , No and Name of polling station

275 PUES KUMULAM .

Date of poll : 19.04.2024

I hereby declare :

(1) that i have demonstrated to the polling agents and other persons present .

(a) by holding a mock poll that the voting machine is in perfect working order and that no vote
is already recorded therein :

(b) that the marked copy of the electoral roll to be used during the poll does not contain any marks
other than those used for issuing postal ballot papers and election duty certificate ;

(c) that the register of voters (form 17A) to be used during the poll does not contain any entry
in respect of any elector.

(2) that i have affixed my own signature on the paper seal used for securing the result section
of control unit of the voting machine and obtained thereon the signatures of such of
the polling agents as are present and desirous of affixing the same .

(3) that i have written the serial number of the control unit on the special tag and i have affixed
my signature on the back side of the special tag and also obtained thereon the signatures
of such of the candidates/polling agents as are present and desirous of affixing their
signature.

(4) that i have affixed my signature on the strip seal and also obtained thereon the signatures
of such of the candidates/polling agents as are present and desirous of affixing their
signature .

(5) that i have read out the pre-printed serial number of the special tag and asked the candidates
/ polling agents present to note down the serial number .

Signature of the presiding officer .

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Signature of the polling agents :

1.V.KUMAR...........(of candidate ....... ) 2.S.RAMESH...........(of candidate ..... )

3.R.SELVAM...........(of candidate ..... ) 4.T.RAJESH...........(of candidate ...... )

The following polling agents declined to affix his/her signature on this declaration :

1......__........(of candidate........ ) 2.... __......(of candidate........ )

Date : 19.04.2024 Signature of the presiding officer .

PART - II

DECLARATION BY THE PRESIDING OFFICER AT THE TIME OF USE OF SUBSEQUENT VOTING

MACHINE ,IF ANY,

{IT CAN BE USED INCASE OF SUBSEQUENT VOTING MACHINE IS USED}

NIL

PART - III

DECLARATION AT THE END OF POLL

Election to VILLUPURAM assembly constituency .

Number and name of polling station 275 PUES-KUMULAM.

I have furnished to the polling agents , who were present at the polling station at the close
of the poll and whose signatures are affixed below , an attested copy of each of the entries in
‘Part – 1 – Account of Votes Recorded’ of form 17C as required under rule 49-S(2) of the Elections
rule .1961 .

Date : 19.04,2024 Signature of presiding officer

Time : 6.30 PM.

Received an attested copy of the entries in the accounts of votes recorded {Part 1 of form 17C}
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Signature of polling agents :

1.V.KUMAR...........(of candidate ....... ) 2.S.RAMESH...........(of candidate ..... )

3.R.SELVAM...........(of candidate ..... ) 4.T.RAJESH...........(of candidate ...... )

The following polling agent who were present at the close of the poll declined to receive an
attested copy of part 1 of form 17C and to give a receipt therefore and so an attested copy of that
form was not supplied to them :

Signature of polling agents :

1.___...........(of candidate ..... ) 2. ___..........(of candidate ...... )

3. ___..........(of candidate ..... ) 4. ___...........(of candidate ..... )

Date : 19.04,2024 Signature of presiding officer

Time : 6.30 PM.

PART - IV

DECLARATION AFTER THE SEALING OF THE VOTING MACHINE

Election to VILLUPURAM PARLIMENTARY constituency .

Number and name of polling station 275 PUES-KUMULAM.

I have affixed my seals , and I have allowed the polling agents who were present at the
polling station at the close of poll to affix their seals on the carrying cases of the control units and
balloting units of the voting machines .

Date : 19.04,2024 Signature of presiding officer

Time : 6.30 PM.

The following polling agents have affixed their seals.

Signature of polling agents :

1.V.KUMAR...........(of candidate ....... ) 2.S.RAMESH...........(of candidate ..... )

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3.R.SELVAM...........(of candidate ..... ) 4.T.RAJESH...........(of candidate ...... )

The following polling agents refused or did not want to affix their seals :

1.___...........(of candidate ..... ) 2. ___..........(of candidate ...... )

3. ___..........(of candidate ..... ) 4. ___...........(of candidate ..... )

Date : 19.04,2024 Signature of presiding officer

ANNEXURE XVII
Mock Poll Certificate
This is certified that I J.Murugasamy Presiding Officer at the Polling Station No of - 275 -
Assembly Constituency Villupuram---Assembly segment under Villupuram---Parliamentary
Constituency conducted the mock poll at - 6.00AM today, the poll day i.e – 15. 04.24 - following
the instructions issued by the Election Commission of India.
A total of --50--- votes were polled in the mock poll and after the mock poll I have carefully
cleared the memory and the total votes polled showed ‘0’ after clearing the memory.
A. At the time of mock poll the following of polling agents representing the candidates whose
names mentioned against the names of such agents were present and I have obtained
their signatures.
B. At the time of mock poll the agent of only one contesting candidate was present. After waiting
for ten more minutes I conducted the mock poll along with other polling staff at - 6.00 AM - I have
mentioned the name of the agent present at the time of mock poll including the name of the
candidate whom he represented.
( In case, no agent was present it shall be mentioned “ No Polling agent was present at the
time of mock poll )

Name of the agent Name of the candidate Signature of agent

R.SELVAM AAA
T.RAJESH BBB
V.KUMAR CCC

Date : 15.04.2024
Time : 6.00AM Presiding officer Signature
Name & of the P.O : 275 – PUES - KUMULAM

JM
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FORM–17A
REGISTER OF VOTERS
(See Rule 49L of Conduct of election Rules 1961 )

Election to the House of the People from VILLUPURAM parliamentary constituency .

No. and Name of Polling Station.........275 KUMULAM.....
Part No. of Electoral Roll …No. 2…………
Date of poll : 19.04.2024.

Sl. No. of Details of the documents Signature

elector in produce by the elector in /thumb
Sl. No. Remarks
the electoral the proof of his/her impression of
roll identification elector
(1) (2) (3) (4) (5)

1 225 EPIC – 0008 Sign/ Thumb -

70 324 BP - 30305678490 Sign/ Thumb -
49(o) Refuse to
290 137 EPIC – 2889 Sign/ Thumb
vote

350 379 DL – 230586979 Sign/ Thumb -

569 159 EPIC – 2309 Sign/ Thumb -

752 598 EPIC – 4531 Sign/ Thumb -

The last entry in the 17A register is 752

வாக்கு முடிவுற்ற ந஥ரம் : 6.30PM

வாக்களித்த ம ாத்த வாக்காளர்களின் எண்ணிக்கக : 751

EPIC மகாண்டுவாக்களித்தவர்களின் எண்ணிக்கக : 690

EPIC இல்லாத பிற ஆவணங்கள் மகாண்டு வாக்களித்தவர்களின்

எண்ணிக்கக : 61
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Signature of the PO2 Signature of the Presiding Officer

Agents signature :

1.

2.

3.

GENERAL ELECTIONS TO PARLIMENTARY - 2024

VILLUPURAM DISTRICT

Abstract statement to be furnished by presiding officer

No.and Name of the constituency : 74 VILLUPURAM

No.and Name of the polling station : 275 PUES – KUMULAM

i Total No.of electors assigned to polling station 950

ii Time fixed by the Election commission for close of poll 6..00PM
iii Number of votes polled by the time fixed for close of poll 741
iv Number of electors standing in queue at the time fixed for close of poll 10
v Number of slips issued to said electors in the queue 10
vi Number of votes actually polled by such electors 10
vii Exact time at which the poll actually closed 6.30PM
viii Total Number of votes polled in the polling station by the time of actual 751
close of poll
Ix Number of votes polled between the time for close of poll and the actual 751 – 741 = 10
close of poll {(viii) – (iii)}

Signature of the presiding officer Signature of the polling agents

1.

2.

3.
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GENERAL ELECTIONS TO PARLIMENTARY - 2024

VILLUPURAM DISTRICT

FORMAT FOR PRESIDING OFFICER’S 16 – POINT ADDITIONAL REPORT TO BE

SUBMITTED TO CONSTITUENCY OBSERVER /RO
Name of the Assembly Constituency : 74 VILLUPURAM

Sl.No Subject Remarks

1 Polling station No. 752
2 CPF deployed (Yes/No) No
3 Micro Observer deployed (Yes/No) Yes
4 Web / Video Camera deployed (Yes/No) Yes
5 Total Voters 950
6 No.of Votes polled 751
7 % of Votes polled 79%
8 Total No.of candidates 17
9 No.of candidates represented by polling agents 10
10 No.of voters who voted using documents other than EPIC 61
11 Whether Mock poll done in the presence of agent ? (Yes/No) Yes
12 Whether mock poll cleared (Yes/No) Yes
13 Whether machines closed and seal properly in the presence of agents Yes
? (Yes/No)
14 Whether 17C given to polling agents after obtaining their signature ? Yes
(Yes/No)
15 No.of Voters who have voted after 6PM by receiving the token at the 10
end of polling hours
16 Whether any significance incident took place during the poll ? No
(Yes/No)
JM
JM
JM
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GENERAL ELECTIONS TO PARLIMENTARY - 2024

VILLUPURAM DISTRICT
Name of the assembly Constituency 74 VILLUPURAM
P.S.No. 275
OBSERVER SCRUTINY REPORT
S.No Item
1 Total Electors in the P.S Male : 503
Female : 447
Other : NIL
Total : 950
2 Number of persons who voted in the P.S Male : 427
Female : 324
Other : NIL
Total : 751
3 Number of Tendered votes NIL
4 Number of Challenged votes NIL
5 Number of Proxy Votes by CSV NIL
6 Number of blind / infirm votes who exercise their right of
vote with the help of companion
01
7 Number of electors who exercise their right of vote on the
basis of EPIC
690
8 Number of electors who exercise their right of vote on the
basis of alternative document
61
9 Number of electors after signing in Register 17A and left
without voting (Rule 49”O”)
01
10 Number of polling agents in the polling station 10
11 Number of overseas electors who voted in the poll NIL
12 Number of EVM and VVPAT is used CU – 1/BU – 1 / BU – 2
/ VVPAT – 1
13 a) Whether the EVM and VVPAT was changed or replaced -
b) If so the time when changed and what was the reason for
it
-
14 Total ASD voters in the list NIL
15 Total persons who cast their votes from the ASD voters list -
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16 Any incident of violence or poll interruption due to any

reason
NIL
17 Complaints received with respect to that polling station NIL

Date : 19.04.2024 Name of the presiding officer

Signature of the presiding officer

FORM–17B
(See Rule 49P)
LIST OF TENDERED VOTES
Election to the House of the People / Legislative Assembly of the State / Union
Territory …TAMILNADU…from …௦74 VILLUPURAM…Constituency.No.
and Name of Part No.of Electoral Roll 02. Polling station..…275 PUES - KUMULAM.....
_
Name of the elector
Sl. No. of Sl. No in register of Signature /thumb
of the person who
elector in the voters impression of Remarks
has already voted in
electoral roll ( Form 17A ) elector
place of elector
(1) (2) (3) (4) (5)

NIL

.
Date : 19.04.2024 Signature of the Presiding Officer

Part II
LIST OF ELECTORS WHO HAVE REFUSED TO MAKE
DECLARATIONS AS TO THEIR AGE
Age as assessed
Name of the Part no . and serial no Age as entered
Sl.no by the presiding
elector . in electoral roll in electoral roll
officer
(1) (2) (3) (4) (5)

NIL
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Dated.....19.04.2024.................. Signature of Presiding Officer

ANNEXURE XII
(CHAPTER XXII, Para 1.3)
DECLARATION BY THE COMPANAION OF
BLIND OR INFIRM ELECTOR
..074Villupuram......AssemblyConstituency (comprised within...Villupuram…Parliamentary
Constituency) Sl. No. and Name of Polling Station …275 Kumulam……
I, ..R.Selvam...son of Ranganathan..aged…. resident of *.......Kumulam.......hereby declare that
(a) I have not acted as companion of any other elector at any polling station today, the
........Parlimentary election....
(b) I will keep secret the vote recorded by me on behalf of.……M.Baskar………

Signature of Companion
* Full address to be given.

Address tag – ல் இருக்ககூடிய தகவல்கள் :

(i) ...VILLUPURAM............ சட்ட஫ன்ற / ஫க்களவைக்கான தேர்ேல்

(ii) .எண் ...74............ தோகுேி஬ின் தப஬ர் ..... VILLUPURAM...........

(iii) கட்டுபாட்டுக் கருைி எண் ...... CU 53650.........

(iv) ைரிவச எண் & ைாக்குசாைடி தப஬ர் 275 PUES KUMULAM..

(iv) தேர்ேல் நாள் .........19.04.2024.............

Special tag படம் :- ( SIZE : 5 ½ × 7 ½ cm )

Front side Back side

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 முன் பகுதி :
Control unit S.No.- ஐ special tag இல் குறிக்க தைண்டும் ஫ற்றும் special tag
Sl.no ஐ presiding officer diary & 17c – ல் குறித்து மகாள்ள தைண்டும்.
 பின் பகுதி :
Presiding officer ஫ற்றும் முகவர்களின் ககமயாப்பம் தபறுேல் தைண்டும்.

5.Voters slip :
ைாக்காளர்களுக்கு PO2 - ஆல் வழங்கப்படும் துண்டுச் சீட்டு ஆகும்.
1 Bundle = 50 rPl;Lfs;. njpy; : ↓

(i) ை.எண் . ( 17A படிைத்ேில் உள்ளபடி )

(ii) ை.எண். ( ைாக்காளர் பட்டி஬ல் ைரிவச எண் )

(iii) PO2 வகத஬ாப்பம் . (iv) குறிப்பு : அவட஬ாள அட்வட எண் குறித்ேல் .

ANNEXURE IV
(CHAPTER I, PARA 6)
CHECK MEMO FOR PRESIDING OFFICERS
ITEM ACTION OF BE TAKEN REMARKS
1. Obtaining and keeping in possession all
relevant instructions from the returning Whether obtained and kept YES
officers
2. Familiarisation with the other members
of the polling party and maintenance of Whether obtained and kept YES
close relationship with them.
Whether ensured That all the
election materials and that too
3. Collection of election material
in sufficient YES
quantities and numbers have
been collected ?
4. Checking up of balloting unit & control
unit of the voting machine, marked copies
of the electoral roll, arrow cross mark Whether done ?
rubber stamp, green paper seals, register
YES
of voter’s, voter’s slips, etc.
 21

5. Separate entrance and exit for voters at

Whether ensured ?
polling stations. YES

6. Display of notice specifying the polling

area and the numbers of electors assigned
Whether displayed ?
and also a copy of the list of contesting YES
candidates;

7.Inter-linking of control unit and balloting

units and switching on the battery. Whether done ? YES

8.Conducting mock control Whether Conducted ? YES

9.Fixing green paper seal on result Whether done ?
compartment of Control unit
YES
10.Sealing the result section of the control Whether done ?
unit.
YES
11.Declaration to be made at the Whether made ?
commencement
YES
12.Reading out the provisions of the Sec.
128 of the poll.of R.P. Act, 1951 with
Whether done ?
regard to the secrecy of voting by Presiding YES
Officer at the beginning of the poll.

13.Allowing polling agents to not the serial

numbers of balloting unit and control unit Whether allowed ?
and green paper seal.
YES

14.Marking of indelible ink on left fore-

finger and being obtaining the Whether properly done ?
signature/thumb impression on the
YES
Registers of Voters (Form 17A)
Whether obtained ?
15.Declaration from under-aged electors YES
Whether events are
Recorded from time
16. Maintenance of Presiding Officer’s Diary to time as and when YES
they occur ?

Whether maintained ?
17. Maintenance of Visit Sheet YES
 22

Whether Done ?
18. Close of poll at the appointed hour YES
Whether attested Copies given
to all the polling agents ?
19.Supply of account of votes recorded in YES
Form 17C
20.Declaration to be made at the close of Whether made ?
poll
YES

ALL THE BEST

J.MURUGASAMY
( PG.ASST - MODEL SCHOOL - EMAPPUR)
ZONAL OFFICER ( Zone – 12 ) -VILLUPURAM Constituency

CONTACT NO. - 9751783008