FORM 2

[See Rule 15(1)]

Nomination paper

Election of Councillors to the City Municipal Council/Town Municipal Council/ Town Panchayat of the City/Town of ………………….. from ………………………… *ward.

I nominate Sri/Smt ………………………………….as a candidate for election of Councillors to the City Municipal Council/Town Municipal Council/ Town Panchayat of the City/Town …………………………………….. from ………………………. * ward, reserved for Backward Classes (A) or (B) **/ Scheduled Castes / Scheduled Tribes/ Women.

Candidates Name :

His/Her father's/
husband's name :

Postal Address :

His/her name is entered at Sl.No …………………in part No……..………….. of the electoral roll for the ……..…………………. *ward.

My name is …………………………….. and it is entered at Sl. No……………. in part No………………..of the electoral roll for the …………………………… *ward.

Date	:	Signature of the Proposer

* Appropriate particulars of the election to be inserted here.
** Strike off the inappropriate alternative.

(To be filled by the candidate)

I, the above mentioned candidate assent to the nomination and hereby declare:

(a) That I have completed …………….. years of age.

(b) That I am a Woman.

(c) That I am a member of ……………….. Class/Caste/Tribe which is a Backward Class (A) or (B)**/Scheduled Caste/Scheduled Tribe of the State of Karnataka. A copy of the Backward Class (A)/(B)/ Scheduled Caste/Scheduled Tribe Certificate issued in my favour by the competent authority is enclosed.

+(d) That I am set up at this election by ………………………recognized/registered party.

(e) That the symbols I have chosen in the order of preference are:

(i) ………………
(ii) ………………. and
(iii) ………………..

Date	:	Signature of the Candidate

+ Score out the clause if not applicable,.

(To be filled by Returning Officer)

Serial number of nomination paper ………………………………….

This nomination was delivered to me at my office at ……………………(hour) on ………………..(date ) by the Candidate/proposer* …………………………..((Name)

Date	:	Returning Officer

* Score out the alternative not applicable
** Strike off the inappropriate alternative

Decision of the Returning Officer
Accepting or rejecting the Nomination paper

I have examined this nomination paper in accordance with Rule 15 of the Karnataka Municipalities (Election), Rules 1977 and decide as follows.

Date	:	Returning Officer

………………………………………Perforation……………………………………

Receipt for nomination paper and notice of scrutiny
(to be handed over to the prson presenting the nomination paper)

Serial number of the Nomination paper ……………………………………. The nomination paper of …………………….. a cancidate for election from ……………….. ward to the City Municipal Council/Town Municipal Council/Town Panchayat of the City of ……………………. Was delivered to me at my office at ……………………. (hours) on ………………………… (date) by the candidate/proposer.*

All nomination paper will taken up for scrutiny at …………. (hour) on ……….. (date) at ………………………….. (Place).

Date	:	Returning Officer

* Appropriate particulars of the election to be inserted here.
** Strike off the inappropriate alternative.