FORMS UNDER ORISSA FORMS UNDER ORISSA GRAMA PANCHAYAT ELECTION RULES 1965.

******************************************************

FORM NO.1	Electoral Roll for the Ward
FORM NO.2	Notice of publication of Electoral Roll.
FORM NO.3	Notice calling for names of candidates for Sarpanch
FORM NO 4	Nomination paper for election of Sarpanch / Naib-Sarpanch and Members of the Grama Panchayat
FORM NO.5	Notice of list of nominated candidates
FORM NO.6	Ballot paper for election of Sarpanch / Ward Member
FORM NO.7	Ballot Paper account
FORM NO.8	Result of counting of vote
FORM NO.8A	Result of counting of votes
FORM NO.8B	Result of counting of votes
FORM NO.9	Notice of Withdrawal
FORMNO.10	Ballot paper for election of Naib-Sarpanch / Member of S.C. / S. T
FORM NO.12	Notice
FORM NO.13	Statement showing division and reservation of wards
FORM NO.15	Statement showing offices of Sarpanch reserved for S.C. / S.T / Women
FORM NO.16	Claim application for inclusion of name
FORM NO.17	Objection to inclusion of name.

FORM NO. 1

[See Rule 7(4)]

Electoral roll for the Ward No……..of …………..Gramasasan, name of village ……………….Police station…………………..District………………name of the Assembly Constituency covering the Grama……………………

 

 

 

 

 

FORM No.2

[See Rule 5(3)]

Notice of publication of Electoral Roll in draft to the electors of the Ward……………………of …………………………………………..Grama Sasan, Police station…………………………………..District…………………Notice is hereby given that the electoral roll has been prepared in accordance with the provisions of Section 9 of the Orissa Grama Panchayats Act, 1964and a copy thereof is available for inspection at ………………………………If there be any claim for omission or incorrect writing of particulars in that roll, it would be lodged on or before ……………….

Every such claim should either be presented in my office or to………….

If sent by registered post the address given below so as to reach me not later than the aforesaid date.

The objections that may be received will be enquired into at………………………..(place) on ……………………..(date) at…………………..A.M./P.M. Persons filling objections are required to appear either in person or through authorised agent for purpose of the enquiry at the above place, date and time. No further notice will be given and the objection disposed of on merit in case of failure to attend.

Date ………………….

BACK

 

FORM NO. 3

[SeeRule 24]

 

Notice calling for name of candidates for the office of Sarpanch…………………………………………………Member of Ward No…………

Notice is hereby given that

1. An election is to be held of ………………………..Grama Panchayat for election of ……………………..Sarpanch

 

 

Ward Member for Ward No………………………..

2. Forms of nomination papers may be obtained at the office of the officer specified in serial No. between the hour of ………………..and ………………………..from………………………….(date)at……………..(place)
3. Nomination papers may be delivered between the hour of 11 in the morning and 3 in afternoon by a candidate or his proposer to the officer specified below, at ( place) the ……………………day of ……………..
4. The nomination papers will be taken up for scrutiny at ……………..hours……………………..(date) at…………………….(Place).
5. Notice of withdrawal of candidature may be delivered by a candidate, to the officer below at his office before…………………….on ……………..

TABLE

 

Designation of Officer, Location of Office

6. Election Officer
7. In the event of the election being contested, the poll will take place on ………………………….between the hours of …………………and ………….

Date…………………

FORM.No.4

[See Rule 29]

Nomination paper for election of Sarpanch/ Naib-Sarpanch and members of the Grama Panchayat

Name of the Grama Sasan……………………..Ward No………………….Election to the …….……………….Grama Panchayat………………………..Police station

……………………………………………………District…………………………………

*To be filled by the proposer

*I hereby nominate…………………………………….as a candidate for election as ………………………………from the Ward No…………………..of ……………………………..Grama Sasan.

1. Full name of Proposer………………………………………………… Serial No. in Electoral Roll……………………………………
2. Full name of the Seconder……………………….Serial No. in Electoral Roll……………...
3. Name of candidate’s Father/Husband………………………………..
4. Full postal address of candidate…………………………………………
5. Electoral roll number of candidate

Signature or thumb impression                                                  Signature or thumb impression

Of Proposer                                                                            of Seconder

Date ……………………………..

( To be filled by the candidate)

I, the above-nominated candidate, assent to this nomination and hereby declare that I have completed………………………….year of age.

                 Signature or thumb impression of Candidate

Date.......................

Further declaration to be made by a Scheduled Caste or Scheduled Tribe candidate.

I, hereby declare that I am a member of……………………….Caste/Tribe which is a Scheduled Caste/Tribe of the State of Orissa relating to……………

(area) in State.

Date:…………………..                                                                                          Signature or thumb impression of Candidate

Serial No………………….of Nomination was delivered to me at 1(*)………..(hours) on…………………(date) by the candidate/proposer.

Date :……………………

ElectionOfficer

Decision of Election Officer accepting or rejecting the nomination paper.

I have examined the nomination paper in accordance with section ……………………………..of the Orissa Grama Panchayat Act, 1964 and decide as follows :-

Date :…………………..                                                                                Election Officer

Receipt for nomination paper for scrutiny

( To be handed over to the person presenting the nomination paper)

Serial No. of nomination paper………………….The nomination paper of…………………..a candidate for election for office of………………..Sarpanch…………………./Ward Member of Ward No……………………….of……………….(***)(name) Grama Sasan was delivered to me at …………………….(hour)on …………………(date) by the candidate /proposer. All nomination papers will be taken up for scrutiny at ………………..(hour) on……………….(date) at…………(Place).

Date :……………….                                                                 Election Officer

FORM NO.5

(See Rule 32)

Election to the……………………*GramaPanchayat………....…            Police-station…………………………………District...................

* Here insert Name of Grama Sasan

** Insert the number of the Ward.

Notice is hereby given that polling will take place on……………between the hours of……………………to ………………………at………………(place)and    counting will take placeon………………………….betweenthehoursof………………….to………………….at……

…………..(place).

In the case of election for Office of Sarpanch the reports of Presiding Officers of all Polling Stations of the Grama Panchayat will be scrutinised on ……………………………………….between the hours of …………………………..to …………………………….at …………………(place) and final results declared.

Election Offier

Date :……………….

Place………………..

 

BACK

 

FORM NO. 6

(See Rule –17)

Ballot paper for election of Sarpanch / Ward Member

FORM NO. 7

[See Rule 3 (e)]

Ballot Paper Account

Election to the ……………...............................................................................................................................

                                   Total No…………….....

1. Ballot paper received …………………………….

2. Ballot paper not used ……………………………

3. Ballot paper issued to the voter………………..

4. Ballot paper cancelled……………………………

Date :……………….

Signature of Presiding Officer.

FORM NO. 8

(See Rule 48)

Result of Counting of Votes

Name of the Grama Sasan ……………………Police-station …………………..

Ward No……………..

Distict………………………..

Shri/Km./Smt……………………………………………………………….

Son/daughter/wife of……………………………………………………………

has been duly declared to have been elected as…………………………………………….

Of ward No…………………………………..of …………………………………….Grama Sasan.

Date ……………………..                                                                      Signature of Presiding Officer

FORM NO. 8-A

(See Rule 50)

Result of counting of votes

Name of Grama Sasan……………………………

Ward No……………………………………………..

District ………………………………………………

Date …………………………….                                                                         Signature of the Presiding Officer

FORM NO. 8-B

(See Rule 51)

Result of counting of votes

Name of Grama Sasan…………………..

Name of Panchayat samiti………………

District ……………………………………..

Shri / Km. / Smt. ……………………………………Son/daughter/wife of ……………….

has been duly declared to have been elected as Sarpanch of …………………… Grama Panchayat.

          Date………………………..                                                                                  Signature of the Election Officer.

Form No.9

[See Rule 34]

Notice of Withdrawal

Election to the ………………………………………………….

To

The Election Officer,

1………………………………….a candidate nominated at the above election do hereby give notice that I withdraw my candidature

           Place …………………………                                                                                        Signature of Candidate               

           Date ……………………

This Notice was delivered to me at my office at ………………….

(hours) on …………………………(date) by………………………………….(name )

 

Date …………………………..                                                                                          Election Officer

 

RECEIPT OF NOTICE OF WITHDRAWAL

(To be handed over to the person delivering the notice)

The notice of withdrawal of candidature by…………………………..a candidate at the election to the………………………………….was delivered to me by the ………………………………..at my office at ………………….(hours) on ………………………(date)

FORM NO. 10

Ballot paper for election of Naib-Sarpanch/Members of Scheduled Castes/Tribes during general election of election of Naib-Sarpanch and Members during bye-elections.

FORM NO. 12

(See Rules 3 & 3A)

NOTICE

Notice is hereby given that a statement showing the number and extent of wards to ………………………………..Grama has been divided under section 8 of the Orissa Grama Panchayat Act, 1964 and reservation of such wards of the members of the Scheduled Caste, Scheduled Tribes, backward class of citizens and women under section 10 of the said Act has been prepared and a copy thereof if available for inspection at ……………………..   Objections if any may be filed with or sent so as to reach the undersigned not later than ……………………………….

 

COLLECTOR

 

FORM NO. 13

[ See rule 3(3)]

Statement showing division and reservation of wards

Name of the Grama Sasan                                                          Total No. of wards

 

Block                                                                                              Wards reserved

        District                                                                                         Men      Women     Total

S.C.

S.T.

B.C.

U.R.

FORM NO. 15

( See Rule 3-A)

Statement showing the offices of the Sarpanches in Grama Panchayats reserved for the Scheduled Castes, the Scheduled Tribes and Women.

 

Name of the Block ______________________District _________________

FORM NO. 16

[See Rule 6(3)]

Claim application for inclusion of name

To

The Electoral Registration Officer,

………………..Grama Panchayat

Sir,

I request that my name be included in the electoral roll for the above Grama Panchayat in Ward No. …………………………….

My name in full ………………………………………………..Sex…………………………..

My father’s /Mother’s / Husband’s Name ……………………………………..

Particulars of my place of residence are –

House No…………………………………..

Street / Mahala …………………………..

Town / Village …………………………….

Post Office…………………………………..

Police Station / Tahasil / Taluka / Mouza ……………………………….

District ………………………………………

I hereby declare that to the best of my knowledge and belief, -

(i) I am a citizen of India;

1. My age on the first day of January / April last was …………..years and …………………..months;
2. I am ordinarily resident at the address given above;
3. I have not applied for the inclusion of my name in the electoral roll for any other constituency;
4. My name has not been included in the electoral roll for this or any other constituency;

My name may have been included in the electoral roll in …………….State in which I was ordinarily resident earlier at the address mentioned below and if so, I request that the same may be excluded from that electoral roll :-

Place :…………………..                                      Signature or thumb impression

Date :…………………..                                              of claimant

 

BACK

 

FORM NO. 17

[See Rule 6 (3)]

Objection to inclusion of name

The Electoral Registration Officer,

……………………………….(Grama Panchayat )

Sir,

I object to the inclusion of the name of ……………………………………………….

at Serial No……………………………..in ward No. ………………….of the electoral roll for the following reason (s) :-

……………………………………

……………………………………

……………………………………

I hereby declare that the facts mentioned above are true to the best of my knowledge and belief :

My name has been included in the electoral roll for this Constituency as follows :-

Name in full …………………………………………Sex……………………………….

Father’s / Husband’s / Mother’s Name ……………………………………………

Serial No…………………………….

Ward No………………………………

Signature/thumb impression of objector

( Full Postal Address)

Date ……………………..

I am an elector included in the electoral roll in which the name objected to appear and my name is enrolled at serial No……………………………….in ward No…………………………….of the roll.

I support this objection and countersign it.

Signature of the Elector

( Name in full )