FORM - Arunachal Pradesh

FORM - 17(A)
(See rule 22.A)
NOTIFICATION
In exercise of power conferred upon under sub-section(3) of section 36 of
the Arunachal Pradesh Municipal Election Act 2009 and in pursuance of the
provision of Rule 22(A) of the Arunachal Pradesh Municipal Election Rule 2011, I
.................... ............................................. the State Election Commissioner,
Itanagar, call upon the municipality of ....................... ......................................
........to elect members from .....................................................
State Election Commissioner,
Arunachal Pradesh
Itanagar
1

FORM-17 (B)
(See Rule 22 B)
NOTICE OF ELECTION
In pursuance of Sub Rule (4) of Rule 22 (B) of the Arunachal Pradesh Municipal
(Conduct of Election) Rules, 2011, I …………………………………………… hereby notify
that Election to fill the vacancies of Councilor/Ward Commissioner from the
……………………………………… under ……………………………………. Municipal area
shall be held as per schedule of programme mentioned below.
1. Date of issue of Public Notice by :-
Municipal Returning Officer.
2. Last date of filing Nomination :-
3. Date of Scrutiny :-
4. Last date of Withdrawal :-
5. Date of Poll :-
6. Date of Counting :-
The respective Municipal Returning Officer shall issue Public Notice of intended
Election under Rule 23 of the Arunachal Pradesh Municipal (Conduct of Election) Rules 2011
on……………………………
State Election Commissioner,
Arunachal Pradesh: Itanagar.
2

FORM-17 (C)
(See Rule 23)
NOTICE OF ELECTION
Notice is hereby given that:-
1. An election is to be held of a member(s) from ward of ………………………………… of
……………………………………………………... Municipal Council/Nagar Panchayat.
2. Nomination paper may be delivered by a candidate or his proposer to the
……………………………..(Authority) at ……………………………………... Between
11 A.M and 3 P.M from …………………………………to………….. …………. (dates).
3. Forms of nomination papers may be obtained at the place and time aforesaid.
4. The nomination papers will be taken up for scrutiny at ……………………………............
5. Notice of withdrawal of candidature may be delivered by a candidate or his proposer to
the authority specified in paragraph (2) above at his office before 3 P.M on the ………..
20…………………..
6. The symbols to the contesting candidates shall be allotted on ………….………….. (date)
at………………… P.M.
7. In the event of the election being contested, the poll will be taken on ………………
between the hours of ……………….. and ………………………………………………...
Municipal Returning Officer.
3

FORM-18
(See Rule 25)
NOMINATION PAPER
Election to the Municipal Council/Nagar Panchayat ……………………………………….
I hereby nominate ……………………………………………………………………
(to be filled by the proposer)
as a candidate for election from……………………………… ward of Municipal Council/Nagar
Panchayat……………………………………………. which is general/ward reserved for women.
1. Full name of proposer ……………………………………………………………………...
2. Serial number of proposer in the roll of the ward from which the candidate for election
has been nominated …………………………………………………………………….. ..
3. Name of the candidate’s Father/Husband ………………………………………………….
4. Full postal address of candidate ……………………………………………………………
5. Serial number of the candidate in the electoral roll of the ward in which he is registered
as an elector…………………………………………………………………………………
Date:-
Signature of Proposer
(to be filled in by the candidate)
1. I, the above mentioned candidate, assent to this nomination and hereby declare:
(a)
that I have completed …………………………. years of age; and
(b)
(c)
that I have not been disqualified for contest of elections under any law in
force.
that the symbols I have chosen are in order of preference.
(i) ……………………………..
(ii)
(iii)
……………………………..
……………………………..
Signature of the Candidate.
Date:-
4

VERIFICATION BY EXECUTIVE MAGISTRATE
The above declaration is solemnly affirmed before me by……………...……………
who is personally known to me/who has been identified by ………………………………...
………………………………………………………………………………………………...
Date:-
Place:-
Signature with seal.
(Decision of Municipal Returning Officer accepting or rejecting the nomination paper).
I have examined this nomination paper in accordance with rule 29 of the Arunachal
Pradesh Municipal Election Rules, 2011, and decided as follow:
Date:-
Place:-
Municipal Returning Officer.
The symbol assigned to the candidate is……………………………………………...
Date:-
Place:-
Municipal Returning Officer.
RECEIPT OF NOMINATION PAPER AND NOTICE OF SCRUTINY
(To he filled in by the Municipal Returning Officer or specified authority)
Serial No. of nomination paper…………………………………………………………………….
This nomination papers was delivered to me at my office on……..…………………
(date) …………………… at …………………… (hours) ……………………………... and shall
be taken up for scrutiny on ……………………….. at Place …………………………. of (hours)
……………………………..
Place:
Date :-
Municipal Returning Officer/Specified Authority.
5

FORM-19
(See Rule 27)
NOTICE OF NOMINATION
Election to the Municipal Council/Nagar Panchayat ………………………….. from
The …………………………………………………………………………………………. Ward.
Notice is hereby given that the following nominations in respect of the above election
have been received upto 3 P.M. today ……………………………………………..........................
SI. No. of Name of candidate Name of Age of Address
nomination paper
Father/Husband Candidate
1 2 3 4 5
Sl.No.of candidate in the
Name of proposer
Sl.No.of proposer in the
electoral roll
electoral roll
6 7 8
Place:-
Municipal Returning Officer or Specified Authority.
Date:-
6

FORM-20
[See Rule 28(8)]
LIST OF VALIDLY NOMINATED CANDIDATES
Election to the Municipal Council/Nagar Panchayat …………………………… from
……………………………………………………….. ………………………………….Ward.
Sl. Name of candidate Name of Father/Husband Address of candidate
No.
1 2 3 4
Place:-
Date:-
Municipal Returning Officer.
7

FORM-21
[See Rule 29 (1)]
NOTICE OF WITHDRAWAL
Election to the Municipal Council/Nagar Panchayat ………………………………………
from ……………………………………………………. ……………………………Ward.
To
The Municipal Returning Officer,
…………………………………..
…………………………………
I, ………………………………………………………………… a candidate nominated
at the above election do hereby give notice that I withdraw my candidature.
Place:-
Date:-
Signature of Candidate.
This notice was delivered to me at my office at ………………………… (hours),
on ……………… …………..(date) by …………………………………………………... (name).
Returning Officer or Specified Authority
RECEIPT FOR NOTICE OF WITHDRAWAL
(To be handed over to the person delivering notice)
The notice of withdrawal of candidature by a candidate at the election to the
Municipal Council/Nagar Panchayat……. ………………………………………………….. from
…………………………ward, was delivered to me by the…...………………………………… at
……………………… my …………………………office at ………………………… (hours) on
…………………………. (date).
Here insert one of the following alternatives as may be appropriate:
1. Candidate.
2. Candidate’s proposer who has been authorized in writing by the candidate to
deliver it.
8

FORM-22
[See Rule 29 (1)]
NOTICE OF WITHDRAWAL
Election to the Municipal Council/ Nagar Panchayat ……………………………….. from
………………………………………………………………………………………………..Ward.
Notice is hereby given that the following Candidate/Candidates at the above election
withdraws/withdraw his/their candidatures today:-
1.
Name of candidate Address of candidate Remarks
1 2 3
2.
3.
4.
5.
etc
Date:-
Place:-
Returning Officer or Specified Authority
9

FORM-23
[See Rule 30]
LIST OF CONTESTING CANDIDATES
Election to the Municipal Council/Nagar Panchayat ………………………………………...
from ……………………………………………………………………………………..Ward.
Sl. No. Name of candidate Address of candidate Symbol allotted
1 2 3 4
Place:-
Date:-
Municipal Returning Officer.
10

FORM-24 (A)
(See Rule 32 (A) (1)
APPOINTMENT OF ELECTION AGENT
Election to Municipal Council/Nagar Panchayat ………………………………
from ……………………………… ………………………………………………………….ward.
I …………………………….. a candidate at the above Election do hereby appoint
………………………………………………. as my election agent from this day at the above
election.
Place :
Date :
Place :-
Date :-
I accept the above appointment.
Signature of Candidate.
Signature of Election Agent.
11

FORM 24 (B)
(See Rule 32 (A) (2))
REVOCATION OF APPOINTMENT OF ELECTION AGENT.
Election to the ………………………………. …………………………………….
Election to the Municipal Council/Nagar Panchayat ……………………… from
……………………………… ………………………………………………………………..ward.
To,
The Returning Officer,
………………………
………………………
I ……………………………….. a candidate at the above Election do hereby
revoked the appointment of …………………………………………………... my election agent.
Place :-
Date :-
Signature of candidate.
12

FORM-24 (c)
[See Rule 32 (B) (1)]
APPOINTMENT OF POLLING AGENT
Election to Municipal Council/Nagar Panchayat …………………………………………
from ………………………………………………………………………………………... Ward.
I, ………………………………………………. a candidate at the above election do
hereby appoint …………………………………...………………. as polling agent to attend
polling station No…………… place fixed for the poll ………………… at ……………………...
Place:-
Date:-
Signature of the Candidate
I agree to act as such polling agent
Signature of Polling Agent.
Place:-
Date:-
(Declaration of Polling Agent to be, signed before Presiding Officer).
I hereby declare that at the above election, I will not do anything forbidden by the
Arunachal Pradesh Municipal Elections Act, 2009 which I have read/has been read over to me).
Place:-
Date:-
Place:-
Date:-
Signed before me
Signature of Polling Agent.
Presiding Officer
13

FORM 24 (D)
(See Rule 32 B (4))
REVOCATION OF APPOINTMENT OF POLLING AGENT.
Election to the Municipal Council/Nagar Panchayat ……………………… from
……………………………………………………………………………………………….. ward.
To,
The Returning Officer,
……………………….
……………………….
I …………………………………. a candidate at the above election hereby
revoke the appointment of …………………………………… polling agent/relief polling agent
……………………………… at the polling station No………………. at ………………. (place).
Place :-
Date :-
Signature of Candidate/Election Agent.
14

FORM-25
(See Rule 35)
FOR USE IN ELECTION WHEN SEAT IS UNCONTESTED
Declaration of the result of election to Municipal Council/Nagar Panchayat …………….
……………………………………. From ………………………………………….. (ward).
In pursuance of the provision contained in rule 34 of the Arunachal Pradesh Municipal
Election Rules, 2011, 1 Declare that:-
…………………………………………………………………………………………….(Name).
…………………………………………………………………………………………..(Address)
has been duly elected to fill a seat in Municipal Council/Nagar Panchayat ……………………….
………………………………………………………………………………………………………
Place:-
Date :-
Signature…………………..
Municipal Returning Officer.
15

FORM-26.
(See Rule 43)
BALLOT PAPER
Municipal Council/ Nagar Panchayat………………………………………………………...
Number and Name of Ward …………………………………………………………………
Serial Number of Elector …………………………………………………………………….
Roll/Part Number ……………………………………………………………………………..
Signature/thumb impression.
Name of Council…………………………..…….. Ward…………..………….……………..
1 2
Name of Candidate
Symbol
16

FORM-27
[See Rule 50(1)]
DECLARATION BY THE COMPANION OF BLIND OR INFIRM
VOTER
Election to Municipal Council/Nagar Panchayat ……………………………………........... Ward
Number and name of polling stations ………………………………………………..
I, …………………………………………. son of……………...…………………… ……
aged ………………………….. resident *of ………………………………………………...........
hereby declare that.
Date:-
Place :-
(a) I have not acted as companion of any other voter at this or any other
polling station today and
(b) I will not disclose the secrecy of the vote recorded by me on behalf of **
………………………………………………………………………………...........
*Fu11 address to be given.
** Name of voter and his serial No. in the electoral roll to be given.
Signature of Companion.
17

FORM-28
[See Rule 50(2)]
LIST OF BLIND AND INFIRM VOTERS
Election to Municipal Council/Nagar Panchayat …………………………………….
from ……………………………………………….. ……………………………………ward.
Number and name of polling station ……………………………………………….
Sl. No. Full name of voter Full name of Address of Signature of
of voter
companion companion companion
1 2 3 4 5
Date:-
Signature of Presiding Officer.
18

SI.
No.
FORM-29
[See Rule 52(2) and 57]
LIST OF TENDERED VOTES
Election to Municipal Council/Nagar Panchayat ………………………………………
from ……………………………………………………………………………………… ward.
No. and name of polling station ………………………………………………………………..
Name of voter Address of voter Serial No. of
tendered
ballot paper
Serial No. in the
register of voters
of the person
who has already
voted
1 2 3 4 5 6
Signature of
thumb
impression of
person
tendering vote
Date:-
Signature of Presiding Officer.
19

FORM-30
(See Rules 53 and 57)
LIST OF CHALLENGED VOTES
Election to the municipal council/ Nagar Panchayat ………………………………
from …………………………………………………………………………………. ward.
No. and name of polling station………………………………………………………
Sl. No. of voter
in the electoral
roll
Name and
address
Signature or
thumb
impression of
voter
Name of
identifier if any
Order of
Presiding
Officer in each
case
Date :
Signature of Presiding Officer.
20

FORM 31
PART I-ACCOUNT OF VOTES RECORDED
Election to the Municipality of the District…………………………………
From Ward No…………………………………………………………….
No. and Name of Polling Station
Identification No. of Voting Machine
1. Total No. of Vote assigned to the Polling Station
2. Total No. of Voters as entered in the Register of Voters (Form 43)
3. No. of voters deciding not to record votes under rule 51(2).
4. No. of voters not allowed to vote
5. Total No. of voter recorded as per voting machine
6. Whether the total no. of votes as shown against
item 5 tallies with the total No. of voters deciding
not to record votes as against item 3 minus No. of
voters not allowed to vote discrepancy noticed.
7. No. of voters to whom tendered ballot papers were
issued under rule 52 (1) (APME Rules, 2011).
8. No. of tendered ballot papers
(a) Received for use
(b) Issued to electors
(c) not used and returned
9. Account of seals
1. Serial Numbers of paper seals supplied
2. Total number supplied
3. Number of paper seal used
4. Number of unused paper seals
returned to Returning Officer
(Deduct item 3 from item 2)
5. Serial number of damaged paper seal
if any
Signatures of Polling Agents
1.
2.
3.
4.
5.
6.
Date.....................
Place ...................
Signature of the Presiding Officer
Polling Station No.
21

FORM-32
[See Rule 41(2)]
PART-I
RECORD OF PAPER SEAL USED
Election to Municipal Council/Nagar Panchayat ……………………………………
from ……………………………………………………………. ……………………….ward.
Number and name of polling station …………………………………………………………
Serial No. of ballot box/ Serial No. of paper seal used
Remarks
electronic voting machine
used
1 2 3
Signature of Polling Agent
PART-II
ACCOUNT OF PAPER SEAL
1. Serial No. of paper seal supplied to …
………to…………….. total……………
2. No. of paper seals used ……….to……...
total …………………………………….
3. No. of unused paper seals………………
to……………….total…………………..
4. Serial No. of damaged seals, if any,
…………..to…………total……………
Place:-
Date :-
1. ………………………………………...
2. ………………………………………...
3. ………………………………………...
4. ………………………………………...
Signature of Presiding Officer.
22

FORM- 33
[See Rule 59 (4)]
APPOINTMENT OF COUNTING AGENTS
Election to the Municipal Council/Nagar Panchayat …………………………………….
From …………………………………………………………… …………………………..ward.
I, a candidate at the above election do hereby appoint the following persons as my
Counting Agents to attend the counting of votes at ………………………………………………
1.
2.
3.
Address of the Counting Agent.
Signature of Candidate.
1.
2.
3.
I agree to act as such Counting Agent.
Signature of Counting Agent.
Declaration of counting agent to be signed before the Municipal Returning Officer.
I hereby declare that at the above election, I shall not do anything forbidden by section 53
and 54 of the Arunachal Pradesh Municipal Elections Act, 2009, which I have read has been read
over to me.
1.
2.
3.
Place:-
Date :-
Signed before me.
Signature of Counting Agent.
Municipal Returning Officer
23

FORM-34
(See Rule 62)
RESULT SHEET
Election to Municipal Council/Nagar Panchayat ……………………………………..
from ………………………………………………………………………………………ward.
Sl. No. and
name of polling
station
No. of valid
votes polled in
favour of
A. B. C. D
Total of
valid votes
polled
No. of
Rejected
votes
Total votes
polled
(Col. 3+4)
Remarks
1 2 3 4 5 6
Total No. of valid votes polled in all polling stations of the ward……………………………
Total No. of rejected votes at all polling stations ………………………………….. of ward.
Total number of votes polled (Valid/rejected) in the ward.. ……………………………….
Place:-
Date:-
N.B.- In Col. 2-A, B, C and: D denote the name of contesting candidates.
Municipal Returning Officer.
24

FORM-35
(See Rule 64)
DECLARATION OF RESULT OF ELECTION WHEN SEAT IS CONTESTED
Election to Municipal Council/Nagar Panchayat …………………………………… …..
from …………………………………………………………………………………… ……ward.
In pursuance of the provisions contained in rules of the Arunachal Pradesh Municipal
Election Rules, 2011, 1 declare that (Name)……………………………………………………….
(Address) ……………………………………………………………. had been duly
elected to fill the seat in the …………………………………… ………Municipal Council/Nagar
Panchayat from the above ward.
Place:-
Date:-
Municipal Returning Officer.
25

FORM-36
(See Rule 65)
RETURN OF ELECTION
Election to Municipal Council/Nagar Panchayat………………………………………….
from …………………………………………………………….. …………………………...ward.
SI. No. of candidate
1.
No. of valid votes polled
2.
3.
4.
5.
Etc.
Total No. of votes polled …………………………………………………………………….
Total No. of valid votes polled ………………………………………………………………
Total No. of rejected votes …………………………………………………………………...
I declare that ………………………….. ..(Name) ……………………………… (address)
has been duly elected to fill the seat in ……………….. …Municipal Council/Nagar Panchayat.
Place:-
Date:-
Municipal Returning Officer
26

FORM-37
[See Rule 71(3)]
I, ………………………………………. the petitioner in the accompanying election
petition calling in question the election of Shri/Shrimati …………………………………… from
……………………………………respondent No …………………………… in the said petition
make solemn affirmation/oath and say-
(a) that the statements made in paragraphs……………………………… of
the accompanying election petition about the commission of corrupt
practice…… …………………………………. and the particulars of such
corrupt practice mentioned in paragraphs…………………………... of the
Schedule annexed thereto are true to my knowledge;
(b) that the statement made in paragraphs of the said petition about the
commission of the corrupt practice of and the particulars of such corrupt
practice given in paragraphs of the of the said petition and in paragraphs
of the Schedule annexed thereto are true to my knowledge
(c)
(d)
etc.)
Signature of the Deponent
Solemnly affirmed/sworn byShri/Shrimati ……………………………………….. at this
……………………………………….. day of …………………….. …………….20 ……………
Before me.
Executive Magistrate
** Here specify the name of the corrupt practice.
27

FORM.38
[See Rule 71(3)]
REGISTER FOR MAINTENANCE OF DAY TO DAYACCOUNTOF ELECTION
EXPENDITURE BY CONTESTING CANDIDATES FOR ELECTION TO NAGAR
PANCHAYAT/ MUNICIPAL COUNCIL
1. Name of the candidate …………………………………………………………………….
2. Ward from which contested ……………………………………………………………….
3. Seat for which contested …………………………………………………………………..
4. Date of filing nomination ………………………………………………………………….
5. Date of declaration of result ……………………………………………………………….
Date of
expenditure
Nature of
Amount of Exp.
expenditure Paid
Outstanding
1 2 3 4 5
Date of
payment
Name and
Address of
payee
No. of
vouchers in
case of
amount paid
No. of bills in
case of amount
outstanding
Name and Address
of person to whom
the amount
outstanding is
payable
Remark
6 7 8 9 10
Certified that this is a true copy of the account kept by me/ my election agent.
Signature of Contesting Candidate.
28

FORM-39
DETAILS OF ELECTION EXPENSES (THE CONTESTING CANDIDATE) FOR THE
ELECTION TO MUNICIPAL COUNCIL/NAGAR PANCHAYAT.
1. Name of contesting candidate ……………………………………………………………
2. Name of Ward ………………………………………………………………………….
Item of expenditure Sources from where money procured Amount of Exp.
1 2 3
1. Expenditure on security deposit.
2. Expenditure on purchase of copies of electoral rolls.
3. Expenditure on printing of manifestos and expenditure
on printing of posters and hand bills etc.
4. Expenditure on pasting of posters.
5. Expenditure on writing of wall writing and on publication
of advertisements.
6. Hiring charges of places for public meetings and hiring
charges of pandals etc. for public meetings.
7. Hiring charges of loudspeakers for public meetings.
8. Hiring charges on vehicle and POL use by the candidate.
9. Hiring charges and POL on vehicle used by election
agent/polling agent.
10. Misc. expenses (other than those listed above).
Date(s) of payment Mode of payment Evidence of payment Remarks.
enclosed with the
account
4 5 6 7
Signature of the Contesting Candidate.
29

FORM-40
[See Rule 33-A (11)]
PROFORMA FOR THE SUBMISSION OF ELECTION EXPENDITURE BY
CONTESTING CANDIDATES FOR ELECTION TO MUNICIPAL
COUNCIL/ NAGAR PANCHAYATS
1. Name of the candidate …………………………………………………………………
2. Ward from which contested ……………………………………………………………
3. Seat for which contested ……………………………………………………………….
4. Date of filing nomination ………………………………………………………………
5. Date of declaration of result ……………………………………………………………
Date of
expenditure
Nature of
Amount of Exp.
Date of
expenditure Paid
Outstanding payment
1 2 3 4 5
No. of vouchers
Remarks
in case of
amount paid
Name and
address of
payee
No. of bills in
case of the
amount
outstanding
Name and
address of
person to whom
outstanding is
payable
6 7 8 9 10
Certified that this is a true copy of the account kept by me/my election agent.
Signature of Contesting Candidate.
30

FORM-41
[See Rule 33-A (11)]
AFFIDAVIT
I, …………………………………son/wife/daughter of …………………………… aged
………………. years ……….. r/o ……………………………….. do hereby solemnly and
sincerely state and declare as under –
1. That I was a contesting candidate at the general election/bye-election to the ward of
…………………………… the result of which was declared on ……………………..
2. That I/my election agent kept a separate and correct account of all expenditure in
connection with the above election incurred or authorized by me or by my election agent
between ………………………….. (the date on which I was nominated) and the date of
declaration of the result thereof, both days inclusive.
3. That the said account was maintained in Forms 38, 39, and 40 appended to the Arunachal
Pradesh Municipal Election Rules, 2011 and a true copy thereof is annexed hereto with the
supporting vouchers/bills mentioned in the said account.
4. That the account of my election expenditure as annexed hereto includes all items of
election expenditure incurred or authorized by me or by my election agent and nothing has
been concealed or withheld/suppressed therefrom.
5. That the statements in the foregoing paragraphs 1 to 4 are true to my personal knowledge,
that nothing is false and nothing material has been concealed.
Deponent,
Solemnly affirmed/sworn by………. …………………….
at …………………….. this day of ………… ……………
20………. before me.
31

FORM-42
[See Rule 33-A (12)]
ACKNOWLEDGEMENT
The detailed accounts of the election expenses on prescribed form are in respect of
Shri ………………………………………. (Candidate) from ………………… (Ward) result of
which was declared on ………… (Date) has been filed by him on ………………... (Date) has
been received by me today the (date) of ………… …………(Month) …………… ……...(Year).
District Municipal Election Officer
District……………………………
Arunachal Pradesh
32

FORM–43
REGISTER OF VOTERS
Election to the Municipality of the.................................... from................................................
Ward No. and Name of Polling Station...................................................................................
Remarks No. electoral roll impression of elector.
Sl.
No.
Sl. No. of elector in the electoral
roll
Signature/Thumb impression
of elector
Remarks
1.
2.
3.
4. etc
Signature of the Presiding Officer
33