FORM 2

[See Rule 12(1)]

Nomination paper

Election of Councillors to the Corporation of the City of ………………….. from ………………………… *ward.

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

Candidates Name :

His/Her father's name/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) or /(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

(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 word not applicable
** Strike off the inappropriate alternative
+ Score out the clause not applicable.

Decision of the Returning Officer
Accepting or rejecting the Nomination paper

I have examined this nomination paper in accordance with Rule 12 of the Karnataka Municipal Corporation (Election), Rules 1979 and decide as follows.

Date	:	Returning Officer

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

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

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

All nomination papers 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.