| Form No.1 | Notification calling for names of candidates for the office of Members of Parishad. |
| Form No.3 | Receipt for deposit amount. |
| Form No.3-A | Receipt for deposit of objection fee. |
| Form No.4 | Nomination Paper |
| Form No.5 | Declaration of result for uncontested candidate |
| Form No.6 | List of validly nominated candidates for election as the Member of Parishad |
| Form No.7 | Statement showing the election symbols allotted to the candidates for the election of the Member of Parishad. |
| Form No.8 | List of validly nominated/final list of contesting candidates for election as the Member of Parishad |
| Form No.9 | Notice of Withdrawal |
| Form No.10 | Ballot Paper |
| Form No.11 | Ballot Paper Account |
| Form No.11A | Result of counting of votes for election to the office of the Member. |
| Form No.12 | Result after counting of votes for election to the office of the Member of Parishad. |
| Form No.13 | Notice for first meeting |
| Form No.14 | Notice calling for nomination of candidates for the office of the President/ Vice-President, Zilla Parishad. |
| Form No.15 | Nomnation paper for election of President / Vice-President Zilla Parishad. |
| Form No.16 | Notice for election of Vice-President |
| Form No.17 | Authorisation of persons to sponsor names of the Party’s candidates for allotment of symbols. |
| Form No.18 | Sponsoring of candidates |
[See rule 4 (A)]
Notification calling for names of candidates for the office of Members of Parishad of ……………………………… Zilla Parishad of ..……………………
Notice is hereby given that -
(1)an election is to be held for the office of every Members of Parishad of ………………………………………….. Zilla Parishad.
(2)Forms of nomination papers may be obtained from the office of the Officer specified in serial No. 6 between the hours of ………………………… and …………………..on ………………………………….(date) at …………………………..( place).
(3)Nomination papers may be delivered between the hours of 11 in the morning and 3 in the afternoon by a candidate or his proposer or seconder to the office specified below, at his office on any date not later than …………………day of ………..
(4)The nomination papers will be taken up for scrutiny at ………………….hours on …………………………..(date) at ……………………….. (place).
(5)Notice of withdrawal of candidature may be delivered by a candidate, to the office specified 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………………………………….
Date ………………
Place ………………. Election Officer
[See rule 12 (3)]
Receipt for deposit amount
(Office copy) No………………Dated…………… Received from Shri………………… Rs. …………………….. (Rupees……………………………. …………………………………..) on account of security deposit for candidature for the office of the member of Parishad of …………………Zilla Parishad Place………………. Election Officer
|
(Depositor’s copy) No………………Dated…………… Received from Shri …… …………. Rs. …………………….. (Rupees…………………………. …………………………………..) on account of security deposit for candidature for the office of the member of Parishad of …………………Zilla Parishad Place………………. Election Officer
|
[See rule 31 (5)]
Receipt for deposit of objection fee
No ………………………………………………….Dated …………………………..
Received from Shri/Shrimati ………………………………………………………….
Rs. …………………………………(Rupees …………………………………) on
account of objection fee being forfeited during election to ………………….Parishad
Constituency.
Polling Station…………………….. Presiding Officer
[See rule 12 (10)]
Nomination Paper
ELECTION TO THE ZILLA PARISHAD OF …………………………DISTRICT
Candidate’s name …………… ………………………….
Father’s/Husband’s name ………………………………..
His/Her postal address ……………………………………
His/Her name is entered at Serial No. ………………… of the electoral roll
for the …………………………………………………..Parishad Constituency.
My name is …………………………………………and it is entered at Serial No………. ……. of the electoral roll for the ……………………………..Parishad Constituency.
Date ……………………. Signature of the proposer
My name is ………………………………………….and it is entered at Serial No. ……of the electoral roll for the ……………………………… Parishad Constituency.
Date ……………………… Signature of the seconder
(a)that I have completed …………………………………………….years of age
*(b)that I am (set up) at this election by the …………………………………. Party
(c ) that the symbols have chosen are, in order of preference (i)……………………………(ii) ……………………. and (iii)…………………….
(d)that my name and my father’s/husband’s name have been correctly spelt out above
in…………………………………………………..(Name of the language).
(e)that to the best of my knowledge and belief. I am qualified and also not disqualified for being chosen to fill the seat in the Zilla Parishad of ……………………….(district)
I further declare that I am a member of the ……………………….** caste/tribe which is a scheduled ** caste/tribe of the State of ………………………. In relation to ………………………. (area) in that State.
Date …………… Signature of candidate
- Score out this paragraph, if not applicable
** Score out the word not applicable
(TO BE FILLED BY THE ELECTION OFFICER)
Serial No, of nomination paper…………………………………………………This
nomination was delivered to me at my office at ………………………(hour ) on ………..
(date) by "candidate/proposer".
Date................. Election Officer
Decision of Election Officer accepting or rejecting the Nomination Paper
I have examined this nomination paper in accordance with the provisions of the Orissa Zilla Parishad Act 1991 and the rules made thereunder, and decide as follows:-
*Nomination Accepted/Rejected
Date…………………. Election Officer
*Score out the word not applicable
REASONS OF REJECTION Election officer
RECEIPT FOR NOMINATION PAPER AND NOTICE OF 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 from the ………………………………. Parishad Constituency was delivered to me at my office at ……………..(hour) on ……………….(date) by the *candidate/proposer. All nomination paper will be taken up for scrutiny at …………….(hour) on ………..(date) at …………………….(place).
Date……………………… Election Officer
[See rules 12 (11) and 14 (8)]
Declaration of result for uncontested candidate
I do hereby declare that Shri/Shrimati ………………………………….. has been elected uncontested as the Member of Parishad from ……………………….. Parishad Constituency of ……………………………………..Zilla Parishad.
Election Officer
{See rule14 (1) }
List of validly nominated candidates for election as the Member of Parishad for
………………. Parishad Constituency of…………..Zilla Parishad
Sl. No. |
Name and Description of candidate |
Address of candidate |
Political Party |
REMARKS |
1
2
3
4
5
6
7
8
9
10
--------------------------------------------------------------------------------------------------------------------------------------------
Date
Place
Signature of Election Officer
{See Rule 14 (3)}
Statement showing the election symbols allotted to the candidates for the election of the Member of Parishad of ……………………….Zilla Parishad
| Sl.No. (1) |
Name of the candidates (2) |
Symbols allotted (3) |
Election Officer
{See Rule 14 (5) and (7) }
List of validly nominated / final list of contesting candidates for election as the Member of Parishad for ………………Parishad Constituency ………………….. Zilla Parishad
Sl.No. |
Name and Description of
|
Address of candidate |
REMARKS |
1. |
2. |
3. |
4. |
1
2
3
4
5
6
7
8
9
10
-------------------------------------------------------------------------------------------------------------------------
Date
Place Election Officer
{See rule 14 (6) }
(Notice of Withdrawal)
Election to the……………………
To
The Election Officer
I……………… a candidate nominated at the above election do hereby give notice that I withdraw my candidature.
Place ………
Date……….
Signature of the candidate
This notice was delivered to me at my office at ………..(hrs) on …………….(date) by………………………..(Name) …………………………….
Election Officer
Date…………
Receipt of notice of withdrawn
(To be handed over to the person delivering the notice)
The notice of withdrawal of candidate by a candidate at the election to the …………………………….was delivered to me at my office ……………at…………..(hours) on ………. (date) ……………..
Election Officer
(See rule 18)
BALLOT PAPER
……………………………………Zilla Parishad Election to …………….. Parishad Constituency
Signature of the Presiding Officer
---------------------------------------------------------------------------------------------------------------------------------------------------------
Name of the Candidate Election Symbol
--------------------------------------------------------------------------------------------------------------------------------------------------------
{See rule 22 (v) }
Ballot Paper Account
Election to the Office of the Member of Parishad of ………………………………
Parishad Constituency of…………………Zilla Parishad…………………
Total number
Name of Polling Station ……………………
Date…………
Signature of the Presiding Officer
(See rule 37)
Result of counting of votes for election officer of the Member
Name of the Parishad Constitunecy…………………………….
Nameof the Zilla Parishad……………………………………….
| Sl.No. | Nameof the candidate | TotalNo.of valid Viotes cast in the polling station |
| 1. | 2. | 3. |
1
2
3
4
5
6
7
8
9
10
Total Number of ballot papers rejected………………………….
Total number of ballot papers found in the ballot box………….
Date……………..
Place……………
Signature of Presiding Officer.
[See Rules 39 and 52]
Result aftercounting of votes for election to the
Office of the Member of Parishad
Name of Parishad Constituency………………….
Name of the Zilla Parishad……………………….
| Sl. No. | Name of the Candidate | Total number of valid voters cast in all the polling stations |
1. |
2. |
3. |
1
2
3
4
5
6
7
8
9
10
_________________________________________________________________________________
Total number of ballot papers rejected ………………
Total number of ballot papers found in the ballot boxes of polling stations ……………
Shri/Smt. …………………………………………………………………………………….
Son/daughter/wife* of -------------------------------------------------------is declared to have been duly
Elected as Member/Parishad/Vice-President* of --------------------------------ZillaParishad Constituency.
Date………………
Place ……………..
Signature of Election Officer
* Strike out whichever is not applicable
[See rule 48,(1) (I)]
NOTICE
Notice is hereby given that the first meeting of the--------------------------------------
Zilla Parishad shall be held at the place mentioned below on-----------------------------------
(date) at --------------------(time)
PLACE OF MEETING
AGENDA……….. To elect the President of the Parishad
Election Officer
[See rule 48(1)(ii)]
Notice calling for nomination of candidates for the office of the *President/Vice-President of ----------------------------------------------------------------------Zilla Parishad.
Notice is hereby given-
TABLE
Designation of the Officer Location of Office
6. Election Officer
Place
Date
Election Officer
................Samiti
[See rule 49(I)]
Nomination paper for election of President/Vice-President _______________Zilla Parishad
We(name) (1) Proposer-------------------------------------------------
Seconder--------------------------------------------------
Members of Parishad doe hereby nominated Shri----------------------------son of/wife of
Shri -----------------------------------------of village----------------------------post office------------------
P.S.----------------------------------District-------------------------------and who is member of Parishad from
------------------------------Parishad Constituency as a candidate for election as President/ Vice-President
-------------------------------------Zilla Parishad
Signature of Seconder Signature of the Proposer
Date_____________ Date___________
I, the undersigned ----------------------------------------------------a person duly qualified for election as
above-------------------------------hereby record my willingness for being nominated of as a candidate
for the election.
Signature of the Candidate
Date------------------------------
ENDORSEMENT BY THE ELECTION OFFICER
Serial No.------------------------------------
This nomination paper was presented to me by ---------------------------------------------------------------------------------------------(name)------------------------------------------------(date and hour).
Date-------------------------
Place------------------------ Signature of the Election Officer
ORDERS OF THE ELECTION OFFICER
Accepted/Rejected
Reasons for rejection
Date
Place
Signature of the Election Officer
[See rule 55(1)]
NOTICE
Notice is hereby given that a meeting of the ---------------------------------------------------------Zilla Parishad shall be held at the place mentioned below on date--------------------------------------at-------------------------------------(time)
PLACE OF MEETING
AGENDA To elect the Vice President of the Parishad
N.B. *The Office of the Vice-President is reserved for Women members of the Parishad.
*Strike out if not applicable Election Officer
( See Rule 7)
To
The Secretary to the State Election Commission, Orissa, Bhubaneswar- 7
Sub : Zilla Parishad Election - Authorisation of persons to sponsor names of the Party's candidates for allotment of symbols etc.
Sir,
In pursuance of sub-rule (3) of rule 7 of the Orissa Zilla Parishad Election Rules, 1994, I do hereby authorise the following persons to sponsor candidates for the ensuing Zilla Parishad Elections and endorse his/her/their specimen signatures duly attested by me against each.
Name of the person(s) authorised to sponsor candidates on behalf (1) |
Zilla Parishad in respect of which he has been authorised (2) |
Specimen signature of the person authorised
(3) |
Attested of the signature by the Presidently / General Secretary (4) |
| 1. 2. 3. 4.
|
Yours faithfully, President/General Secretary of the State Level / National Political Party Name of the Party…………………. (Seal of the Party) |
||
NOTE - To be submitted in quadruplicate to the State Election Commission
[ See rule 14 (4)]
To
The Election Officer
In respect of ………………………..
Zilla Parishad Constituency.
Sir,
Having been authorised by the President / General Secretary of the State Level / National Political Party, namely .………………………………………………Party, I hereby give notice that the following person(s) has / have been sponsored by………………………………………..party as its candidate(s) at the ensuring Zilla Parishad Election and that ……………………………………
Symbol be allotted to him/her.
Sl.No. |
Name of the Zilla Parishad Constituency |
Name of the candidate sponsored by the party |
Father's/Husband's name of the candidate |
Address of the candidate |
1. |
2. |
3. |
4. |
5. |
| 1. 2. 3. 4. 5. |
||||
Yours faithfully, (Name and signature of the person who has been authorised by the state Level / National Political Parties to sponsor candidates ) |
||||
NOTE - This must be delivered to the Election Officer on or before the date and time fixed for scrutiny of nomination papers.