Page 58 - election 2018 sg currection pdf

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FORM

PART – I

Record of Paper Seals used at Election to ……………………………Constituency …………….Polling Station No………………………….

………………………………….

Serial Serial No. of Paper
Serial No. of Box used Ballot Box No. (engraved) Remarks
No. seal used

1 2 3 4 5

1

2

PART – II

Account of Paper Seals

1. Serial numbers of paper seals supplied from Sl. No…… to
Signature of Polling Agents
Sl. No……………

2. Total No. Supplied……………… 1.

3. Number of Paper seals used …………… (Sl.. Nos. 2.

……………………….)

4. Number of unused paper seals returned to Panchayat 3.
Returning Officer (Deduct item 3 from item 2) 4.

5. Serial No. of damaged paper seals, if any …….

Date ………………….

Place ……………….. Signature of Presiding Officer