| Form - I | Preliminary Electoral Roll |
| Form - II | Notice to file claims and objections |
| Form -III | Notice to claim for correction of Registry Registration |
| Form -IV | Notice of objection to Registration |
| Form -V | List of Claims and Objections |
| Form -VI | Notice of application for Registration |
| Form -VII | Application for Registration |
| Form - VIII | Nomination Paper |
| Form - IX | Authorisation of persons to intimate names of candidates sponsored by political party. |
| Form X | Notice as to names of candidates sponsored by the political party |
| Form XI | List of nominations received |
| Form XII | List of Valid Nomination. |
| Form XIII | Ballot Paper |
| Form XIV | Tendered Votes List. |
| Form XV | Declaration of Personation. |
| Form XVI | List of Challenged Votes. |
| Form XVII | Form of Authorization to vote out side Polling Area. |
| Form XVIII | Ballot Paper Account |
| Form XIX | Return showing the result of Polling |
| Form No.XX | Declaration of Result. |
| Form XXI | Draft notification showing division of Wards and reservation of seats in the Municipalities |
| Form XXII | Final notification showing division of Wards and reservations of seats in the Municipalities |
| Appendix |
( See rule 4 )
District …………………Municipality /N.A.C./Corporation…………………………… ……………………… Subdivision………………………… Electoral Ward No……………Registration Unit (Ward)…………………………..
Serial No. (1) |
House No. (2) |
Name of elector with Father’s or husband’s Name (3) |
Age (4) |
|
.
[(See rules 7 and21 (3) (b)]
Notice to file claims and objections
The preliminary Electoral Roll of voters of Ward No……..of the Municipality/N.A.C./Corporation has been duly published for general information :-
Any person who is not less than 18(Eighteen) years of age on the date of this notice and is not otherwise disqualified to become a voter shall been titled to have his name entered in this roll.
Any person who claims to be entered in this roll and who is not entered in it or is entered in an incorrect place, or with in correct particulars may put in a claim to the Election Officer to have his name entered or the rolls corrected.
Any person whose name is on this register and who objects to the correctness of the entry or to the inclusion of his own name or the name of any other person whose name is on the roll may prefer an objection to the Election Officer.
Claims shall be preferred in Form III and objection in Form IV. Copies of the Forms will be supplied free of cost by the Election Officer on application.
Claims and objections may be presented in person or sent by post or by messenger. They shall in all cases reach the Election Officer at ………………………….(give address in details here) before the termination of office hours on the………………..
Presentation in person or delivery by messenger shall be during the office hours only.
Claims and objections which are not preferred in proper Form or are not received by the date and time aforesaid will be rejected.
All claims and objections received in time and in proper Form will be heard by Election Officer on ……………………..at ……………………(Place).
ElectionOfficer……….
Date…………………………
[See rule 8 (2)]
Notice to claim for correction of Registry Registration
To
The Election Office of …………………..
Municipality / N.A.C./Corporation
Sir,
I hereby given notice that I claim to have my name corrected/entered in the register of the electoral roll for the Ward No……………..of ……………..Municipality / N.A.C./ Corporation as follows :-
Name in full of claimant and father’s or husband’s name also number on the preliminary roll. (1) |
Address, Holding No., Mahals, Ward No.
(2) |
Age
(3) |
|
I declare that I attained the age of 18 (Eighteen years on ………………………and that I am ordinary resident (within the meaning of sections 19 and 20 of the Representation of the People Act, 1950) of Holding No………………….in ……………… Mahala ……………..Ward ……………..of …………………..Municipality/N.A.C./Corporation.
Yours faithfully
Signature of claimant
[See rule 8 (2)]
Notice of objection to Registration
To
The Election Officer of ………………
Municipality/N.A.C./Corporation
Sir,
I hereby give notice that I object to the name of the person/my name mentioned and described below being retained in the electoral roll for the electoral Ward No…………….of………………….Municipality/N.A.C./Corporation.
Name of person objected to (1) |
Electoral Ward and number in preliminary roll. (2) |
Nature of objection (3) |
|
Date………………….
Address-Holding No…………….Mahala………….Ward No………
and number in the Preliminary roll.
Yours faithfully
Signature of objector
(See rule 10)
(a)The following persons have put in claims to be registered as electors ( or to have the registry of their names corrected ) in the roll of electoral Ward No………………..of ………………….Municipality/ N.A.C./Corporation.
Municipality
|
Electoral Ward
|
Name of the Claimant and No. if any on the preliminary roll
|
Father’s or husband’s name
|
Address
|
Age
|
(1) |
(2) |
(3) |
(4) |
(5) |
(6) |
(b) The following objections have been received regarding entries in electoral roll for the electoral Ward No…………….. of…………………Municipality / N.A.C./Corporation.
Municipality
|
Electoral Ward
|
Name of Objector and number of roll
|
Name of persons objected to and number on roll |
(1) |
(2) |
(3) |
(4) |
(c) The following corrections have been made by the Election Officer of his own motion in the roll for the electoral Ward No……………….…of ………..Municipality /N.A.C./Corporation.
Municipality
|
Electoral Ward
|
Name and number of roll
|
Nature of correction
|
(1) |
(2) |
(3) |
(4) |
The above claims and objections will be heard and the above corrections considered by Election Officer on …………..at………………
Election Officer
[See rule 21 (3)(a)]
Notice of application for Registration
Notice is hereby given that the person named in column (1) below has applied for the inclusion of his name in the electoral roll for the Ward No……………………..the application will be heard by me at ………………………….at …………………………..A.M./P.M. on the …………………19
Name of applicant (1) |
Father’s or husband’s name (2) |
Address (3) |
Age (4) |
|
|||
[See rule 21 (3)(c)]
To
The Election Officer of ……………..
Municipality / N.A.C/ Corporation
Sir,
As I am duly qualified to be entered in the electoral roll of the Electoral Ward No…………………of ……………..Municipality/N.A.C./ Corporation, I hereby apply that my name may be entered in the electoral roll of the Ward No……………….. as follows :-
Name of applicant and applicants’ father or husband (1) |
Address, Holding No. Mahala and Ward No. (2) |
Age
(3) |
|
||
I declared that I …………………….have attained the age of (18) years and that my name is not entered in any other electoral Ward of this Municipality / N.A.C./ Corporation.
Yours faithfully
Signature
[See rule 25 (1) ]
1. Name or number of the Ward for :
which the candidate is nominated
(mention here whether the nomi-
nation is for a reserved seat, if any),
2. Full name of candidate :
3. Number of candidate on the :
electoral roll.
4. Father’s or husband’s name :
5. Age :
6. Address :
7. Community :
8.Full name of proposer
9. Number of proposer on the :
electoral roll
10. Signature of the proposer :
11. Full name of the seconder :
12. Number of seconder on the :
Electoral roll
13. Signature of the seconder :
14. Election symbol adopted :
by the candidate.
Candidate’s Declaration
I declare that I am twenty-one years of age as required under rule 25 and I am willing to stand for the election. I further declare that I have been sponsored for this election by the …………………..Party. I further declare that I will stand for the election as an independent Candidate. ( Strike out which is not necessary ).
Signature of the candidate
Endorsement by the Election Officer or other authorised person serial number…………………….…This nomination paper was presented to me by …………….at ………….on………………….
Signature of the Election Officer
Or other authorised person
Decision after scrutiny
Signature of the Election Officer
[ See rule 25 Note I ]
To
The Election Officer ………………………. Municipality
Subject-General Elections of Councillors to ………….Municipal Council- Allotment of Symbols – Authorisation of persons to intimate names of candidates.
Sir,
In pursuance of rule 25 (8) of the Orissa Municipal (Delimitation of Wards, Reservation of Seats and Conduct of Election) Rules, 1994, I hereby intimate that the following persons (s) has have been authorised by the party, which is a National Party/State of Orissa, to intimate the names of the candidates proposed to be sponsored by the party for the Election cited above –
Name of person authorised to send notice.
|
Name of office held in the party.
|
District(s)/Area(s)/ Municipalities in respect of which he has been authorised
|
(1) |
(2) |
(3) |
(i)……………………………(ii)…………………(iii)……………..
(i)……………………………(ii)…………………(iii)…………….
(i)……………………………(ii)…………………(iii)……………..
Yours faithfully
Place ……………….. President/Secretary
Date ………………… Of the State Level
Organisation of the
Political Party.
Name of the party
( Seal of the party )
"N.B. – This must be communicated to the Election Officer at least two days before the date fixed for scrutiny of nomination paper.
[See rule 25 Note 1 & 43(3)]
Notice as to names of candidates sponsored by the political party
To
The Election Officer…………………………….Municipality
Sub : General Election of Councillor to …………………Municipal Council sponsoring of candidates.
Sir,
In pursuance of rule 25(8) of the Orissa Municipal (Delimitation of Wards, Reservation of Seats and Conduct of Election ) Rules, 1994. I hereby give notice that the following person has been sponsored by …………………………………Party as its candidate at the ensuing General/Bye Election of Councillor to ………………………………….. Municipal Council.
Serial No.
|
Name of the Municipality
|
Name of the approved candidate
|
Father’s/ Husband’s name of approved candidate
|
Postal address of approved candidate
|
(1) |
(2) |
(3) | (4) | (5) |
Place………………..
Date :………………
Yours Faithfully
(Name and signature of the President or Secretary of the State Level Organisation of the Politial Party or of the Office bearer authorised in Form IX by the Political Party.)
N.B. – This must be delivered to the Election Officer at least one
day before the date fixed for scrutiny of nomination papers.
(See rule 28 )
List of nominations received on ……………(date ) for Ward No………..
Serial No.
|
Name of candidate
|
Father’s or husband’s name
|
Community
|
Occupation and address
|
Name of proposer
|
Name of seconder
|
(1) |
(2) | (3) | (4) | (5) | (6) | (7) |
Note : The nomination paper will be taken up for scrutiny at ………..
a.m./p.m. on the ……………………day of ……………….at ( Place)……..
Signature of the Election Officer or authorised person
[ See rule 30( 1)]
…………………………Municipality Ward No………………
Serial No.
|
Name of candidate.
|
Communities to which candidates belong .
|
Address of the Candidate.
|
(Symbol) as assigned to candidates.
|
Whether eligible for reserved seat.
|
(1) |
(2) | (3) | (4) | (5) | (6) |
Note – The poll will be taken on the ………………………day of 19……
between …………………………and …………………….at the Polling Station already notified.
Election Officer
[ See rule 43 (1) ]
…………………………Municipal Council Election Ward No…………
Serial No. of General (Distinguishing mark to be
Ballot Paper Reserved affixed by the
Polling Officer)
Name of the candidate (1) |
Election symbol allotted (2) |
[ See rule 50 (2) ]
Name of Polling Station…………………………………………………………
Name and number of Ward . (1) |
Name of elector. (2) |
Number on Electoral Roll . (3) |
Signatue of elector, if literate, or thumb impression of elector, if illiterate and address. (4) |
|
|||
Signature of Polling Officer
[ See rule 51 (2) ]
I, (Name )………………………………….hereby declare and undertake to prove that the person described below has, by apply for a ballot paper at this Polling Station, commit the offence of personation.
Description of the person
Name (1) |
Address (2) |
Signature or thumb impression. (3) |
|
||
Witness :
Signature of candidate or agent
1. ( Name and address ) ( Before me )
2. (Name and address)
Signature of Polling Officer.
[ See rule 51 (3) ]
Name of Polling station …………………………..
Signature Sheet No. ………………………….
Number of elector on electoral roll.
|
Name of elector
|
Signature of elector if literate or thumb impression of elector if illiterate.
|
Signature and address of identifier, if any
|
(1) |
(2) | (3) | (4) |
Order of Polling Officer ( in each case )
Signature of Polling Officer
Station …………………..
Date……………………….
{ See rule 52 }
Form of Authorisation to vote outside Polling Area
Certified that …………………………………………entitled to vote at ………………………………for Ward No……………………..has been employed in connection with the election for Ward No…………………..and is prevented from voting at the said station and that I have therefore authorised him to vote at ……………………
Signature of Election Officer
Station ……………………
Date ………………………
{ See rule 57 }
Statement of ballot paper sent by Polling Officer of……………….
Polling station of………………………..Municipality after the polling on …………………….19……………for the Ward No………………………..
Number received
|
Number in boxes
|
Number in packets under rule 52(2)(ii)
|
Number of tendered ballot papers rule 50
|
Number unused
|
Number spoiled
|
Remarks
|
(1) |
(2) | (3) | (4) | (5) | (6) | (7) |
Signature of Polling Officer.
[See rule 58(3) (c) ]
Return showing the result of polling for seat for Ward No………………Municipality…………………………
Polling Station …………………………Date of Polling……………………
Serial No.
|
Name of the candidate
|
No. of votes polled
|
No. of valid votes
|
No. of invalid votes
|
(1)
|
(2) | (3) | (4) | (5) |
Signature of the Election Officer
( See rule 60 )
I do hereby declare that Shri/ Shrimati ………………………has been duly elected for Ward No. ………………of …………………Municipality
Signature of Election Officer.
[ See rule 2-A(1)]
Draft notification showing division of Wards and reservation of seats in the Municipalities :
NOTIFICATION
In exercise of the powers conferred by sub-sections (3) and (3-A) of section 12 of the Orissa Municipal Act, 1950 (Orissa Act 23 of 1950) read with sub-rule (1) of rule 2-A of the Orissa Municipal ( Delimitation of Wards, Reservation of Seats and Conduct of Election ) Rules, 1994, notice is hereby given that the…………………Municipal Corporation / Municipal Council / Notified Area Council in the district of …………….shall be divided into …………. Wards as specified in Column (2) of the Statement I below with the description and boundaries of the said Wards against each in Columns (3) and (4) respectively thereof for the purpose of ensuing election of Councillors to the same and the Wards as specified in Column (2) of the Statement II below in which the seats reserved under section 11 of the said Act, shall be set assigned against each in Column (3) thereof.
Any objection or suggestion which may be received from any person interested in respect of the said draft notification on or before the date of expiry of the period of ten days from the date of publication of this notification will be considered. Objections or suggestions received after the said period shall not be taken into consideration.
STATEMENT I
Serial No.
|
Ward No.
|
Description of the Ward
|
Four side boundary of the Wards
|
(1) |
(2) | (3) | (4) |
STATEMENT II
Serial No.
|
Wards determined for reservation
|
Assignment for S.C., S.T.,S.C. Women, S.T. Women, Backward Classes of Citizens including their women and other women.
|
| (1) | (2) | (3) |
District Magistrate.............
TOP
[ See rule 2-A (5) ]
Final notification showing division of Wards and reservation of seats in the Municipalities
NOTIFICATION
Whereas the draft notification bearing No…………….dated the ……………..was published in From XXI of the Orissa Municipal ( Delimitation of Wards, Reservation of Seats and Conduct of Election ) Rules, 1994 inviting objections and suggestions from all persons interested in respect of the said draft notification showing the division of the area of the Municipal Corporation / Municipality/ Notified Area Council into Wards and reservation of seats thereof on or before the date of expiry of the period of ten days;
And whereas, objections or suggestions received within the period so specified have been duly considered;
Now, therefore, in exercise of the powers conferred by sub-section (3) of section 12 of the Orissa Municipal Act. 1950 ( Orissa Act 23 of 1950), the District Magistrate, …………after consulting the Council of ………………..Municipal Corporation / Municipality / Notified Area Council do hereby divide the area of the said Municipal Corporation / Municipality/ Notified Area Council into ……………….Wards as specified in column(2) of the Statement I below with the description and boundaries of the said Wards against each in columns (3) and (4)respectively thereof for the purpose of ensuing election of Councillors to the same and determine the wards as specified in column (2) of the Statement II below in which the seats reserved under section 11 of the said Act shall be set assigned against each in column (3) thereof.
STATEMENT I
Serial No.
|
Ward No.
|
Description of the Wards
|
Four side boundaries of the Wards
|
| (1) | (2) | (3) | (4) |
STATEMENT II
Serial No.
|
Wards determined for reservation
|
Assignment for S.C.,S.T., S.C. Women, S.T. Women, Backward Classes of Citizens including their women and other women.
|
| (1) | (2) | (3) |
District Magistrate……………………….