(1) The Himachal Pradesh Gram Panchayat and Panchayat Samiti (Election) Rules, 1991, Himachal Pradesh Zila Parishad (Co-option of Members) Rules, 1973 and Himachal Pradesh Panchayat Samiti (Co-option of Members) Rules, 1973 are hereby repealed.
(2) Notwithstanding such repeal anything done or action taken under the rules so repealed (including the orders issued or directions given) shall always be deemed to have been taken or done under the corresponding provisions of these rules.
FORM-1 (See rule 15) NOTICE OF PUBLICATION OF ELECTORAL ROLL To The Electors of Constituency No. ……………… of Gram Sabha/Panchayat Samiti/Zila Parishad of ………………… District, Himachal Pradesh.
Notice is hereby given that the electoral roll has been prepared in accordance with the Himachal Pradesh Panchayati Raj (Election) Rules, 1994 and a copy thereof is available for inspection at my office and the offices of Gram Panchayats/Panchayat Samiti/Zila Parishads.....................................
during office hours.
If there is any claim for the inclusion of a name in the electoral roll or any objection to the inclusion of a name or any objection to particulars in any entry, it should be lodged on or before ………………….. (date) in forms 2, 3 and 4 as may be appropriate.
Each such claim or objection should be addressed to the …………………………… (full address) Revising Authority and should either be presented in person or through agent or sent by registered post so as to reach him not later than the aforesaid date.
Place ………………………..
Date ……………………….. District Election Officer, (Panchayats).
________ 60 1 [FORM-2 [See rule 18 (1) and 24] CLAIM APPLICATION FOR INCLUSION OF NAME To The Revising Authority, Gram Panchayat …………………………….
Development Block ………………………… District ………………….., Himachal Pradesh.
Sir, I request that my name be included in the electoral roll for the ………………………………………………………. constituency relating to Gram Panchayat …………………………………….
My Name (in full)...............................................................................................
My father‘s/mother‘s/husband‘s Name........................ ……………………… Particulars of my place of residence are………………………………………..
House No............................................................................................................
Street/Mohalla Village ......................................................................................
Post Office ......................................................................................................
Tehsil and District. ..........................................................................................
I hereby declare that, to the best of my knowledge and belief that:-
(i) I am a citizen of India.
(ii) My age on.................................................. i.e. the date notified by the State Election Commission under clause (e) of rule 14 was /will be ............................. years …………. months.
(iii) I am an ordinarily resident of the address given above.
(iv) I have not applied for the inclusion of my name in the electoral roll for any other Constituency.
(v) My name has not been included in the electoral roll for any constituency of the above mentioned Gram Panchayat or any constituency of any other Gram Panchayat in Himachal Pradesh.
OR That my name has been included in the electoral roll for the Ward Number ................................. of Gram Panchayat ………………… Development Block ……………… District ……………. at Serial No.
1 . Form-2 subs. vide Not. No. PCH-HA(1)18/2000-II dated 30-12-2005 published in R.H.P. Extra., dated 30-12-2005, p. 5647-5662.
61 ……………….. and, I request that the same may be excluded from the electoral roll.
Signature/thumb impression of Place …………….. claimant ……………………..
Date ……………... (Full postal address)................
……………………………….
……………………………….
……………………………….
I am an elector included in the electoral roll of the same part in which the claimant has applied for inclusion viz. Part No. …………………………...
……………………….. relating to ...................................................................
my serial number therein to.................................................. support his claim and countersign it.
……………………………… Signature of the elector.
DECLARATION I hereby declare that I am aware that in case any of the information given by me is proved to be wrong, I shall be liable to criminal action under various sections of the Indian Penal Code.
………………………………………….
Signature of the claimant.
__________________________ Strike off the inappropriate words.]
Note.- Any person who makes a statement or declaration which is false and which he either knows or believes to be false or does not believe to be true is punishable in accordance with the law in force.]
________ FORM-3 (See rule 18) OBJECTION TO INCLUSION OF NAME To The Revising Authority, ……………………….. Constituency.
Sir, I object the inclusion of the name of ................................ at serial No.
……………………….. in the electoral roll for.....................constituency 62 relating to ………………………………….Gram Panchayat/Panchayat Samiti/Zila Parishad for the following reason (s):- ..................................................
…………………………………… ..................................................
I hereby declare that the facts mentioned above are true to the best of my knowledge and belief that my name has been included in the electoral roll for this constituency as follows:- Name in full. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Father‘s/Husband‘s/Mother‘s name. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...
Serial No. .................................................. .........................................................
No. and name of the constituency .................................... relating to......................................... Gram Panchayat/ Panchayat Samiti/Zila Parishad.
Signature/thumb impression of objector (Full postal address)………………..
Dated ………………….
I am an elector included in the same electoral roll in which the name objected to appears, viz. number and name of the constituency……………….
………………….. relating .................................................................................
.................................................. Gram Panchayat/ Panchayat Samiti/ Zila Parishad, my serial number therein is …………………………… I support this objection and countersign it.
Signature/thumb impression of the elector.
(Full postal address) …………………………………………….
Note.- Any person who makes a statement or declaration which is false and which he either knows or believes to be false or does not believe to be true is punishable in accordance with the law in force.
________ FORM-4 (See rules 18 and 23) OBJECTION TO PARTICULARS IN ANY ENTRY To The Revising Authority for Panchayat Election ……………………..
.................................................. Constituency.
63 I submit that the entry relating to myself which appears at serial No.
.................................................. in the electoral roll for ……………………… ..................................................Constituency relating to ……….......................
Panchayat as .................................................................................... is incorrect.
It should be corrected to read as follows:- ..................................................
..................................................
..................................................
Place ........................................... ……………………………………… Signature/thumb impression of elector.
Date……………………. (Full postal address) ………………..
---------- FORM-5 [See rule 18 (4) and 20 (1)] REGISTER OF CLAIMS FOR INCLUSION OF NAMES . . . . . . . . . . . . . . . . . . . . . . Gram Panchayat/Panchayat Samitit/Zila Parishad.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. Constituency.
Sl.
No.
1 Name, father‘s name and address 2 Date of presentation of claim 3 Date of decision with note in the presence of parties 4 Decision Signature of Revising Authority Signature of official by whom effect was given to the decision of the Revising Authority and date Admitted Rejected 5 6 7 8 64 ------------- FORM-6 [See rule 18(4) and 20(1)] REGISTER OF OBJECTION TO INCLUSION OF NAMES …………………………….. Gram Panchayat/Panchayat Samiti/Zila Parishad.
............................................................................................................................
Constituency.
Person objected to Name, father‘s/ husband‘s name and address of the objector Sl. No. of objector in the electoral roll Date of presentation of objection Sl.
No.
Under Name of With Sl. No.
in the electoral roll 1 2 3 4 5 6 Date of decision with note as to presence of parties Decision Signature of Revising Authority Signature of official by whom effect was given to the decision of the Revising Authority and date Admitted Rejected 7 8 9 10 11 ------------------- FORM-7 [See rule 18(4) and 20(1)] REGISTER OF OBJECTIONS TO THE PARTICULARS IN AN ENTRY …………………………… Gram Panchayat/Panchayat Samiti/Zila Parishad ........................................................................................ Constituency.
S1.
No.
Name of the objector Date of presentation of objection Particulars as existed in the electoral roll Correct particulars as requested by the objector 1 2 3 4 5 65 Decision Signature of the Revising Authority Signature of official by whom effect was given to the decision of the Revising Authority and date Admitted Rejected 6 7 8 9 ------------ FORM-8 [See rule 19(1)] LIST OF CLAIMS …………………………………………….. Gram Panchayat/Panchayat Samiti/Zila Parishad …………………………………….. Constituency.
Date of receipt Serial No.
Name of claimant Name of Father/Husband/ Mother Address Date, time and place of hearing 1 2 3 4 5 6 ………………………………….
Signature of Revising Authority.
------------ FORM-9 [See rule 19(1)] LIST OF OBJECTIONS TO INCLUSION OF NAMES ………………………………………….. Gram Panchayat/Panchayat Sarniti/ Zila Parishad …………………..........................................................................
Constituency.
66 Date of receipt Sl.
No.
Full name of objector Particulars of name objected to Objection in brief Date, time and place of hearing Sl. No. of entry in electoral roll Name in Full 1 2 3 4 5 6 7 ………………………………….
Signature of Revising Authority.
-------------- FORM-10 [See rule 19 (1)] LIST OF OBJECTIONS OF PARTICULARS IN ENTRIES IN ELECTORAL ROLL Date of receipt Sl.
No.
Name in full of elector objecting Part No. and Sl. No. of entry of electoral roll Nature of objection Date, time and place of hearing 1 2 3 4 5 6 ………………………………….
Signature of Revising Authority.
------------- FORM-11 [See rule 19 (2)] NOTICE OF HEARING OF CLAIM To 67 Full name and address of claimant …………………………………… Reference/objection No. …………………………………..
Your claim for the inclusion of your name in the electoral roll will be heard at ………………………………. (place) at …………………… O‘clock on the 1 […………………………………. day of 20……. .]
You are directed to be present personally or through your authorised agent at the hearing with such evidence as you may like to adduce.
………………………………….
Place …………………….. Signature of Revising Authority.
Date ……………………… ……………………. (Constituency) ------------- FORM-12 [See rule 19 (2)] NOTICE OF HEARING OF OBJECTION To Full name and address of objector …………………………………….
………………………. Reference/Objection No. ……………………………..
Your objection to the inclusion of the name of ……………………… ……………………………….. will be heard at ……………………………… O‘Clock on the 2 [……………………….. day of ……….20...]
You are directed to be present personally or through your authorised agent at the hearing with such evidence as you may like to adduce.
Place ……………………………...... …………………………………… Date …………………………….. Revising Authority ---------------- FORM-13 [See rule 19 (2)] NOTICE OF HEARING OF AN OBJECTION TO PARTICULARS IN AN ENTRY IN THE ELECTORAL ROLL To 1 Substituted for signs, words and figure "…….day of 19…." , vide Not. No. PCH- HA(1)- 18/2008, dated the 8th September, 2010, published in Rajpatra, Himachal Pradesh, dated 10 th of September, 2010 , page . 4456-4467 .
2 . Substituted for signs, words and figure "…….day of 19…." , vide Not. No. PCH- HA(1)- 18/2008, dated the 8 th September, 2010, published in Rajpatra, Himachal Pradesh, dated 10 th September, 2010, page . 4456-4467.
68 Full name and address of objector …………………………………….
………………………………………… Reference: Objection No. ……………………………..
Your objection to certain particulars in the entry relating to you will he heard at ……………………… (place) at ……………………………….
O‘clock the 1 […………….. day of ……………………………….. 20…….]
You are directed to be present personally or through your authorised agent at the hearing with such evidence as you may like to adduce.
Place ……………………………...... …………………………………… Revising Authority Date …………………………….. …………….. Constituency.
FORM-14 [See rule 19 (3)] NOTICE OF HEARING OF OBJECTION To Full name and address of person objected to ………………………… ……………………………………………… Reference: Objection No. ....................................................
The objection to the inclusion/deletion of your name at the serial No.
…………………………… in the electoral roll for …………….................
Constituency relating to ……………………………………………………….
Gram Panchayat/Panchayat Samiti/Zila Parishad filed by (Full name and address of objector) …………………………………………………. will be heard at …………………………. (Place) at ………………………. O‘clock on the […………………….day of ……………. 19…. ] You are directed to be present personally or through your authorised agent at the hearing with such evidence as you may like to adduce.
The grounds of objection (in brief) are;
(a) ……………………………………..
(b) ……………………………………..
1 . Substituted for signs, words and figure "…….day of 19…." , vide Not. No. PCH- HA(1)- 18/2008, dated the 8 th September, 2010, published in Rajpatra, Himachal Pradesh, dated 10 th September, 2010, page . 4456-4467.
69
(c) ……………………………………..
Place …………………………… ……………………………………..
Date ……………………………. Revising Authority ………………Constituency.
---------------- 1 [FORM-15 [See rule 21 (1)] NOTICE OF FINAL PUBLICATION OF ELECTORAL ROLL It is hereby notified for public information that the additions/deletions and corrections ordered by the Revising Authority/Appellate Authority to the draft electoral roll for Constituency No.……… (Constituency) of Gram Panchayat/Panchayat Samiti/ Zila Parishad…………… has been incorporated in the said draft roll or list of such amendments has been prepared in accordance with the Himachal Pradesh Panchayati Raj (Election) Rules, 1994 and a copy of the electoral roll so corrected alongwith list of amendments has been published finally.
Registration Officer.
Place …………………… Date ………………………] __________ FORM-16 (See rule 23) 1 Form-15 substituted vide Not. No. PCH- HA(1)- 18/2008, dated the 8th September, 2010, published in Rajpatra, Himachal Pradesh,,dated 10 th of September, 2010, page . 4456-4467.
70 APPLICATION FOR DELETION OF ENTRY IN ELECTORAL ROLL To The District Election Officer (Panchayat), District .………………………… (H. P.).
Sir, I submit that the entry at Serial No. ............................ in the electoral roll for …………………………………….. constituency relating to Shri/Shrimati …………………………………….. son/daughter of ………………………… …………………………………….. requires to be deleted as the said person is not entitled to be registered in the electoral roll for the following reasons … …………………………………….……………………………………..
I hereby declare that the facts mentioned above are true to the best of my knowledge and belief.
I declare that I am an elector of this constituency being enrolled at serial No. ......................................................
Place ………………………… …………………………………… Date ………………………… Signature/Thumb impression of applicant (Full postal address) …………………… ………………………………………… _______________________ *Strike off the inappropriate words.
Note.- Any person who makes a statement or declaration which is false or which he either knows or believes to be false or does not believe to be true is punishable in accordance with the law in force.
------------ FORM-17 (See rule 33) NOTICE OF ELECTION PROGRAMME Notice is hereby given that:-
(1) an election is to be held for electing a Pradhan/Up-Pradhan from a Gram Sabha/one member from each constituency of the Gram Sabha/one member from each constituency of the Panchayat Samiti/one member from each constituency of the Zila Parishad shown in the Table below;
(2) nomination papers may be delivered by a candidate or his proposer to the officer appointed as Returning Officer at the place, date and time mentioned in the Table below:- 71 TABLE ………….. (Block) in ………………… (Tehsil) of ………………. District.
Name of Zila Parishad No. and Name of Zila Parishad constituency No. and name of Panchayat Samiti No. and Name of Panchayat Samiti constituency Name of Gram Sabha No. and Name of Gram Sabha constituency 1 2 3 4 5 6 Officer before whom Nomination Papers may be presented For member of Zila Parishad For member of Panchayat Samiti For Member, Up- Pradhan and Pradhan of Gram Panchayat Place Date and time 7 8 9 10 11
(3) forms of nomination paper may be obtained from the respective Gram Panchayat Office or from the officer specified in columns 7, 8, 9, as the case may be, and at the place and date specified in columns 10 & 11 of the Table above;
(4) the nomination papers will be taken up for scrutiny by the officer specified in columns 7, 8 or 9, as the case may be, and at the place specified in column 10 of the Table above at ………………………. (hours) on ……………………………….. (date ......................................
(5) notice of withdrawal of candidature may be delivered by candidate or his proposer duly authorised, in writing, by the candidate for the purpose to the Officer specified in column 7 or column 8 or column 9 as the case may be, and at the place specified in column 10 of the Table above upto ……………..
(hours) on …………………………………………….. (date);
(6) the symbols to the contesting candidates shall be allotted by the officer specified in column 7 or column 8 or column 9, as the case may be, of the Table above immediately after the expiry of the time fixed for the withdrawal of candidature and list of contesting candidates shall be affixed outside his office;
(7) in the event of election being contested, the poll shall be taken between the hours . . . . . . . . . . . . . . . . . . . .and. . . . . . . . . . . . . . . . on the date and place in the Table below;
(8) on completion of poll, counting shall take place at place, date and time given in the Table below and the result shall be declared after counting, namely:- 72 TABLE Name of Zila Parishad No. and name of Zila Parishad constituency Name of Panchayat Samiti No. and name of Panchayat Samiti constituency 1 2 3 4 Name of Gram Sabha No. and name of Gram Sabha constituency Date of poll Place of counting 5 6 7 8 Date and time of counting Place and date for declaration of result of Pradhan, Up- Pradhan and member Gram Panchayat and name of authorised officer Place and date for declaration of result of member of Panchayat Samiti and name of authorised officer Place and date for declaration of result of members of Zila Parishad and name of authorised officer 9 10 11 12 Place ............................................. District Election Officer (Panchayat).
_____________________________ * Strike off which is not applicable.
Note.- In case of single election or bye-elections column(s) of tables above which are not applicable need not be filled in.
--------------- 73 1 [FORM-18 (See rule 35) NOMINATION PAPER *Election of member from …………………………………… (Constituency) of ……............................................. Gram Sabha.
*Election of Pradhan from ……………………. Gram Sabha.
*Election of Up-Pradhan from ………………… Gram Sabha.
*Election of member to Panchayat Samiti ……………………… from …………………………………. constituency.
*Election of member to Zila Parishad .........................................
from ………………….. constituency.
I, nominate as a candidate for above election— Candidate's Name …………………………………………….
Father's or Husband's name .............................…………… Postal Address ………………………………………………..
His name is entered at serial No. ……………………………… in the electoral roll for constituency of ………………………… Gram Sabha/Panchayat Samiti/ Zila Parishad.
My name is entered at Serial No .……………… in the electoral roll for ……………………… ………………..………. constituency of …………………..………Gram Sabha/Panchayat Samiti/Zila Parishad.
Date ………………………………. Name and Signature of Proposer.
I …………………………………. the above mentioned candidate, assent to this nomination and hereby declare that-
(a) I have completed …………………………… years of age.
(b) I have not encroached upon any land belonging to or taken on lease or requisitioned by, or on behalf of, the State Government, Municipality, Gram Panchayat, Panchayat 1 FORM-18 Subs. vide Not. No. PCH-HA(1)18/2008-I dated 12 th December, 2013, published in R.H.P. dated 27.12.2013 at pages 5356-5359 again subs. vide No.
PCH-HA(1)1/2015 the 28 th October, 2015 published in R.H.P. dated 6.11.2015, p.
5063-5083.
74 Samiti, Zila Parishad or a Co-operative Society and also do not suffer from any other disqualifications under the Act.
(c) I further declare that I am a member of the………………… Caste/Tribe which is a Scheduled Caste/Tribe.
(d) I have enclosed ―No Dues Certificate‖ duly issued by the competent authority as required under rule 35(2) of the Himachal Pradesh Panchayati Raj (Election) Rules, 1994.
(e) I shall neither use narcotics nor cultivate the poppy, opium and cannabis and shall also persuade others not to use narcotics and cultivate the poppy, opium and cannabis in the Panchayat area.
Signature of Candidate.
Place…………………… Date ………………… (To be filled by the Returning Officer).
Serial No. of nomination paper ………………………………….
This nomination paper was delivered to me at ………… (Place) at …………………………………………. (hour) on ……………… (date) by the ……………………………………. *candidate/proposer.
Date…………………………… Returning Officer (Decision of the Returning Officer accepting or rejecting the nomination paper).
I have examined this nomination paper in accordance with law and decide as follows:— Date ………………………… Returning Officer _________ The nomination paper of the above candidate has neither been rejected nor he has withdrawn his candidature and therefore ……………………………… (name of symbol) is hereby allotted.
Date ……………………… Returning Officer _________________________________________________________ 75 RECEIPT FOR NOMINATION PAPER AND NOTICE OF SCRUTINY AND WITHDRAWAL (To be handed over to the person presenting this nomination paper) Serial No. of nomination paper ………………………..................
The nomination paper of………………………… a candidate for election of or *member/Pradhan/Up-Pradhan of Gram Panchayat, Member of Panchayat Samiti/member of Zila parishad from………...… …………………………………..……………………………………….
..................…….. constituency of ……………………………………… Gram Sabha .........……………….………………… Constituency of Panchayat Samiti …….............………………………….……………… Constituency of ……………………….............Zila Parishad delivered to me at my office at ..............……………….……………… (hour) on………………………………... (date) by the *candidate/proposer.
All nomination papers will be taken up for scrutiny at ……………… ……………………….……………. (hours) on …………………… (date) at ……………… (place).
The candidature may be withdrawn upto ……………………….
(hours) …………………………………………. (date). The symbol may be allotted immediately after the expiry of time fixed for withdrawal.
Returning Officer Date ………………… _____________________________ *Score out the words not applicable.
_______________ 1 [FORM-18-A [see rule 35 (2)] No Dues Certificate Office of the Gram Panchayat/Panchayat Samiti/ Zila Parishad ………………... District………..
Certified that no arrears of tax imposed by the Panchayat or arrears of any kind due to the Sabha, Samiti or Zila Parishad or retained amount which forms the part of Sabha, Samiti or Zila Parishad fund are due from Sh/Smt/Kumari ………………………………….…..
S/o/D/o/W/o Sh.............................................................Resident of Gram 1 Form 18-A ins. vide Not. No. PCH-HA(1)18/2008-I dated 12 th December, 2013, published in R.H.P. dated 27.12.2013 at pages 5356-5359.
76 Panchayat…………………………Village ...………………………Post Office………………………Development Block …..……………… Distt………………….., Himachal Pradesh as per the Panchayat record.
Secretary, Zila Parishad/Panchayat Samiti………… Secretary/Sahayak………….…………… Gram Panchayat………………………….
Development Block ……………….….… District ……...…………….…………..… Note:-*Certificate issued by the Gram Panchayat shall be countersigned by the Executive Officer, Panchayat Samiti.
** Strike out whichever is not applicable.‖.
______________ FORM-19 (See rule 36) FORM OF OATH OR AFFIRMATION TO BE MADE BY A CANDI- DATE FOR ELECTION TO THE GRAM PANCHAYAT AND PANCHAYAT SAMITI AND ZILA PARISHAD OF A STATE ― I, …………………………………………. having been nominated as a candidate to fill a seat in the Gram Panchayat ............................ /Panchayat Samiti …………………………………………. of Zila Parishad……………..
..…………………………………………. do swear in the name of God and solemnly affirm that I will bear true faith and allegiance to the Constitution of India as by law established and that I will uphold the sovereignty and integrity of India‖.
--------------------- FORM-20 (See rule 38) NOTICE OF NOMINATION Election to the Gram Panchayat/Panchayat Samiti/Zila Parishad …….
…………………………. from the ……………......................... Constituency.
Notice is hereby given that the following nominations in respect of the above election have been received upto 3.00 P.M. today. . . . . . . . . . . . .. . .
Sl. No. of nomination paper Name of Candidate Name of father/husband Age of Candidate Address 1 2 3 4 5 77 Seat/Office for which candidate is nominated Particulars of caste /tribe of candidate belonging to Scheduled Caste /Tribe Sl. No. of candidate in electoral roll Name of propo ser Serial No. of Proposer in the electoral roll 6 7 8 9 10 Place …………………………. Returning Officer Date …………………………..
________________________________ *Strike off the inappropriate alternative.
FORM-21 [See rule 39 (8)] LIST OF VALIDLY NOMINATED CANDIDATES Election to the Gram Panchayat/Panchayat Samiti/Zila Parishad …….
…………………………………. from ………………………. Constituency.
Sl.
No.
Name of candidate Name of *father/husband Address of candidate Seat/Office for which candidate is nominated 1 2 3 4 5 Place ………………………….. Returning Officer Date …………………………… ________________________________ *Strike off the inappropriate alternative.
FORM-22 (See rule 40) NOTICE OF WITHDRAWAL OF CANDIDATURE Election to.................................................................
*Constituency No. ……………………………… of ZiIa Parishad …………...
*Constituency No. ……………………..…. of Panchayat Samiti .....................
*Pradhan/Up-Pradhan of Gram Panchayat .........................................................
To 78 The Returning Officer, ………………………………… .
I, …………………………………………. son/daughter/wife of …….
………………………………….. a candidate validly nominated at the above election do hereby give notice that I withdraw my candidature.
Place ……………………….. ……………………………………………….
Date ………………………... Signature of validly nominated candidate.
This notice was delivered to me at my office at. . . . . . . . . . . . . . . . . . .
…………………………. (hour) on ……………………………………. (date) by …………………………………… (name) the candidate/candidate‘s proposer/candidate‘s election agent.
Date ………………………. ……………………………………… Returning Officer _____________________________ *Strike out which is not applicable.
RECEIPT FOR NOTICE OF WITHDRAWAL (To be handed over to the person delivering the notice) The notice of withdrawal of candidature by Shri/Sushri. …………..
……………………………………… a validly nominated candidate at the election to the ……………………………………… was delivered to me by the candidate/candidate‘s proposer/candidate‘s election agent(*) at my office at ……………………………………… (hour) on ………………. (date).
Date ………………………….. ……………………………………… Returning Officer.
----------------------------------------- *Strike out which is not applicable.
-------------------- FORM-23 [See rule 40(3)] NOTICE OF WITHDRAWAL OF CANDIDATURE Election to the Gram Panchayat/Panchayat Samiti/Zila Parishad …… …………………………………………… from.................................................
Constituency.
Notice is hereby given that the following candidate/candidates at the above election have withdrawn his candidature/their candidatures today:- Name of candidate Address of candidate Seat/Office for which candidature has been Remarks 79 withdrawn 1 2 3 4
1.
2.
3.
4.
5.
etc.
Date …………………………. …………………………… Place ………………………… Returning Officer --------------------------- FORM-24 [See rule 41 (1)] LIST OF CONTESTING CANDIDATES Election to the Gram Panchayat/Panchayat Samiti/Zila Parishad. . . . .
……………………………………….from …………………………………… Constituency.
Sl. No. Name of Candidate Address of Candidate Symbol allotted 1 2 3 4 Date ……………………… Signature …………………………..
Place ……………………… Returning Officer --------------------- FORM 25 (See rule 43) FORM OF APPOINTMENT OF ELECTION AGENT I, ……………………………………………………………………… a candidate for election of- *Member from Constituency …………………………………… 80 Gram Panchayat ……………………………… (Block) …………………… *Pradhan/Up-Pradhan Gram Panchayat ……………………………… Block ………………………………………).
*Member of Panchayat Samiti from Constituency No. ……………….
of Panchayat Samiti…………………………........................................
*Member of Zila Parishad from Constituency No. ………………….
to be held on ……………………………………… hereby appoint Shri/Sushri. …………………………………………………..… as my ………………… (Name of the agent) 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.
____________________________ *Strike out which is not applicable.
------------------- FORM-26 (See rule 44) APPOINTMENT OF POLLING AGENT Election to- *Member from Constituency ………………………….. of Gram Panchayat …...………………………………………………………....
*Pradhan, Gram Panchayat ……………………………………… *Up-Pradhan, Gram Panchayat ...........................................................
*Member of Panchayat Samiti from Constituency No. ………..........
*Member of Zila Parishad from Constiuency No. ………………… of Zila Parishad.............................................. ……………………………..
81 I, …………………………. a candidate/the election agent of Shri/Sushri …………………………. who is a candidate at the above election do hereby appoint ………………………….…………………………. (Name and address) ………………………….……………………………………….
as a Polling Agent to attend Polling Station No. …………………………. at ………………………….………………………….
Place ………………………… …………………………… Date …………………………. Signature of Candidate/Election Agent.
I agree to act as such Polling Agent. Place. . . . . . . . . . . . . . . . . . . .
Place ………………………… …………………………… Date …………………………. Signature of Polling Agent.
DECLARATION 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 Himachal Pradesh Panchayati Raj Act, 1994 or Rules made thereunder.
………………………….……… Signature of Polling Agent.
Signed before me.
Place ………………………… …………………………….
Signature of Presiding Officer.
Date ………………………….
____________________________ *Strike out which is not applicable.
------------------ FORM-27 (See rule 45) APPOINTMENT OF COUNTING AGENT Election to- *Member of Constituency ……………….. Gram Panchayat ………………… ………………………………………………………………………………….
*Pradhan, Gram Panchayat …………………………………………………….
82 *Up Pradhan Gram Panchayat ………………………………………………… *Member of Panchayat Samiti from Constituency No. ………………………..
of Panchayat Samiti …………………………………………………………… *Member of Zila Parishad from Constituency No. …………………………….
I ………………………………. a candidate/the election agent of Shri/Sushri. ………………………………… who is a candidate at the above election do hereby appoint …………………………………. (Name and address) …………………………………………….. as a Counting Agent to attend Polling Station No. ………………………….. at ……………………… Place ……………………….. ……………………………………… Date ………………………... Signature of Candidate/Election Agent.
I agree to act as such Counting Agent.
Place ……………………….. ……………………………………… Date ………………………... Signature of Counting Agent.
DECLARATION OF COUNTING AGENT TO BE SIGNED BEFORE THE RETURNING OFFICER I hereby declare that at the above election I will not do anything forbidden by the Himachal Pradesh Panchayati Raj Act, 1994 or Rules made thereunder.
……………………………………… Signature of Counting Agent.
Signed before me.
Place ……………………….. ……………………………………… Date ………………………... Signature of Returning Officer /Officer authorized by the Returning Officer.
____________________________ Strike out which is not applicable.
-------------- FORM-28 (See rule 49) DECLARATION OF RESULT IN UNCONTESTED ELECTION *Election of member from …………………………… constituency of ……...
…………………….. Gram Sabha.
83 *Election of Pradhan from …………………………………….. Gram Sabha.
*Election of Up-Pradhan from ………………………………… Gram Sabha.
*Election of Member of Panchayat Samiti ………………………………….
from ………………………………….. constituency.
In pursuance of the provisions contained in rule 42 of the Himachal Pradesh Panchayati Raj (Election) Rules, 1994, I declare that:- ……………………………………………………… (Name) ……………………………………………………… (Address) has been duly elected to fill a seat in the **…………………………………..
Place ……………………………….. (Signature) Date ………………………………... Returning Officer.
__________________________________________________ ** Here insert one of the following alternatives as maybe appropriate;
(1) Office of member from ………………. constituency of Gram Sabha.
(2) Office of Pradhan of …………………………………. Gram Sabha.
(3) Office of Up-Pradhan of ……………………………… Gram Sabha.
(4) Office of member of ………………………………….. Panchayat Samiti from ………………………………. ……………constituency.
(5) Office of member of ……………………………….. Zila Parishad from ……………………………………. constituency.
-------------------- 1 [FORM-28A [See rule 49-B] LETTER OF INTIMATION TO RETURNING OFFICER To The Returning Officer, Panchayat…………., Development Block……… District…………(H.P.)
1 Form-28A to Form-28E added vide Not. No. PCH- HA(1)- 18/2008, dated the 8 th September, 2010, published in Rajpatra, Himachal Pradesh, dated 10 th September, 2010 page . 4456-4467 .
84 Sir, I am a voter on election duty within the same Block and my name is entered at Sr. No.…… of the electoral roll for ward No…… of Gram Panchayat………………Panchayat Samiti…………. Zila Parishad ………….
I intend to cast my vote at the ensuing elections to the said Panchayats from ward No……… of Gram Panchayat……………….
Yours faithfully, Place…………….
Date…………… __________ FORM-28B [See rules 49-D(1) (a), 49-E (2) and 73-A (3) & (6)] DECLARATION BY ELECTOR Election to the..........
(This side is to be used only when the elector signs the declaration himself) I hereby declare that I am the elector to whom the poll duty ballot paper bearing serial number............has been issued at the above election.
Signature of elector.
Date.............
Address...............
Attestation of signature The above declaration has been signed in my presence by...............(elector) who is personally known to me/has been identified to my satisfaction by..........(identifier) who is personally known to me.
Signature of Attesting Officer.
Signature of identifier, if any.....................
Designation................
Address.............
Date.......................
85 FORM-28C [See rules 49-D(1)(b) and 73-A (5)&(6)] COVER FOR POLL DUTY BALLOT PAPER (Put only one Ballot Paper) A.
NOT TO BE OPENED BEFORE COUNTING *Election of ..................(Name of office of Panchayat for which elections are to be held) from............ Constituency.
POLL DUTY BALLOT PAPER Serial number of ballot paper……… *Appropriate particulars of the election to be inserted here.
FORM-28D [See rules 49-E(1)(c) and 73-A(5)] LARGE COVER FOR POLL DUTY BALLOT PAPERS B. ELECTION-IMMEDIATE POLL DUTY BALLOT PAPER COVER NOT TO BE OPENED BEFORE COUNTING To The Returning Officer For election of ..................(Name of office of Panchayat for which elections are to be held) from............ * Constituency.
Signature ……………...........
of sender ...........…………… 86 *Returning Officer to insert here the name of the appropriate Constituency of the Gram Panchayat.]
___________ FORM-28E [See rules 49-E(1)(d) and 49-G(1)] INSTRUCTIONS FOR GUIDANCE OF ELECTORS (To be used at an election to the Panchayats) Election to the*...........from the..............................…………………………… The persons whose names are printed on the ballot paper sent herewith are candidates at the above election. Record your vote by placing clearly a mark opposite the name of the candidate to whom you wish to cast your vote.
The mark should be so placed as to indicate clearly and beyond doubt to which candidate you are casting your vote. If the mark is so placed as to make it doubtful to which candidate you have cast your vote, your vote will be invalid.
The number of members to be elected is one. Please remember that you have only one vote. Accordingly you should not vote for more than one candidate. If you do so, your ballot paper will be rejected.
Do not put your signature or write any word or mark any mark, sign or writing whatsoever on the ballot paper other than the mark required to record your vote.
After you have recorded your vote on the ballot paper, place the ballot paper in the smaller cover marked 'A' sent herewith. Close the cover and secure it by seal or otherwise.
You may then sign the declaration in Form 28-B.
After your declaration has been signed and your signature has been attested, place the declaration in Form 28-D as also the smaller cover marked 'A' containing the ballot paper in the larger cover marked 'B'. After closing the larger cover, deliver it to the Returning Officer or the Officer authorized in this behalf by the State Election Commission personally.
You have to give full signature in the space provided on the cover marked `B'.
________________________________________________ * Appropriate particulars of the election, to be inserted here.
87 You must ensure that the cover is delivered to the Returning Officer or the Officer authorized in this behalf by the State Election Commission before**....................**on....................................
Please note that —
(i) if you fail to get your declaration attested or certified in the manner indicated above, your ballot paper will be rejected; and
(ii) if the cover reaches the Returning Officer or the Officer authorized in this behalf by the State Election Commission after**.........................on the**........... ......................your vote will not be counted.
______________________________________ *(Here specify the hour and date fixed for the commencement of counting of votes).]
FORM-29 [See rule 52(3) and (66)] BALLOT PAPER ACCOUNT Election to- *Member of Gram Panchayat ………………………… Contituency No.
…………………………………………..
*Pradhan/Up-Pradhan Gram Panchayat ……………………………………….
*Member of Panchayat Samiti from Constituency No. ……………………….
*Member of Zila Parishad from Constituency No. …………………………… Polling Station No. …………………………………………………………….
1. Number of ballot papers received by the Presiding Officer at the polling Station ……………….
……………..
2. Number of unused ballot papers ………………. ……………..
3. Number of ballot papers used (1+2=3) ………………. ……………..
4. Number of ballot papers used but not inserted in the ballot box.
……………….
……………..
(a) Number of ballot papers cancelled ………………. ……………..
88
(b) Number of tendered ballot papers ………………. ……………...
(c) Number of ballot papers cancelled for error in printing/writing.
(a+b+c) ……………….
……………...
5. Number of ballot papers in ballot boxes (3-4=5) ……………….
……………...
Place ……………………… Signature of Polling Officer.
Date ………………………..
FORM-30 (See rule 58) LIST OF CHALLENGED VOTES Particulars of Challenged votes during the election to ……………………….
………………………………………………..
* Member of Gram Panchayat …………………………………..Constituency.
No. ……………………………………………………………………………..
*Pradhan Gram Panchayat ……….....................................................................
*Up-Pradhan Gram Panchayat ...........................................................................
*Member of Panchayat Samiti from Constituency No. ……………………… of Panchayat Samiti *………………………………………………………………………………...
*Member of Zila Parishad from Constituency No. …………………………… Polling Station No. ……………………………………………………..
Place …………………………………..
Sl.
No.
Name of Challenger Name of voter Sl. No.
in voter list Name of Gram Panchayat to which voters‘ list pertains Present address of the person challenged Signature or thumb impression of the persons challenged 89 1 2 3 4 5 6 7 Name of identifier, if any Order of Presiding Officer Signature of challenger on receiving refund of deposit 8 9 10 Place ……………………. ……………………………………… Signature of Presiding Officer.
Date ..................................
*Strike out which is not applicable.
**In case of dearth of space, back page may be used.
---------------------- FORM-31 (See rule 63) LIST OF TENDERED VOTES Election to- Member of Gram Panchayat..................................
Constituency No. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Pradhan/Up Pradhan, Gram Panchayat........................
Member of Panchayat Samiti from Constituency No. ……………….
of Panchayat Samiti ……………….……………….………………….
Member of Zila Parishad ……………….………………………… from Constituency No. ……………….……………….……………….
Polling Station No. ……………….……………….
Sl.
No.
Name of voter Sl. No. in voter‘s list of Constituency No.
Name of Gram to which voter‘s list pertains Sl. No.
of tendered ballot paper Sl. No.
of the ballot paper issued to the person who has Signature or thumb impression of the person tendering Vote 90 already voted 1 2 3 4 5 6 7 Place …………………………… ……………………………………… Date.. ........................................... Signature of Presiding Officer.
_____________________________________ In case of dearth of space, back page may be used.
1 [FORM-32 (See rule 75) RESULT SHEET OF COUNTING FOR ELECTION OF MEMBER Gram Panchayat ………………………….. From Constituency No.
………………………………………………………………………… Polling Station No. ……………………. Place ………………………..
_________________________________________________________ Sl. No. Name of candidates No. of votes cast in favour of the candidate _________________________________________________________ 1 2 3.
_________________________________________________________
1.
2.
3.
4.
5.
6.
7.
8.
9.
* _________________________________________________________
(a) Total No. of valid votes …………………………………… 1 Forms 32, 33, 34, 35, 36, 37, 38, and 39 subs. vide No. PCH-HA(1)1/2015 the 28 th October, 2015 published in R.H.P. dated 6.11.2015, p. 5063-5083.
91
(b) Total No. of rejected votes ……………………………………
(c) Total No. of votes for NOTA……………………………
(d) Total No. of votes polled (a+b+c) …………………………
(e) Total No. of tendered votes ………………………………
(f) Remarks …………………………………… Place of counting ……………………… ………………………… Date .......................... Returning Officer (Gram Panchayat)/ Officer authorized by Returning Officer (Gram Panchayat) _______ FORM-33 (See rule 75) FORM OF RETURN OF ELECTION OF MEMBER GRAM PANCHAYAT ...................................................................
Election for member from Constituency No. ..................................
_________________________________________________________ Sl. No. Name of candidate No. of valid votes cast in favour of the candidate _________________________________________________________ 1 2 3.
_________________________________________________________ _________________________________________________________
(a) Total No. of valid votes ………………………………………
(b) Total No. of invalid votes...........................................................
(c) Total No. of votes for NOTA……………………………………
(d) Total No. of votes polled............................................................
I declare that (Name) ………………………………………..
Address………………………………………..
………………………………………………...
92 has been duly elected as a Member.
Signature of Returning Officer/Officer authorised by Returning Officer (Panchayat).
Dated the .…………………… day of ……………………. 20 ……..
_____________________________________ *In case of dearth of space, back page may be used.
____________ FORM-34 (see rule 75) RESULT SHEET OF COUNTING OF VOTES FOR PRADHAN/UP-PRADHAN Gram Panchayat ………………………………………… No. of Polling Stations included …………………………………………….
_________________________________________________________ Sl. No. Name of candidate No. of valid votes cast in favour of the candidate _________________________________________________________ 1 2 3.
_________________________________________________________ _________________________________________________________
(a) Total No. of valid votes ………………………………………
(b) Total No. of rejected votes...........................................................
(c) Total No. of votes for NOTA……………………………………
(d) Total No. of votes polled (a+b+c) ................................................
(e) Total No. of tendered votes …………………………………....
Place of counting.............. Returning Officer/ Officer Date ………….................. authorised by Returning Officer.
____________________________________ *In case of dearth of space, back page may be used.
____________ 93 FORM-35 (See rule 75) FORM OF RETURN OF ELECTION FOR PRADHAN/UP- PRADHAN GRAM PANCHAYAT ........................................................
Election of Pradhan/Up-Pradhan………………………… _________________________________________________________ Sl. No. Name of candidate No. of valid votes cast in favour of the candidate _________________________________________________________ 1 2 3.
_________________________________________________________
1.
2.
3.
4.
5.
6.
7.
*______________________________________________________
(a) Total No. of valid votes ………………………………………
(b) Total No. of invalid votes...........................................................
(c) Total No. of votes for NOTA……………………………
(d) Total No. of votes polled (a+b+c) .............................................
(e) Total No. of tendered votes …………………………………..
I declare that- (Name) …………………………………………… Address …………………………………………...
……………………………………………………… has been duly elected.
Signature of Returning Officer(Panchayat)/ Place: Officer authorized by Returning Officer.
Dated the …………………………….. day of …………… 20 .
___________________________________________________ In case of death of space, back page may be used ___________ 94 FORM-36 (See rule 75) RESULT SHEET OF COUNTING OF VOTES IN THE ELECTION OF PANCHAYAT SAMITI _________________________________________________________ Sl. No. Name of candidate No. of valid votes cast in favour of the candidate _________________________________________________________ 1 2 3.
_________________________________________________________
1.
2.
3.
4.
5.
6.
7.
8.
* _________________________________________________________
(a) Total No. of valid votes ……………………………………
(b) Total No. of rejected votes.........................................................
(c) Total No. of votes for NOTA………………………………
(d) Total No. of votes polled (a+b+c) .............................................
(e) Total No. of tendered votes ……………………………....
Place........................ Returning Officer/ Officer Date …………......... authorised by Returning Officer ______________________________________ *In case of dearth of space, back page may be used.
___________ 95 FORM-37 (See rule 75) FORM OF RETURN OF ELECTION OF MEMBER OF PANCHAYAT SAMITI Election of Member of Panchayat Samiti from Constituency No.
…………………………………… of Panchayat Samiti ......................
_________________________________________________________ Sl. No. Name of candidate No. of valid votes cast in favour of the candidate _________________________________________________________ 1 2 3.
_________________________________________________________ _________________________________________________________
(a) Total No. of valid votes ……………………………………….
(b) Total No. of invalid votes...............................................................
(c) Total No. of votes for NOTA………………………………….
(d) Total No. of polled votes ...............................................................
I declare that— (Name) ………………………………………..
Address ……………………………………… ………………………………………………..
has been duly elected.
…………………….
Returning Officer.
Dated the ………………………. day of …………20…..
_________________________________________ *In case of dearth of space, back page may be used.
96 FORM-38 (PART-I) (See rule 75) RESULT SHEET OF COUNTING OF VOTES OF MEMBER OF ZILA PARISHAD …………………..
Constituency No. .........................
BLOCK LEVEL COUNTING No. of Polling Stations of Zila Parishad constituency No. …….
………………………… situated in Block …………………………….
_________________________________________________________ Sl. No. Name of candidates No. of valid votes cast in favour of the candidate _________________________________________________________ 1 2 3.
_________________________________________________________
(a) Total No. of valid votes ……………………………………
(b) Total No. of rejected votes ……………………………………
(c) Total No. of votes for NOTA……………………………….
(d) Total No. of votes polled .…………...………………………
(e) Total No. of tendered votes …………………………………… Place of counting ……………………… Date ......................................... Returning Officer/ Officer authorized by Returning Officer, __________________________________________ *In case of dearth of space, back page may be used.
___________ FORM 38 (PART-II) (See rule 75) DISTRICT LEVEL COUNTING RESULT SHEET OF COUNTING OF VOTES OF MEMBER OF ZlLA PARISHAD……………………………………………….
Constituency No. ………………..
97 Sl. No Name of candidates No. of votes secured by candidate in Polling Stations situated in various Blocks Total Block........ Block. ....... Block.......
1. 2. 3. 4. 5. 6.
1.
2.
3.
4.
5.
6.
*
(a) Total No. of valid votes ……………………………………
(b) Total No. of rejected votes …………………………………
(c) Total No. of votes for NOTA…………………………………
(d) Total No. of votes polled (a+b+c) .............................................
(e) Total No. of tendered votes ………………………………… Place of counting ……………………………..
Dated ………………… Returning Officer/Officer authorized by Returning Officer _____________________________________________ *In case of dearth of space, back page may be used.
______________ FORM-39 (See rule 75) FORM OF RETURN OF ELECTION OF MEMBER OF ZILA PARISHAD Election of member of Zila Parishad …………………………… from constituency No. …………………………………… _________________________________________________________ 98 Sl. No. Name of candidate No. of valid votes cast in favour of the candidate _________________________________________________________ 1 2 3 _________________________________________________________ _________________________________________________________
(a) Total No. of valid votes ……………………………………….
(b) Total No. of invalid votes..............................................................
(c) Total No. of votes for NOTA………………………………….
(d) Total No. of polled votes ...............................................................
I declare that- (Name) ………………………………………..
Address ……………………………………… ………………………………………………..
has been duly elected.
…………………….
Returning Officer.
Dated the ………………………. day of ………20…….
______________________________________ *In case of dearth of space, back page may be used.]
1 [xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx] FORM-40 (See rules 85 and 86) 2 [OATH OR AFFIRMATION OF ALLEGIANCE TO THE MEMBERS OF PANCHAYAT SAMITI/ZILA PARISHAD OR ELECTION OF CHAIRMAN/VICE-CHAIRMAN OF PANCHAYAT SAMITI/ZILA PARISHAD] To Office-bearers of 1 Forms 39-A, 39-B and 39-C added vide Not. No. PCH-HA(1)18/2000-II dated 30- 12-2005 and deleted vide Not. No. PCH-HA(1)18/2008, dated 20.10.2008, published in Rajpatra, Himachal Pradesh dated 21.10.2008, p. 4318-4319.
2 Subs. for the words ―ELECTION OF CHAIRMAN/VICE-CHAIRMAN OF PANCHAYAT SAMITI/ZILA PARISHAD‖ vide Not. No. PCH-HA(1)12/2000 dated 26-12-2000 published in R.H.P. Extra., dated 27-12-2000, p. 4778-4780.
99 Panchayat Samiti/Zila Parishad.
In pursuance of sub-rule (2) of rules 1 [85/86] of the Himachal Pradesh Panchayati Raj (Election) Rules, 1994, I, ………………………………. (prescribed authority), do hereby give notice that a meeting of the Panchayat Samiti/Zila Parishad shall be held on ………………………………………… (date) at ……………………………………….. (hours) at the ……………… (place) for oath or affirmation of allegiance 2 [or] to elect Chairman/Vice- Chairman of Panchayat Samiti/Zila Parishad under section 79/90 of the Act.
Place …………………………. ……………………………………..
Dated ……………………….... Prescribed Authority.
_____________________________ *Strike out which is not applicable.
------------------- FORM-41 (See rules 85 and 86) FORM OF NOMINATION PAPER FOR ELECTION FOR THE OFFICE OF CHAIRMAN/VICE-CHAIRMAN OF ……………………… PANCHAYAT SAMITI AND …………………………. ZILA PARISHAD Name of Panchayat Samiti/Zila Parishad ……………………………...
Name in full of candidate ……………………………...
S1. No. of voter list with particulars thereof ……………………………...
Father‘s name/Husband‘'s name ……………………………...
Full address ……………………………...
3 [Name of proposer in full] ……………………………...
4 [Name of seconder in full] ……………………………...
Place .................................. ……………………………...
Date ……………………...
5 [Signature of Proposer and Secondar.]
1 Subs. for figures and sign ―83/84‖ vide Not. No. PCH-HA(1)12/2000 dated 26-12- 2000 published in R.H.P. Extra., dated 27-12-2000, p. 4778-4780.
2 Subs. for the word ―and‖ vide Not. No. PCH-HA(1)12/2000 dated 26-12-2000 published in R.H.P. Extra., dated 27-12-2000, p. 4778-4780.
3 Subs. for the words ―Name in full of proposer‖ vide Not. No. PCH-HA(1)18/2000- II dated 30-12-2005 published in R.H.P. Extra., dated 30-12-2005, p. 5647-5662.
4 Subs. for the words ― Name in full of seconder‖ vide Not. No. PCH-HA(1)18/2000- II dated 30-12-2005 published in R.H.P. Extra., dated 30-12-2005, p. 5647-5662.
5 Subs. for the words ―Signature of Proposer‖ vide Not. No. PCH-HA(1)18/2000-II dated 30-12-2005 published in R.H.P. Extra., dated 30-12-2005, p. 5647-5662.
100 DECLARATION OF CANDIDATE I hereby declare that I agree to the nomination and I am willing to serve.
Place …………………. ……………………………………… Date ………………….. Signature of Candidate.
FORM-42 (See rules 85 and 86) PUBLICATION OF RESULT OF CHAIRMAN/VICE-CHAIRMAN OF PANCHAYAT SAMITI/ZILA PARISHAD In exercise of the powers conferred by section 126 of the Himachal Pradesh Panchayati Raj Act, 1994 (No. 4 of 1994), I ………………………… ………………………………… (prescribed authority) ……………………….
…………………………………… District, hereby publish the election result of Chairman/Vice-Chairman of Panchayat Samiti/Zila Parishad Block ……...
……………………………………….. District ……………………………….
Sl.
No.
Name with name of Father/Husband and address Name of the office viz.
Chairman/Vice-Chairman Elected 1 2 3 4 ………………………..
Prescribed Authority.
Place ………………………….
District ………………………..
Dated ………………………… ---------------- FORM-43 [See rule 91(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 of *…………………………………………… ……………………………… and the particulars of such corrupt practice mentioned in paragraphs ……………………………….
of the Schedule annexed thereto are true to my knowledge;
101
(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 said petition and in paragraphs ………………………………………..
of the Schedule annexed thereto are true to my knowledge:
(c)
(d) etc.
Signature of Deponent.
Solemnly affirmed/sworn by Shri/Shrimati …………………………...
at this 1 […………………………………. day of ……………20…….. ] before me.
Executive Magistrate.
----------------------------------------------------------------------- *Here insert one of the following alternatives as may be appropriate:-
(1) Office of Member from …………………………………………… constituency of Gram Sabha ………………………………………
(2) Office of Pradhan of ……………………………… Gram Sabha.
(3) Office of Up-Pradhan of …………………………… Gram Sabha.
(4) Office of Member of ……………………….….. Panchayat Samiti from ……………………………….. constituency.
(5) Office of Chairman of …….……. Panchayat Samiti/Zila Parishad.
(6) Office of Vice-Chairman ………………………………………….
Panchayat Samiti/Zila Parishad.
**Here specify the name of the corrupt practice.
--------------- 2 [FORM-44 [See rule 92 (1) and 92 (3)] FORM FOR MAINTENANCE OF DAY-TO-DAY ACCOUNT OF ELECTION EXPENDITURE AND SUBMISSION THEREOF 1 Substituted for the for the signs, words and figure "…….day of 19… vide Not. No.
PCH- HA(1)- 18/2008, dated the 8 th September, 2010, published in Rajpatra, Himachal Pradesh, dated 10 th of September, 2010 page . 4456-4467.
2 . Form-44 to Form-47 added vide Not. No. PCH-HA(1)18/2000-II dated 30-12-2005 published in R.H.P. Extra., dated 30-12-2005, p. 5647-5662.
102
1. Name of the Panchayat ……………………………………………
2. Name of the candidate …………………………………………….
3. Number and name of the constituency ……………………………
4. Date of filing of nomination ………………………………………
5. Date of declaration of result ……………………………………… Sl.
No.
Date of expenditure Nature of expenditure Amount of expenditure Date of Payment Name and address of Payee Paid Outstanding 1 2 3 4 5 6 7 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 Remarks 8 9 10 11 Certified that this is a true copy of the account kept by me/my election agent.
Signature of the candidate.
Form-45 [See rule 92 (3)] DETAILS OF ELECTION EXPENSES
1. Name of the Panchayat ………………………………………………
2. Name of the candidate ………………………………………………
3. Number and name of the constituency ………………………………
4. Date of filing of nomination …………………………………………
5. Date of declaration of result ………………………………………… It em o f ex p en d it u re S o u rc es f ro m w h er e m o n ey p ro cu re d A m o u n t o f ex p en d itu re D at e (s ) o f p ay - m en t M o d e o f P ay m en t E v id en ce o f p ay m en t en cl o se d w it h th e ac co u n t R em ar k s 1 2 3 4 5 6 7 103
1. Expenditure on security deposit.
2. Expenditure on purchase of copies of electoral rolls.
3. Expenditure on printing of manifesttos, posters, hand bills etc.
4. Expenditure on pasting of posters.
5. Expenditure on wall writing and publication of advertise-ments.
6. Hiring charges of places for public meetings, pandals etc.
7. Hiring charges of loudspeakers for public meetings.
8. Hiring expenditure on account of vehicle repairs, petrol, oil and lubri-cants, repairs etc. by the candidate.
9. Hiring charges, repairs and petrol, oil and lubri-cants on vehicle used by the election agent/ polling agent.
10. Miscellane-ous expenses other than those listed above.
Signature of the candidate Form-46 [See rule 92 (3)] FORM OF DECLARATION Before the District Election Officer (Panchayat) ……………………..
Constituency ………………………. of …………….. (Name of Panchayat).
104 Declaration of Shri/Smt./Km. ………………………………….. son/ wife/daughter of Shri. ………………………………..
I, ………………………………… son/wife/daughter of Shri. ……… …………………………. aged ………….. years …………… resident of …………………………… do hereby solemnly affirm and declare as under:-
1. That I was a candidate at the general election/bye-election to the constituency of ………………………. (Name of the Panchayat), the result of which was declared on …………………………..
2. That I/my election agent kept a separate and correct account (running into ……. Pages) of all expenditure in connection with the above election incurred or authorized by me or by my election agent between …………………… (the date of nomination) and ………………….. (the date of declaration of result thereof), both days inclusive.
3. That the said account was maintained in the Form prescribed under rule 92 of the Himachal Pradesh Panchayati Raj (Election) Rules, 1994 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 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 and that nothing is false and nothing material has been concealed.
Deponent.
Solemnly affirmed by …………….
on ……………… this day of 20… before me.
Signature/Seal of the District Election Officer (Panchayat), District ……………….., Himachal Pradesh.
_____________ Form-47 [See rule 92 (4)] ACKNOWLEDGEMENT The detailed account of the election expenses and the supporting declaration on the prescribed Forms in respect of Shri. ……………………….
(contesting candidate) from ……………… (Constituency) result of which was declared on …………………….. (date) filed by him on ………………..
(date) has been received by me today the ……………………. (date) of (month) …………….. (year).
105 District Election Officer (Panchayat), District ……….., Himachal Pradesh.]
________________ __________________________________ (R.H.P. Extra., dated 8-2-1995, p.764-829)