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handbook for presiding officers - Chief Electoral Officer, Govt. of Sikkim

handbook for presiding officers - Chief Electoral Officer, Govt. of Sikkim

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ANNEXURE XII<br />

(CHAPTER XXII, Para 1.3)<br />

DECLARATION BY THE COMPANAION OF<br />

BLIND OR INFIRM ELECTOR<br />

...............………………………………………………....................................Assembly<br />

Constituency (comprised within.....................................………. Parliamentary<br />

Constituency)<br />

Sl. No. and Name <strong>of</strong> Polling Station …………………………………………..……....<br />

I, ........................................................... son <strong>of</strong> ..........………...aged…......................<br />

resident <strong>of</strong>*...................................................................……….….. hereby declare<br />

that<br />

(a) I have not acted as companion <strong>of</strong> any other elector at any polling station today,<br />

the .......................................................................................<br />

(b) I will keep secret the vote recorded by me on behalf <strong>of</strong><br />

.………………...............................<br />

Signature <strong>of</strong> Companion<br />

* Full address to be given.

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