Company : Sol Infotech Pvt. Ltd. Website : www.courtkutchehry.com .style1 {font-family: Verdana} --> To, The Registration Officer ........................................................ Sir, I request that my name be included in the voters list of Ward No. ..................... of the Panchayat Circle ...................................................................................................................... The particulars of my place of residence are :- Name House Number and Name of Mohalla Fathers/Husbands Name 1 2 3 I hereby declare to the best of my knowledge and belief :- (1) that I am qualified to be registered in State Assembly Electoral Roll relatable to the area comprised in the ward mentioned above. (2) that my age on the Ist day of January last was ............................ years ...................... months. (3) that my name has been included in the voters list for any other ward in this Panchayat Circle. OR that my name has been included at Serial No. ............... of the voters list of Ward No. ................... and request that the same may be excluded from the said list. Signature or Thumb impression of Claimant FORM 2 FORM II [See Rule 13(3)] Objection to inclusion of name .style1 {font-family: Verdana} --> To, The Registration Officer ........................................................ Sir, object to the inclusion of the name of ............................... S.No. ........................ of the voters list of Ward No. ................ of Panchayat Circle .............................................................. for the following reasons :- .................................................................................................................................................................... .................................................................................................................................................................... I hereby declars that the facts mentioned above are ture to the best of my knowledge and belief. My name has been included in the voters list of the said ward at Serial Number ........................................ as follows :- Name in full ........................................................................... Fathers/Husband/s Name .................................................... Signature/Thumb impression of objector. (Full Postal Address) ........................................................... .......................................................... FORM 3 FORM III [See Rule 13 (4)] Objection to particulars in any entry .style1 {font-family: Verdana} --> To, The Registration Officer ........................................................ Sir, I submit that the entry relating to myself which appears at Serial Number .............. in the voters list of ward No. ..........of Panchayat Circle..................as ............................ is not correct. It should be corrected to read [as] follows ................................................................................ .................................................................................................................................................................... .................................................................................................................................................................... Place : Date : Signature/Thumb impression of objector. FORM 4 FORM IV [See Rule 25 (1)] Nomination Paper .style1 {font-family: Verdana} --> Election of Panch/Sarpanch 1[xxx] Election to ....................... Panchayat 1[xxx] of ............................................... Panchayat Samiti/District. I hereby give notice that I propose myself as a candidate for election as Panch/Sarpanch 2[xxx] of the above Panchayat 2[xxx] from ward 2[xxx] No. .................................................. 1. Full Name .................................................................................................................................... 2. Sex of the candidate .................................................................................................................. 3. Caste of the candidate ............................................................................................................... (To be filled by persons belonging to Scheduled Castes/Tribes/OBC only). 4. 3[Serial number of elector indicating relevent ward number and name of panchayat] ..................................................................................................................................................... 5. Name of the Candidates father/husband ................................................................................ I further declare that - *(1) I am qualified to be a Panch/Sarpanch 2[xxx] under the provisions of the Rajasthan Panchayati Raj Act, 1994. (2) I am not subject to any of the disqualifications specified in section 19 of the said Act. (3) I belong/do not belong to the Scheduled Castes/Scheduled Tribes/ Other Backward Classes. (4) That I have deposited security as required under Rule 56 (3) (only applicable for Sarpanch 2[xxx]. Date ................................................ Place ............................................... Signature of the candidate. (To be filled by the Returning Officer) *Serial Number of the Ward/Panchayat 2[xxx] from which the candidate proposes to seek election .......................................................................................................... *Serial Number of the nomination paper for such Ward/Panchayat 2[xxx] ......................................................................... 1. Deleted vide notification no. F.15(Vidhi)/PR/94/28, dt. 3.12.99, the expressions "Member of Panchayat Samiti/ member of Zila Parishad" or "Member of Panchayat Samiti/Zila Parishad" or "Constituency". 2. Deleted vide notification no. F.15(Vidhi)/PR/94/28, dt. 3.12.99, the expressions "Member of Panchayat Samiti/ Zila Parishad" or "Constituency". 3. Subs. by ibid, for expression "Number in the Voters lits". This nomination was presented to me at ................. (hrs) on ...................... (date) by Shri/Smt./Miss ......................................... (candidate) 1(accompanied by Shri ...................................) Decision accepting or rejecting the nomination paper. I have examined the nomination in accordance with the provisions of these rules and decide as follows - Date ............................................ (Receipt for nomination paper) Serial Number of the Ward/Panchayat 1[xxx] from which the candidate proposes to seek election ................................................ Serial Number of nomination paper for such Ward/Panchayat 1[xxx] ............................ The nomination paper of ........................... a candidate for election as Panch/Sarpanch 1[xxx] was delivered to me at ............................... (hrs.) on ........................... (date) by Shri ........................................ accompained by Shri .................................... as identifier. The nomination paper will be taken up for security at ................................................ (hrs.) on .............................................. (date) at .............................................. (Place). Date ..................................... Place .................................... Returning Officer * Note - Please strike off which is not related. 1. Deleted vide notification no. F (15) Vidhi/PR/94/28, dt. 3.12.99, the expression - "/member of Panchayat Samiti/Zila Parishad" or "Constituency". FORM 4A FORM - IV(A) (See rule 58) NOMINATION PAPER .style1 {font-family: Verdana} --> Election of member of Panchayat Samiti/member of Zila Parishad - Election of member of Panchayat Samiti/Zila Parishad ......................................................................... of District. [Strike off Part I or Part II below whichever is not applicable.] PART 1 PART-I .style1 {font-family: Verdana} --> (To be used by the candidate setup by recognised political party) 1. I nominate as a candidate for election to the member of Panchayat Samiti/Zila Parishad of the above Panchayat Samiti/Zila Parishad from constituency No. ...................... the following person :- Name .......................... Fathers/Husbands name ...................................... ................................................................................................................... Sex............... Age ...................... Postal Address His name is entered at S.No........................................................ in the Ward No. .............................. of electoral roll for Panchayat ............................. of Panchayat Samiti ................................................................ 2. My name is ......................................................................... and it is entered at S.No. ............................ in the Ward No. ............................ of electoral roll for Panchayat ........................ which is comprised within above constituency of Panchayat Samiti .................................................................... Date .............../............../......................... (Signature of the proposer) 1. Subs. by notification no. F.(15)Vidhi/PR/94/28, dt. 3.12.99, Form IV (A). PART 2 PART-II .style1 {font-family: Verdana} --> (To be used by candidate NOT set up by recognised political party) We hereby nominate as candidate for election to the member of the above Panchayat Samiti/Zila Parishad from constituency No. ................. Candidates name .............................................................................. Fathers/husbands name ...................................................... Sex ...................................... Age ................................. Postal address ............................................................................. ........................................................................... ........................................................................... His name is entered at Sl. No. ........................... in the electoral roll for the ..................................... Ward No. ....................... of Panchayat ................................................. of Panchayat Samiti ................................. We declare that we electors of the above Constituency No. .................... and our names are entered in the electoral roll for Ward No. ............ of Panchayat, which is comprised within the above Constituency No. ............ as indicated below and we append our signatures below in token of subscribing to this nomination :- Particulars of the proposers and their signatures :- S.No. Electoral Roll No. of proposers Full Signature Date name Ward No. & S.No.in that ward Name of Panchayat Constituency No. in which the ward of Panchayat falls 1 2 3 4 5 6 7 N.B. There should be five electors of the constituency as proposers. PART 3 PART-III .style1 {font-family: Verdana} --> 3. I, the above mentioned candidate, assent to this nomination and hereby declare :- (a) that I have completed ........................................... years of age; @(b) that I am set up at this election by .................................... party; or that the symbols I have chosen are - (i) ........................................ (ii) ........................................................... (d) that my name and my fathers/husbands name have been correctly spelt out above in Hindi in Devnagri Script and I request that my name may be entered as such on the ballot paper; (e) that to the best of my knowledge and belief, I am qualified and not also disqualified for being elected to the member of the constituency; (f) that I have filed/not filed nomination paper in Constituency number/any other Constituency. 4. @*I further declare that I am a member of the ............................................... caste/tribe/class, which is a Scheduled Caste/Scheduled Tribe/Backward Classes in Rajasthan State. I am enclosing herewith an authenticated copy of the caste/tribe/class certificate issued by ................................................................................................ Place......../........./................ Date......../........./................ (Signature of the candidate) @ Score out this paragraph if not applicable. PART 4 PART-IV .style1 {font-family: Verdana} --> (To be filled by the Returning Officer) 1. Serial Number of the nomination paper is ................................................... 2. This nomination was delivered to me at my office at ..................................... (hours) on............/......../................ (date) by the * candidate/proposer. Date................/............/................ Returning Officer * Substituted vide No. F15/LAW/Rules/2000 dated 5.2.2000. PART 5 PART-V .style1 {font-family: Verdana} --> (Decision of Returning Officers Accepting or Rejecting the Nomination Paper) I have examined this nomination paper in accordance with the provisions of the Rajasthan Panchayati Raj Act 1994 and Rules made there-under and decide as follows:- Date ............ Returning Officer PART 6 PART-VI .style1 {font-family: Verdana} --> (To be filled in by the Returning Officer and given to the person presenting the nomination paper). 1. Serial Number of the nomination paper is ................................................... 2. This nomination was delivered to me at my office at ..................................... (hours) on............/......../................ (date) by the * candidate/proposer. Date................/............/................ Returning Officer *Score out which is not applicable. FORM 4B FORM IV (B) (See Rule 59, 61, 62) Nomination paper .style1 {font-family: Verdana} --> Nomination form of election of *Pradhan/UP Pradhan/Pramukh /Up Pramukh of *Panchayat Samiti/Zila Parishad ......................................... 1. Full Name of the candidate........................................................................................................ 2. Fathers or Husbands name ....................................................................................................... 3. Age .................................................................................................................. 4. Sex .................................................................................................................. 5. Caste ............................................................................................................... 6. Address ............................................................................................................... 7. S.No. of Constituency from which he was elected member ........................................................................... 8. Full name and address of the proposer ................................................................................ Date ............................... Place ............................. Signature of the candidate Candidates Declaration I, the above named candidate, give my consent to this nomination and hereby declare that I do not hold any of the disqualifications enumerated in the Rajasthan Panchayati Raj Act, 1994 and that I am qualified to be candidate for the seat under the provisions of the said act. I further declare that :- (a) I am set up at this election by .................... (Name of Political Party), or (b) I have chosen following symbols:- (i) ..................................... (ii) ........................................ (iii) ....................................... Date ............................... Place ............................. Signature of the candidate Endorsement by the Returning Officer S.No. This nomination paper was presented to me by ................................... (name of the candidate or his proposer) at .................................. (date and hour). Date ............................... Place ............................. Signature of the Returning Officer Order of the Returning Officer Accepted/Rejected Reasons for rejection .............................................. Date ............................... Place ............................. Signature of the Returning Officer ACKNOWLEDGEMENT Received nomination paper of Shri .......... for election as ........ of ................. Panchayat Samiti/ Zila Parishad which was presented to me at ............... (time) this day of .............. 20 ......... by Shri ............................ Date ............................... Place ............................. Signature of the Returning Officer * Score out which is not applicable. FORM 4C FORM IV(C) .style1 {font-family: Verdana} --> (See Rule 59, 61, 62) List of candidates validly nominated for election as ............................. of Panchayat Samiti/ Zila Parishad ............................... S.No. Name & description of candidate Address of candidate Remarks 1 2 3 4 5 6 Date ............................... Place ............................. Signature of the Returning Officer FORM 5 FORM V-A .style1 {font-family: Verdana} --> (See Rule 59(7)) List of validly nominated candidate whose nominations papers have been accepted and have not been withdrawn ELECTION TO THE PRADHAN/UP-PRADHAN/PRAMUKH/UP-PRAMUKH OF Panchayat Samiti/Zila Parishad, .................................. Date of Election......................................... S.No. of the Panchayat Samiti/Zila Parishad. S.No. and name of the candidate with address Party affiliation Distinative symbol allotted 1 2 3 4 Strike out which is not applicable. Date .............................. Place ............................. Signature of the Returning Officer FORM 6 FORM VI .style1 {font-family: Verdana} --> (See Rule 44) List of Tendered votes ELECTION TO THE WARD/PANCHAYAT/CONSTITUENCY OF P.S./J.P. .................... S.No. of the Ward/Panchayat/ Constituency of P.S./J.P. S.No. and name of the Elector Address of Elector S.No. of tendered Ballot paper S.No. of ballot paper issued to the person who has already voted Signature or thumb Impression of person tendering vote 1 2 3 4 5 6 Date ..................................... Place .................................... Signature of the Returning Officer * Inserted vide No. F15/LAW/Rules/2000 dt 5.2.2000. FORM 7 FORM VII .style1 {font-family: Verdana} --> (See rule 52, 59, 60, 61) Return showing the results of election for the office of Panch/Sarpanch/Member of Panchyat Samiti/Member of Zila Parishad. Panch/Sarpanch/Member of Panchayat Samiti/Member of Zila Parishad. Panchayat/Panchayat Samiti/Zila Parishad ........................................... Total Electorate ................................ Panchayat Samiti ................................. District ............... Date of election ........................... 1 2 3 No. of Ward/ Panchayat/ Constituency of Panchayat Samiti/Zila Parishad with total electorate. Name of the candidates declared unopposed under rule 29(2) Names of the candidates for whom valid votes have been cast. Particular of the candidates mentioned in columns (2) and (3) (a) (b) (c) (d) (e) (f) Address Caste (mention S.C. or S.T. or O.B.C. Educational standard whether illiterate below middle/matric/ Graduate. Age in years Occupation Whether held office of Panch of Sarpanch previously. 5 6 7 8 No. of valid votes cast for each condidate No. of rejected votes Result of lot if any under rule 51 Remarks I hereby declare that the following candidate/candidates has/have been elected as Panch/from the wards specified against each/as Sarpanch of the above Panchayat/as member of Panchayat Samiti/Zila Parishad from Constituency No............................... 1 2 3 4 5 6 7 S.No. Name of Office (Panch or Sarpanch) Member Panchayat Samiti/Zila Parishad Name and address of the elected candidate Sex Caste S.No. of Ward/ Constituency Ramarks. Date ..................................... Place .................................... Returning Officer FORM 7A FORM VII-A .style1 {font-family: Verdana} --> (See rule 59, 61, 62) Declaration of the result of election for Pradhan//Up-Pradhan/Pramukh/Up-Pramukh/Panchayat Samiti/Zila Parishad. Date of Election......................................... S.No. Name of candidate (Party affiliation) As indicated in the Nomination Form Number of votes polled Total Votes ................................................... Total Number of valid votes polled ................................................... Total Number of rejected votes ................................................... Total Number of tendered votes ................................................... In pursuance of the provision contained in the Rajasthan Panchayati Raj (Election) Rules, 1994, I declare that ................................................... (Name) ................................................... (Address) has been duly elected to fill the office of Pradhan/Up-Pradhan/Pramukh/Up-Pramukh of ................. Panchayat Samiti/ Zila Parishad. Date ..................................... Place .................................... Returning Officer * Substituted vide notification No.F.15/LAW/Rules 2000, dt. 5.2.2000. FORM 8 FORM VIII .style1 {font-family: Verdana} --> (See Rule 68) I ................................................................................. a candidate for election of 1[xxx] 2[xxx] *Member of Panchayat Samiti from Constituency No. ........................................... of Panchayat Samiti .......................................................................................... *Member of Zila Parishad from Constituency No. ................................................................ to be held on ........................................................ hereby appoint Shri ................................ as my election agent. from this date at the above election. Place .................... Date ..................... .................................... Signature of Candidate I accept the above appointment. Place .................... Date ..................... ............................................. Signature of Election Agent Approved Place .................... Date ..................... ............................................. Signature of Returning Officer * Strick out which is not applicable. FORM 9 FORM IX .style1 {font-family: Verdana} --> (See Rule 69) Appointment of Polling Agent Election to - 1[xxx] *Sarpanch, Gram Panchayat ..................................................................................................... *Member of Panchayat Samiti from Constituency No. ...................................................... *Member of Zila Parishad from Constituency No. .................................of Panchayat Samiti /Zila Parishad ........................................ * Strike out which is not applicable. 1. Deleted by notification no. F.(15) Vidhi/PR/94/28, dt. 3.12.99, the expression "Panch from ward no. ..... of Gram Panchayat ......" 2. Deleted by ibid, the expression "Sarpanch, Gram Panchayat ......". I............................a candidate/ the election agent of ......................... who is a candidate at the above election do hereby appoint ............................... (Name and address) ....................................... as Polling Agent to attend polling station No. .............................. at ......................................... Place .................... Date ..................... Signature of Candidate/ Election Agent I agree to act as such Polling Agent. Place .................... Date ..................... Signature of Polling Agent Decleration of Polling Agent to be signed before the Presiding Officer I hereby declare that at the above election I will not do anything forbidden by the Act or Rules made thereunder. .................................................. Signature of Polling Agent Signed before me Place .................... Date ..................... ................................................. Signature of Presiding Officer FORM 10 FORM X .style1 {font-family: Verdana} --> (See Rule 70) Appointment of Counting Agent Election to - 1[xxx] 2[xxx] *Member of Panchayat Samiti from Constituency No........................................................... *Member of Zila Parishad from Constituency No. ................................................... of ................................................... Panchayat Samiti/Zila Parishad..................................... I......................... a candidate/ the election agent of .................... who is a candidate at the above election do hereby appoint .................................. (Name and address) .............................. as a 3[counting agent to attend the place fixed for counting of votes] at ....................................... Place .................... Date ..................... ............................................. Signature of Candidate/ Election Agent 1. Deleted by notification no. F.(15) Vidhi/PR/94/28, dt. 3.12.99, the expression "Panch from ward no. ..... of Gram Panchayat ......" 2. Deleted by ibid, the expression "Sarpanch, Gram Panchayat ......". 3. Subs. by, ibid, for expression "Polling Station No.......". I agree to act as such Polling Agent. Place .................... Date ..................... ............................................ Signature of Counting Agent Declaration of Counting Agent to be singed before the Returning Officer. I hereby declare that at the above election I will not do anything forbidden by the Act or Rules made thereunder. ................................................. Signature of Polling Agent Signed before me Place .................... Date ..................... .................................................. Signature of Returning Officer * Strike out which is not applicable. FORM 11 FORM XI .style1 {font-family: Verdana} --> (See Rule 75) Form of Oath I ...................................... having become a Panch/Sarpanch/Pradhan/Up-Pradhan/ Pramukh/ Up- Pramukh/member of Panchayat Samiti/Zila Parishad of the Panchayat/Panchayat Samiti/ Zila Parishad ................................... swear in the name of God/Solemaly affirm that I will bear true faith and allegiance to the Constitution of India as by law established and that I will faithfully discharge the duty upon which I am about to enter. Signature or thumb impression of Person taking oath with designation Signature of Returning Officer or Authorised person with designation.