Appointment of proxy by classified service voter to give vote.

I ……………………………………….(name of the classified service voter) aged about ……………..s/o, d/o, w/o………………………. r/o presently working as ……………………..and posted at……………………….... am entitled to appoint proxy under sub-rule(2) of rule 27N of the Conduct of Election Rules, 1961. I hereby appoint……………..……………….. (name of the proxy) aged about…………. s/o,d/o, w/o…………………….. r/o…………….... as my proxy to give vote my behalf and in my name in……………….. Assembly constituency of the state/Union territory of ………………………….in which I am entitled to give vote under the Representative of people Act, 1951 (43 of 1951) and the rules made there under.

Note:-

(1) The person to be appointed as proxy shall be an ordinary resident in the constituency concerned and of not less than eighteen years of age and shall not be a person disqualified for registration as an elector in an electoral roll under section 16 of the Representation of the People Act, 1950(43 of 1950).

(2) The signature of the classified service voter and the proxy shall be made before a First Class Magistrate or Notary or the Commanding Officer of the Unit concerned who shall verify the signatures under his hand and seal. In case of First class Magistrate or Notary verifying the signature, he shall personally check the service identity card of the classified service voter to authenticate veracity of the classified service voter.

(3) Score out the word(s) which are not applicable

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Receipt of Form 13F for the appointment of proxy by classified service voter
(To be handed over to the person depositing the said form)

Serial No……………….

Received Form 13 F of Shri/Smt/Kum …………………………………..