III-1(a) Ex. (449—1)

No. 449]

CHENNAI, WEDNESDAY, DECEMBER 4, 2019

Karthigai 18, Vikari, Thiruvalluvar Aandu-2050

Part III—Section 1(a)

General Statutory Rules, Notifications, Orders, Regulations, etc.,

issued by Secretariat Departments.

NOTIFICATIONS BY GOVERNMENT

TAMIL NADU

GOVERNMENT GAZETTE

EXTRAORDINARY

PUBLISHED BY AUTHORITY

[Regd. No. TN/CCN/467/2012-14.

GOVERNMENT OF TAMIL NADU

[R. Dis. No. 197/2009.

2019

[Price: Rs. 18.40 Paise.

[ 1 ]

MUNICIPAL ADMINISTRATION AND WATER SUPPLY (ELECTION) DEPARTMENT

AMENDMENTS TO THE TAMIL NADU TOWN PANCHAYATS, MUNICIPALITIES AND

CORPORATIONS (ELECTIONS) RULES, 2006.

[G.O. Ms. No. 161, Municipal Administration and Water Supply (Election), 4th December 2019,

è£˜ˆF¬è 18, Mè£K, F¼õœÀõ˜ Ý‡´-2050.]

No. SRO A-43(b-1)/2019.

In exercise of the powers conferred by section 303 of the Tamil Nadu District Municipalities Act, 1920 (Tamil Nadu Act

V of 1920), section 347 of the Chennai City Municipal Corporation Act, 1919 (Tamil Nadu Act IV of 1919), section 431 of

the Madurai City Municipal Corporation Act, 1971 (Tamil Nadu Act 15 of 1971), section 430 of the Coimbatore City Municipal

Corporation Act, 1981 (Tamil Nadu Act 25 of 1981), read with section 8 of the Tiruchirappalli City Municipal Corporation Act,

1994 (Tamil Nadu Act 27 of 1994), section 8 of the Tirunelveli City Municipal Corporation Act, 1994 (Tamil Nadu Act 28 of

1994), section 8 of the Salem City Municipal Corporation Act, 1994 (Tamil Nadu Act 29 of 1994), section 8 of the Tiruppur

City Municipal Corporation Act, 2008 (Tamil Nadu Act 7 of 2008), section 8 of the Erode City Municipal Corporation Act,

2008 (Tamil Nadu Act 8 of 2008), section 8 of the Vellore City Municipal Corporation Act, 2008 (Tamil Nadu Act 26 of 2008),

section 8 of the Thoothukudi City Municipal Corporation Act, 2008 (Tamil Nadu Act 27 of 2008), section 8 of the Thanjavur City

Municipal Corporation Act, 2013 (Tamil Nadu Act 24 of 2013), section 8 of the Dindigul City Municipal Corporation Act, 2013

(Tamil Nadu Act 25 of 2013), section 8 of the Hosur City Municipal Corporation Act, 2019 (Tamil Nadu Act 10 of 2019),

section 8 of the Nagercoil City Municipal Corporation Act, 2019, (Tamil Nadu Act 11 of 2019) and section 8 of the Avadi City

Municipal Corporation Act, 2019 (Tamil Nadu Act 24 of 2019), the Governor of Tamil Nadu, after consultation with the Tamil

Nadu State Election Commission, hereby makes the following amendments to the Tamil Nadu Town Panchayats, Municipalities

and Corporations (Elections) Rules, 2006:-

AMENDMENTS.

In the said Rules,-

(1) in rule 2, in sub-rule (1), in clause (i), —

for the expression “the Thanjavur City Municipal Corporation Act, 2013 (Tamil Nadu Act 24 of 2013) in respect of

Thanjavur City Municipal Corporation; and

TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY

the Dindigul City Municipal Corporation Act, 2013 (Tamil Nadu Act 25 of 2013) in respect of Dindigul City Municipal

Corporation;”,

the expression “the Thanjavur City Municipal Corporation Act, 2013 (Tamil Nadu Act 24 of 2013) in respect of Thanjavur

City Municipal Corporation;

the Dindigul City Municipal Corporation Act, 2013 (Tamil Nadu Act 25 of 2013) in respect of Dindigul City Municipal

Corporation;

the Hosur City Municipal Corporation Act, 2019 (Tamil Nadu Act 10 of 2019) in respect of Hosur City Municipal Corporation;

the Nagercoil City Municipal Corporation Act, 2019, (Tamil Nadu Act 11 of 2019) in respect of Nagercoil City Municipal

Corporation; and

the Avadi City Municipal Corporation Act, 2019 (Tamil Nadu Act 24 of 2019) in respect of Avadi City Municipal Corporation;”

shall be substituted;

(2) in rule 13, after the ﬁ rst proviso, the following proviso shall be added, namely:—

“Provided further that the ofﬁ cers or servants of the Central Government may also be appointed as Presiding Ofﬁ cers

or Polling Ofﬁ cers, with the permission of the competent authority of that Government.”.

[G.O. Ms. No. 162, Municipal Administration and Water Supply (Election), 4th December 2019,

è£˜ˆF¬è 18, Mè£K, F¼õœÀõ˜ Ý‡´-2050.]

No. SRO A-43(b-2)/2019.

In exercise of the powers conferred by section 303 of the Tamil Nadu District Municipalities Act, 1920 (Tamil Nadu Act V of

1920), section 347 of the Chennai City Municipal Corporation Act, 1919 (Tamil Nadu Act IV of 1919), section 431 of the Madurai

City Municipal Corporation Act, 1971 (Tamil Nadu Act 15 of 1971), section 430 of the Coimbatore City Municipal Corporation Act,

1981 (Tamil Nadu Act 25 of 1981) read with section 8 of the Tiruchirappalli City Municipal Corporation Act, 1994 (Tamil Nadu

Act 27 of 1994), section 8 of the Tirunelveli City Municipal Corporation Act, 1994 (Tamil Nadu Act 28 of 1994), section 8 of the

Salem City Municipal Corporation Act, 1994 (Tamil Nadu Act 29 of 1994), section 8 of the Tiruppur City Municipal Corporation

Act, 2008 (Tamil Nadu Act 7 of 2008), section 8 of the Erode City Municipal Corporation Act, 2008 (Tamil Nadu Act 8 of 2008),

section 8 of the Vellore City Municipal Corporation Act, 2008 (Tamil Nadu Act 26 of 2008), section 8 of the Thoothukudi City

Municipal Corporation Act, 2008 (Tamil Nadu Act 27 of 2008), section 8 of the Thanjavur City Municipal Corporation Act, 2013

(Tamil Nadu Act 24 of 2013), section 8 of the Dindigul City Municipal Corporation Act, 2013 (Tamil Nadu Act 25 of 2013),

section 8 of the Hosur City Municipal Corporation Act, 2019 (Tamil Nadu Act 10 of 2019), section 8 of the Nagercoil City

Municipal Corporation Act, 2019, (Tamil Nadu Act 11 of 2019) and section 8 of the Avadi City Municipal Corporation Act, 2019

(Tamil Nadu Act 24 of 2019) the Governor of Tamil Nadu, after consultation with the Tamil Nadu State Election Commission,

hereby makes the following amendments to the Tamil Nadu Town Panchayats, Municipalities and Corporations (Election)

Rules, 2006:-

AMENDMENTS.

In the said Rules,-

(1) in rule 22, in sub-rule (1), for the expression “Councillors or Chairmen or Mayors” the expression “Councillors”, shall

be substituted;

(2) for rule 23, the following rule shall be substituted, namely:-

“23. Notice of Election.-(1) In pursuance of the notiﬁ cation of the Tamil Nadu State Election Commission under rule

22, the Returning Ofﬁ cer shall cause to be published, on the appointed date, a notice of election in Tamil in Form 2 and

also in any other language or languages in which the electoral roll is published for the election of councillors in the Town

Panchayat or Municipality or Corporation and also afﬁ x a copy of the notice in two conspicuous places in the concerned wards.

(2) The notice of election shall contain the following particulars, namely:-

(a) the ward or wards for which elections are to be held;

(b) whether the ward is reserved or not; if reserved, whether it is reserved for Scheduled Caste or Scheduled

Tribe and/or for woman;

presented;

(d) the person or persons by whom the nomination papers will be received;

(e) the date on which and the hours at which and the place at which the nomination papers will be taken up for

scrutiny;

TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY

(f) the last date on which and the hours upto which the nomination papers can be withdrawn;

(g) the date on which and the place or places at which and the hours between which the votes of the electors will

be taken at the poll, should there be a poll;

(h) the date on which and the place or places and the hour at which the Returning Ofﬁ cer will commence the counting

of votes;

(i)

the date before which the election shall be completed; and

(j) the date on which the ﬁ rst meeting of the newly elected councillors shall be held, in the case of ordinary elections.”;

(3) in rule 24,-

(a) in sub-rule (2), for the expression “in the respective ward of the Town Panchayat or Municipality or Corporation,

in the case of election of Councillors and in any ward of the respective Town Panchayat or Municipality or Corporation in

the case of election of Chairman or Mayor, as the case may be”, the expression “in the ward of the Town Panchayat or

Transitional Area or Municipality or Corporation in the election of councillors” shall be substituted;

(b) in sub-rule (2-A), in clause (a), the expression "Mayor or Chairman or" shall be omitted;

(4) in rule 25 , in sub-rule(1),-

(a) for “the table”, the following Table shall be substituted, namely:-

“THE TABLE

Sl.

No.

(1)

Nature of Election

(2)

Amount

(3)

Other than

SC/ST

(Rs.)

SC/ST

(Rs.)

(1)

for election of Ward

Member of a Town

Panchayat

500

250

(2)

for election of Councillor of

a Municipality

1000

500

(3)

for election of Councillor of

a Corporation

2000

1000

(b) in the proviso, for the expression “Councillor or Chairman or Mayor”, the expression “Councillor” shall be substituted;

(5) in rule 26, in sub-rules (2) and (3), the following sentence occurring at the end, shall be omitted, namely:-

"Separate notice shall be prepared and published in respect of election of Chairman or Mayor and Councillors.”;

(6) in rule 27,-

(a) sub-rule (5-a) shall be omitted;

(b) in sub-rule (9), the following sentence occurring at the end, shall be omitted, namely:-

“Separate list shall be prepared and published in respect of election of Chairman or Mayor and Councillors.”;

(7) in rule 28, sub-rule (3-a) shall be omitted;

(8) in rule 33, for sub-rule (4), the following sub-rule shall be substituted, namely:-

“(4) The Returning Ofﬁ cer shall then complete the list of contesting candidates in Form 9 and publish the same

at the ofﬁ ce of the Town Panchayat or Municipality or Corporation as the case may be. The list shall also be

published in two or more conspicuous places in the respective ward.”;

(9) in rule 47, in sub-rule (1), for the expression “Chairman or Mayor or Councillor”, the expression “Councillor” shall

be substituted;

TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY

(10) in rule 54, in sub-rule (7), for the expression “Chairman or Mayor or Councillor” the expression “Councillor” shall

be substituted;

(11) in PART VIII, for the heading, the following heading shall be substituted, namely:-

“ELECTION OF CHAIRMAN, VICE-CHAIRMAN, MAYOR, DEPUTY MAYOR, MEMBERS OF THE STATUTORY

COMMITTEES AND CHAIRMAN OF WARDS COMMITTEE.”;

(12) for rule 94, the following rule shall be substituted, namely:-

“94. Election of Chairman, Vice-Chairman, Mayor and Deputy Mayor.- The Chairman and Vice-Chairman of a

Town Panchayat or Municipal Council or the Mayor and Deputy Mayor of a Corporation Council shall be elected by and

from among the councillors of the wards of the Town Panchayat or Municipality or Corporation, as the case may be, in the

manner prescribed in these rules, at a meeting specially convened by the Returning Ofﬁ cer:

Provided that where the ofﬁ ce of the Mayor or Chairman of a Council is reserved for persons belonging to Scheduled

Castes or Scheduled Tribes and /or for women under the provisions of the Act(s), only persons belonging to that category

shall be eligible to contest the election for such ofﬁ ce:

Provided further that where no such reservation has been made, nothing contained in the above proviso shall be

deemed to prevent any member belonging to Scheduled Castes or Scheduled Tribes or women of a Town Panchayat or

Municipality or Corporation, as the case may be, from contesting the election as Chairman or Mayor.";

(13) for rule 98, the following rule shall be substituted, namely;-

“98. Place and meeting for the election.- The election of the Chairman and Vice-Chairman of the Town Panchayat or

Municipal Council or Mayor and Deputy Mayor of the Corporation Council or the election of Members of Statutory Committee

or the election of Chairman of Wards Committee shall be held in the ofﬁ ce of the concerned Town Panchayat or Municipality

or Corporation where the meetings of the Town Panchayat or Municipality or Corporation Council are ordinarily held.”;

(14) in rule 99,-

(a) in sub-rule (1),-

(i) for the expression “Vice-Chairman”, the expression “Chairman and Vice-Chairman” shall be substituted;

(ii) for the expression “Deputy Mayor”, the expression “Mayor and Deputy Mayor” shall be substituted;

(b) in sub-rule (2),-

(i) for the expression “Vice-Chairman”, the expression “Chairman or Vice-Chairman” shall be substituted;

(ii) for the expression “Deputy Mayor”, the expression “Mayor or Deputy Mayor” shall be substituted;

(15) in rule 100, after sub-rule (1), the following sub-rule shall be inserted, namely:—

“(2) Where the ofﬁ ce of the Chairman or Mayor is reserved under the provisions of the Act(s) to persons belonging

to Scheduled Caste or Scheduled Tribe, the candidate shall give in writing a further declaration that he or she belongs to

the Scheduled Caste or Scheduled Tribe, as the case may be.”;

(16) for rule 117, the following rule shall be substituted, namely:-

“117. Maximum Election Expenses.- (1) The total expenditure which can be incurred or authorised in connection with

an election under these rules shall not exceed the amount mentioned in the Table below:-

THE TABLE

Sl.No.

(1)

Nature of election

(2)

Expenditure

(3)

Rs.

(a)

for election as Member of a Town

Panchayat

17,000

(b)

for election as Councillor of a Municipality

(Second and First Grade)

34,000

TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY

(c)

for election as Councillor of a

Municipality (Selection and Special

Grade)

85,000

(d)

for election as Councillor of a

Corporation (Other than Corporation of

Chennai)

85,000

(e)

for election as Councillor of Corporation

of Chennai

90,000

(2) Any candidate, either by himself or by his election agent, whose expenditure has exceeded the amount mentioned

above or who has not kept a separate and correct account of all expenditure in connection with the elections as speciﬁ ed in

sub-rule (1) or rule 116 or who fails to lodge an account of election expenses with the authority concerned within the period

speciﬁ ed in sub-rule (3) of rule 116, shall be deemed to have indulged in a corrupt practice for the purposes of the Act(s).”;

(17) for Forms 1 to 29, the following Forms shall, respectively, be substituted, namely:—

“ FORM 1

NOTICE OF PUBLICATION OF ELECTORAL ROLL

[See rule 18(1)]

Notice is hereby given that the Town Panchayat / Municipality / Corporation Electoral Roll has been prepared in accordance

with the Tamil Nadu Town Panchayats, Municipalities and Corporations (Elections) Rules, 2006 by adopting the existing

entries in the relevant part of the electoral roll of the ......................................................... Tamil Nadu Legislative Assembly

Constituency. A copy thereof relating to the ................................................................ Ward/Division of the ...............................

........... Town Panchayat / Municipality / Corporation has been published for inspection.

Any person who wishes to lodge any claim for including his/her name in the roll or any objection to the inclusion of

a name or any objection to the particulars in any entry in the said roll, shall ﬁ rst get such claim or objection settled with

reference to the corresponding entry in the Assembly Roll by lodging suitable claim or objection under the provisions of the

Representation of the People Act, 1950 (Central Act 43 of 1950) and the Registration of Electors Rules, 1960 before the

(xx)…….Electoral Registration Ofﬁ cer of the said Assembly Constituency located at .............................. .................................

......................

All orders of inclusion, deletion or corrections issued on the basis of these claims and objections by the Assembly

Electoral Registration Ofﬁ cer till the last date ﬁ xed for making nomination for election of Councillors of the Town Panchayat

or Municipality or Corporation will be duly incorporated in the .................................................................. Town Panchayat /

Municipality / Corporation Electoral Rolls.

Place :..........

Date:..............

Electoral Registration Ofﬁ cer,

.............................................Town Panchayat /

Municipality / Corporation

FORM 2

NOTICE OF ELECTION

[See rule 23(1)]

Election of the Councillors of Wards / Divisions No…. of............................. Town Panchayat / Municipality / Corporation.

Notice is hereby given that -

1. (a) elections are to be held to elect a Councillor(s) of Wards / Divisions of ..................................... Town

Panchayat / Municipality / Corporation

TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY

(b) the wards/divisions which are reserved for persons belonging to Scheduled Castes/ Scheduled Tribes and

/ or Women are given below:

Ofﬁ ce

= = = Reserved = = =

Unreserved

for S.C.

for S.T.

for women

S.C.

S.T.

Open

Councillor-

Ward/ Division 1

Ward / Division 2

…..

Total

2) Nomination papers may be delivered by a candidate or his proposer to the Returning Ofﬁ cer/Assistant Returning Ofﬁ cer

at ….............................................. between ….......... A.M. and….......P.M. on any day (other than a public holiday) from …....

....................................... to …..................................

3) Forms of nomination papers will be available in the ofﬁ ce of the Town Panchayat / Municipality/Corporation

and from this date on all working days, and at the ofﬁ ce of the Assistant Returning Ofﬁ cer.

4) The nomination papers will be taken up for scrutiny at ….......... A.M. on ….................….............................

..at ….................................................. ;

5) Notice of withdrawal of candidature may be delivered by a candidate or his proposer who has been

speciﬁ cally authorised in this behalf in writing by the candidate to the Returning Ofﬁ cer / Assistant Returning Ofﬁ cer upto

…..... P.M. on ….....................;

6) In the event of the election being contested the poll will be taken on …......................... between ….........A.M.

and …........P.M. at the polling stations notiﬁ ed for this purpose.

7) The counting of votes shall commence at …........ A.M. on …...........................;

8) The election shall be completed before …..........................................................;

9) The ﬁ rst meeting of the newly-elected Councillors shall be held on …............................ at the ofﬁ ce of the

….......................................Town Panchayat / Municipality / Corporation.

Place :..........

Date:..............

Returning Ofﬁ cer,

.............................................Town

Panchayat / Municipality / Corporation

FORM 3

NOMINATION PAPER

[See rule 24(1) and (2)]

Election of the Councillor to Ward / Division No…… of ............................... Town Panchayat / Municipality /

Corporation.

(To be ﬁ lled in by the proposer)

I hereby nominate Thiru / Tmt / Selvi............................................................as a candidate for the election as a

Councillor from Ward/Division No..................of the ........................................................Town Panchayat / Municipality / Corporation.

His name is entered at Serial No. ........... in part No./ street No................................. of the electoral roll for Ward/Division

No. ............ of .......................................................... Town Panchayat / Municipality / Corporation.

My name is entered at Serial No. ......... in Part No. / Street No........................ of the electoral roll for Ward/

Division No. .......... of ..................................................... Town Panchayat / Municipality / Corporation

Place :..........

Date:............

Signature of the proposer

TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY

(To be ﬁ lled by the candidate)

I, the above mentioned candidate assent to this nomination and hereby declare that -

(a) I have completed ............................................................ years of age;

(b) the symbols I have chosen are in the following order of preference:

(i)............................................................

(ii)........................................................... and

(iii)............................................................

(c) *** I am a member of the ................................................................... caste / tribe which is a Scheduled Caste/

Tribe in the State of Tamil Nadu in relation to ................................................................... area).

(d) I am not employed as Village Administrative Ofﬁ cer or village servant or an ofﬁ cer or servant of the State or Central

Government or of a Village Panchayat, Panchayat Union Council, District Panchayat, Town Panchayat, Municipal Council or

Municipal Corporation or of any Iindustrial Township or of Cantonment or of any body Corporate, owned or controlled by the

State or Central Government.

Date:........... Signature of the Candidate.

Note:

****item (c) needs to be made only by a SC/ST candidate.

(To be ﬁ lled by the Returning Ofﬁ cer)

Serial No…………. of nomination paper:

The nomination was presented to me at my ofﬁ ce at ........................... (hour) on ........................... (date) by the candidate/

proposer.

Place :.........

Assistant Returning Ofﬁ cer/ Returning Ofﬁ cer.

Date:...........

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 as Councillor from Ward/

Division No........................... of the Town Panchayat / Municipality / Corporation, was presented to me at my ofﬁ ce at

.......................... (hour) on .................................... (date) by the candidate/proposer.

All nomination papers will be taken up for scrutiny at .............................. A.M..(time) on ...................... (date)

at ............................................... (place).

Place :..........

Assistant Returning Ofﬁ cer / Returning Ofﬁ cer.

Date:...........

TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY

FORM 3-A

[See rule 24(2-A)]

Afﬁ davit to be furnished by the candidate along with

Nomination Paper before the Returning Ofﬁ cer

Election of the Councillor to Ward / Division No…… of ............................... Town Panchayat / Municipality / Corporation.

PART-A

I …………………….………………………, son/daughter/wife^* of …………………… aged …………………years, resident of

………………………………………………… ……………………………………………………………………………………………………

…………………………………..…..(mention full postal address including pincode), a candidate at the above election, do hereby

solemnly afﬁ rm and state on oath as under:-

(1) I am a candidate set up by ……………………………………………. (name of the political party) / I am contesting as

an Independent candidate^*.

(2) My name is enrolled in Ward/Division No ..… of Electoral Roll of ........................... Town Panchayat / Municipality /

Corporation at Serial No …………. in Part No ………

(3) My contact telephone number ....................................... (with STD Code) / mobile number (s) is / are …………........

..................................……………… and my e-mail id (if any) is …………………………………..

(4) Details of Permanent Account Number (PAN) and status of ﬁ ling of Income Tax return:

Sl.

No.

(1)

Names

(2)

PAN

(3)

The ﬁ nancial year for

which the last Income-tax

return has been ﬁ led

(4)

Total income shown in

Income - tax return (in

Rupees)

(5)

Self

Spouse

Dependent-1

Dependent-2

Dependent-3…….

*strike out whichever is not applicable

(5) I have / have not been sentenced / imprisoned for any offence(s) punishable with imprisonment for

more than six months under section 49 of the Tamil Nadu District Municipalities Act, 1920 (in the case of Town

Panchayats / Municipalities) / section 52 of the Chennai City Municipal Corporation Act, 1919 (in the case of Chennai

Corporation) / more than two years (in the case of Madurai / Coimbatore Corporation) under section 56 of the Madurai

City Municipal Corporation Act, 1971 / section 58 of the Coimbatore City Municipal Corporation Act, 1981 read

with section 8 of other Corporation Acts in a pending case(s) in which a charge(s) has / have been framed by the court(s)

of competent jurisdiction.

If the deponent is accused of any such offence(s) he/she shall furnish the following information:-

(i) The following case(s) is /are pending against me in which charges have been framed by the court for an offence

punishable with imprisonment for two years or more:-

Please afﬁ x

your recent

passport size

photo here

TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY

(a)

Case / First Information Report No. / Nos. together

with complete details of concerned Police Station/

District/State

(b)

Section(s) of the concerned Act(s) and short

description of the offence(s) for which charged

(c)

Name of the Court, Case No. and date of order

taking cognizance

(d)

Court(s) which framed the charge(s)

(e)

Date(s) on which the charge(s) was/ were framed

(f)

Whether all or any of the proceeding(s) has/have

been stayed by any Court(s) of competent jurisdiction

(ii) The following case(s) is /are pending against me in which cognizance has been taken by the court [other than the

cases mentioned in item (i) above]:-

(a)

The details of cases where the court has taken

cognizance, section(s) of the Act(s) and description

of the offence(s) for which cognizance taken

(b)

Name of the Court, Case No. and date of order

taking cognizance

(c)

Details of Appeal(s)/ Application(s) for revision (if

any) ﬁ led against the above order(s)

(6) I have been / have not been convicted of an offence(s) other than any offence(s) referred to Sl.No.5 above. And, I

have been/have not been removed/disqualiﬁ ed under the relevant Urban Local Bodies Act.

If the deponent is convicted and punished as aforesaid, he/she shall furnish the following information:-

(i)

Cases in which, I have been convicted and sentenced to imprisonment by a court of law:-

(a)

The Details of cases, section(s) of the concerned

Act(s) and description of the offence(s) for which

convicted

(b)

Name of the Court(s), Case No. and date(s) of

order(s)

(c)

Punishment imposed

(d)

Whether any appeal was/has been ﬁ led against the

conviction order. If so, details and the present status

of the appeal

TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY

(ii) If the deponent is dismissed / disqualiﬁ ed from the post of ……………………………………under the Tamil Nadu District

Municipalities Act, 1920 (in the case of Town Panchayats / Municipalities) / the Chennai City Municipal Corporation Act, 1919

/ the Madurai City Municipal Corporation Act, 1971 / the Coimbatore City Municipal Corporation Act, 1981 read with Section

8 of other Corporation Acts, he/she shall furnish the following information:-

(a)

Removed/Disqualiﬁ ed under which Section(s) of

relevant Urban Local Bodies Act

(b)

Period of punishment

From ................. to ......................

(........................... Years)

(c)

Order No. and Date (i.e. Statutory Orders issued

by the Tamil Nadu State Election Commission or

Proceedings issued by the authority)

(d)

Date of enforcement of removal / disqualiﬁ cation

(e)

Whether any appeal was/has been ﬁ led against the

removal / disqualiﬁ cation order. If so, details and the

present status of the appeal

(7) That I give herein below the details of the assets (movable and immovable etc.) of myself, my spouse and all

dependents:-

A. Details of movable assets

Instructions:

1. Assets in joint name indicating the extent of joint ownership will also have to be given.

2. In case of deposit / investment, the details including Serial Number, Amount, date of deposit, the scheme,

Name of the Bank/Institution and Branch are to be given.

3. Value of Bonds / Share Debentures as per current market value in Stock exchange in respect of listed companies

and as per books in case of non-listed companies should be given.

4. Dependent here means a person, substantially dependent on the income of the candidate.

5. Details including amount is to be given separately in respect of each investment.

Sl.

No.

Description

Self

Spouse

Dependent-1

Dependent-2

Dependent-3

(i)

Cash in hand

(ii)

Details of deposit in Bank accounts

(FDRs, Term Deposits and all other

types of deposits including saving

accounts), Deposits with Financial

Institutions, Non-Banking Financial

Companies and Co-operative

Societies and the amount in each

such deposit

(iii)

Details of investment in Bonds,

debentures / shares and units in

Companies / Mutual funds and

others and the amount

TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY

(iv)

Details of investment in NSS,

Postal Savings, Insurance Policies

and investment in any Financial

instruments in Post office or

Insurance Company and the amount

(v)

Personal loans / advance given

to any person or entity including

Firm, Company, Trust etc., and

other receivables from debtors and

the amount

(vi)

Motor Vehicles / Aircrafts / Yachts /

Ships (Details of Make, registration

number etc., year of purchase and

amount)

(vii)

Jewellery, bullion and valuable

thing(s) (give details of weight

and value)

(viii)

Any other assets such as value of

claims / interest

(ix)

Gross Total Value

B. Details of Immovable Assets

Instructions:

1. Properties in joint ownership indicating the extent of joint ownership will also have to be indicated.

2. Each land or building or apartment should be mentioned separately in this format.

Sl.

Description

Self

Spouse

Dependent-1

Dependent-2

Dependent-3

(i)

Agricultural Land :

- Location(s)

- Survey number(s)

Area

(total measurement in acres)

Whether inherited property (Yes

or No)

Date of purchase in case of self-

acquired property

Cost of Land (in case of purchase)

at the time of purchase

Any investment on the land by way

of development, construction, etc.

Approximate current market value

TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY

Sl.

Description

Self

Spouse

Dependent-1

Dependent-2

Dependent-3

(ii)

Non-Agricultural Land:

- Location(s)

- Survey number(s)

Area

(total measurement in sq.ft.)

Whether inherited property (Yes

or No)

Date of purchase in case of self-

acquired property

Cost of Land (in case of purchase)

at the time of purchase

Any investment on the land by way

of development, construction, etc.

Approximate current market value

(iii)

Commercial Buildings (including

apartments)

- Location(s)

- Survey number(s)

Area (total measurement in sq.ft.)

Built-up Area (total measurement

in sq.ft.)

Whether inherited property (Yes

or No)

Date of purchase in case of self-

acquired property

Cost of property (in case of purchase)

at the time of purchase

Any investment on the property by

way of development, construction,

etc.

Approximate current market value

TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY

Sl.

Description

Self

Spouse

Dependent-1

Dependent-2

Dependent-3

(iv)

Residential Buildings (including

apartments):

- Location(s)

- Survey number(s)

Area (total measurement in sq.ft.)

Built-up Area (total measurement

in sq.ft.)

Whether inherited property (Yes

or No)

Date of purchase in case of self-

acquired property

Cost of property (in case of purchase)

at the time of purchase

Any investment on the property by

way of development, construction,

etc.

Approximate current market value

(v)

Others (such as interest in property)

(vi)

Total of current market value of (i)

to (v) above

(8)

I give herein below the details of liabilities/dues to public ﬁ nancial institutions and Government:-

(Note: please give separate details of name of bank, institution, entity or individual and amount before each item)

Sl.

No.

Description

Self

Spouse

Dependent-1

Dependent-2

Dependent-3

(i)

Loan or dues to Bank / ﬁ nancial

institution(s) Name of the Bank

or financial institution, Amount

outstanding, Nature of Loan

Loan or dues to any other

individuals/entity other than

mentioned above Name(s), Amount

outstanding, nature of loan Any

other liability

Total of liabilities

(ii)

Government dues:

Dues to departments dealing with

Government accommodation

Dues to department dealing with

supply of water

Dues to department dealing with

supply of electricity

Dues to department dealing with

supply of telephone / mobiles

TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY

Sl.

No.

Description

Self

Spouse

Dependent-1

Dependent-2

Dependent-3

Dues to department dealing with

government transport (including

aircrafts and helicopters)

Income tax dues

Wealth tax dues

Service tax dues

Municipal / Property Tax dues

Sales tax dues

Any other dues

(iii)

Total of all Government dues

(iv)

Whether any other liabilities are in

dispute, if so, mention the amount

involved and the authority before

which it is pending

(v)

Grand total of serial number (i) to

(iv) above

(9) Details of profession or occupation:

(a) Self ……………………………………………………………………..

(b) Spouse ………………………………………………………………..

(10)

My educational qualiﬁ cation is as under:-

………………………………………………………………………………………

(Give details of highest School/University education mentioning the full form of the certiﬁ cate / diploma / degree course,

name of the School / College / University and the year in which the course was completed.)

PART-B

(1) ABSTRACT OF THE DETAILS GIVEN IN (1) TO (10) OF PART-A:

Name of the Candidate

Thiru/Tmt/Selvi

Full postal address

Name of the Local Body and District

Name of the political party which set up the candidate

(otherwise write ‘Independent’)

(i) Total number of pending cases where charges have

been framed by the Court for offences punishable with

imprisonment for more than six months under section

49 of the Tamil Nadu District Municipalities Act, 1920

(in the case of Town Panchayats / Municipalities) /

section 52 of the Chennai City Municipal Corporation

Act, 1919 (in the case of Chennai Corporation) / more

than two years (in the case of Madurai/Coimbatore

Corporation) under section 56 of the Madurai City

Municipal Corporation Act, 1971 / section 58 of the

Coimbatore City Municipal Corporation Act, 1981 read

with section 8 of other Corporation Acts

TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY

(ii) Total number of pending cases where the

court(s) have taken cognizance [other than the

cases mentioned in item (i) above]

Total number of cases in which convicted and sentenced

to imprisonment other than any offence(s) referred to

Sl.No.5 above and Dismissal / Disqualiﬁ cation period

under the Urban Local Bodies Acts.

From ................... To ...........................

(...................... Years)

PAN of

Year for

which last

income tax

return ﬁ led

Total income

shown

(a) Candidate

(b) Spouse

(c ) Dependents

Details of Assets and Liabilities in Rupees

Description

Self

Spouse

Dependent- I

Dependent-II

Dependent-III

(1)

Movable Assets

(Total Value)

(2)

Immovable Asset

Purchase price of self-

acquired immovable

property

Development / construction

cost of immovable property

after purchase

(if applicable)

III

Approximate Current

market price of -

(A) self acquired assets

(Total value)

(B) inherited assets (Total

value)

Liabilities

(i)

Government dues (Total)

(ii)

Loans from Bank, Financial

Institutions and others

(Total)

10.

Liabilities that are under dispute

(i)

Government dues (Total)

(ii)

Loans from Bank, Financial

Institutions and others

(Total)

11.

Highest educational qualiﬁ cations:-

(Give details of highest School / University education mentioning the full form of the certiﬁ cate / diploma /

degree course, name of the School / College / University and the year in which the course was completed.)

TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY

VERIFICATION

I, the deponent, above named, do hereby verify and declare that the contents of this afﬁ davit are true and correct to

the best of my knowledge and belief and no part of it is false and nothing material has been concealed there from. I further

declare that:-

(a) there is no case of conviction or pending case against me other than those mentioned in items 5 and 6 of Part A

and B above;

(b) I, my spouse, or my dependents do not have any asset or liability, other than those mentioned in items 7 and 8 of

Part A and items 8, 9 and 10 of Part B above.

may extend to six months, or with ﬁ ne, or with both under relevant sections of the Acts.

Veriﬁ ed at …………………… this the ………… day of …………………………………

DEPONENT

Instructions:

1. Afﬁ davit should be ﬁ led along with the Nomination of paper.

2. Afﬁ davit should be sworn before an Oath Commissioner or Magistrate of the First Class or before a Notary Public.

The afﬁ davit shall be prepared in a non judicial stamp paper of Rs.20/- (Rupees twenty only).

3. All column should be ﬁ lled up and no column to be left blank. If there is no information to furnish in respect of any

item, either "Nil" or "Not applicable", as the case may be, should be mentioned.

4. The Afﬁ davit should be either typed or written legibly and neatly.

TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY

FORM 4

NOTICE OF NOMINATION

[See rule 26(2)]

Election of the Councillor to Ward/Division No…….. of ........................................... Town Panchayat / Municipality / Corporation.

Notice is hereby given that the following nominations in respect of the above election have been received upto ................ P.M.. today:-

Serial No. of

Nomination paper

Name of

Candidate

Name of

father/

husband

Age of

Candidate

Address

Sex

Caste/ Tribe (in

case of S.C. / S.T.

candidates)

Electoral roll

No. of the

candidate

Name of

Proposer

Electoral roll

No. of the

Proposer

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

Note : The nomination papers will be taken up for scrutiny at 10.00 A.M. on the .............…… . day of ……..............……… at …..…………. (Place).....................

Place :..........

Assistant Returning Ofﬁ cer/ Returning Ofﬁ cer.

Date:...........

TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY

FORM 5

LIST OF NOMINATIONS RECEIVED

[See rules 26(3), (4) and 27(1)]

........................................................................ Town Panchayat / Municipality / Corporation.

List of nominations received for election of the Councillors of Wards/Divisions of .................................. ...........................

................................... Town Panchayat / Municipality / Corporation.

Sl.

No.

Name of Candidate

Father’s/

Husband’s

Name

Community

(Scheduled Caste/

Scheduled Tribe or

not)

Sex

Address

(1)

(2)

(3)

(4)

(5)

(6)

Note:- The nomination papers will be taken up for scrutiny at .............. A.M. on ............................. at .........................

.............................. (place).

Place :..........

Assistant Returning Ofﬁ cer / Returning Ofﬁ cer.

Date:...........

TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY

FORM 6

LIST OF VALIDLY NOMINATED CANDIDATES

[See rule 27(9)]

…………………….....……Town Panchayat / Municipality / Corporation.

List of nominations which are found valid among the nominations received for the election of the Councillor to Ward /

Division No……. of .................................. ................................. Town Panchayat / Municipality / Corporation.

Sl.

No.

Name of Candidate

Father’s/

Husband’s

Name

Community

(Scheduled Caste/

Scheduled Tribe or

not)

Sex

Address

(1)

(2)

(3)

(4)

(5)

(6)

Place :.......... Assistant Returning Ofﬁ cer / Returning Ofﬁ cer.

Date:...........

TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY

FORM 7

NOTICE OF WITHDRAWAL

[See rule 28(1)]

Election of the Councillor to Ward / Division No…… of..................................... Town Panchayat / Municipality /

Corporation.

The Returning Ofﬁ cer,

I, ...................................................., a candidate nominated at the above election do hereby give notice that I withdraw

my candidature.

2. I am fully aware that I can not cancel this notice of withdrawal under sub-rule (3) of rule 28 of the Tamil Nadu Town

Panchayats, Municipalities and Corporations (Elections) Rules, 2006..

Place :……………………………. Signature of candidate.

Date: ……………………………..

The notice was delivered to me at my ofﬁ ce at ................................... (hour) on ................................(date) by

.............................................................(name) the ......................................*

Date:...............

Assistant Returning Ofﬁ cer/ Returning Ofﬁ cer.

-------------------------------------------------------------------------------------------------------------------------------------------------------------------

RECEIPT FOR 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 of Councillor

to Ward / Division No. ............................... of ....................................................................... Town Panchayat / Municipality

/ Corporation was delivered to me by the *................................................ at my ofﬁ ce at .................................... (hour) on

............................(date).

Assistant Returning Ofﬁ cer / Returning Ofﬁ cer.

NOTE :

* Here insert one of the following alternatives as may be appropriate:-

(1) Candidate.

(2) Candidate’s proposer who has been authorised in writing by the candidate to deliver it.



TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY

FORM 9

LIST OF CONTESTING CANDIDATES.

[See rules 29(1), 30(1)(i), 33(4), 39(4)(a), 47(1), 59(2) and 60(4)(a)]

............................................... Town Panchayat / Municipality / Corporation.

List of contesting candidates for election of the Councillor to Ward / Division No……… of ..................................

............................ Town Panchayat / Municipality / Corporation.

Sl.

No.

Name of Candidate

Sex

Whether the

candidate belongs

to Scheduled

Caste, Scheduled

Tribe or not.

Address

Candidate.

Distinctive symbol

assigned to the

candidate

(1)

(2)

(3)

(4)

(5)

(6)

Note:- The poll will be taken on ................... between ........... A.M. and .........P.M. at the polling stations notiﬁ ed for the

purpose.

Place :.......... Assistant Returning Ofﬁ cer / Returning Ofﬁ cer.

Date:...........

TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY

FORM 10

APPOINTMENT OF ELECTION AGENT.

[See rule 36]

Election of the Councillor to Ward / Division No…... of ....................................... Town Panchayat / Municipality / Corporation.

The Returning Ofﬁ cer,

I, ..................................................... of ............................................., a candidate at the above election do hereby appoint

Thiru / Tmt / Selvi .......................................... of ......................................................... as my election agent from this day at

the above Election.

His recent photograph, duly attested by me, is pasted below.

Place :……………………………. Signature of candidate.

Date: ……………………………..

I accept the above appointment.

Place :……………………………. Signature of Election Agent.

Date: ……………………………..

TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY

FORM 11

APPOINTMENT OF POLLING AGENT

[See rule 38(2)]

Election of the Councillor to Ward / Division No………. of .................................. Town Panchayat / Municipality / Corporation.

I, ............................................................................. a candidate / election agent of .......................................................

who is a candidate in the above election do hereby appoint Thiru / Tmt. / Selvi.............................................................................

of .................................................................... as polling agent to attend the Polling Station No.............................. at ..........

........................................

Date : Signature of candidate or election agent.

I agree to act as such polling agent.

Place :……………………………. Signature of Polling agent.

Date: ……………………………..

Declaration of polling agent to be signed before the Presiding Ofﬁ cer.

I hereby declare that at the above election I will not do anything forbidden by the relevant Section of the Act which I

have read/ has been read over to me.

Date : Signature of poling agent.

Signed before me.

Date: …………………………….. Signature of Presiding Ofﬁ cer.

---------------------------------------------------------------------------------------------------------------------------------------------------------------

(To be handed over to the polling agent for production at the polling station.)

Relevant provisions of the Acts

“Every ofﬁ cer, clerk, agent or other person performing any duty in connection with the recording or counting of votes at

an election who, except for some purpose authorised by law, communicates to any person any information showing directly

or indirectly for which candidate any voter has voted, and every person, who by any improper means procures any such

information, shall be punished with imprisonment [of either description]* which may extend to six months or with ﬁ ne, or

with both”.

_________________________________________________________________________________________________

*only in the case of Chennai Corporation vide section 66 of the Chennai City Municipal Corporation Act, 1919.

TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY

FORM 12

PART I

DECLARATION BY THE PRESIDING OFFICER BEFORE THE COMMENCEMENT OF POLL.

[See rule 40(6)]

Election of the Councillor to Ward / Division No……… of ...................................... Town Panchayat / Municipality / Corporation.

Name of the Town Panchayat / Municipality/

Corporation

No. and name of the polling station

Date of Poll

I hereby declare –

(1) that I have demonstrated to the polling agents and other persons present that the ballot boxes to be used for

the poll are empty.

(2) that on the paper seal used for securing the ballot box, I have afﬁ xed my own signature and obtained thereon

the signatures of such of the polling agents who are present and desirous of afﬁ xing the same.

(3) that I have demonstrated to the polling agents and others present that the marked copy of the electoral roll/ rolls

to be used during the poll does/do not contain any marks other than those used for issuing election duty certiﬁ cates, and

(4) that I have allowed the polling agents to note the ﬁ rst and the last of the serial numbers of the ballot papers and

also the numbers on the paper seals which will be used at the polling station.

(Signature of Presiding Ofﬁ cer.)

Signature of polling agents.

1. ..................................... (of candidate ................................................)

2. ......................... ........... (of candidate ................................................)

3. ..................................... (of candidate ................................................)

4.........................................(of candidate ...............................................)

5. .......................................(of candidate ...............................................)

6. ..................................... (of candidate ................................................)

7. .......................................(of candidate ...............................................)

8. ..................................... (of candidate ................................................)

9. ..................................... (of candidate ................................................)

The following agents declined to afﬁ x their signatures to this declaration:-

1. ..................................... (of candidate ................................................)

2. ......................... ........... (of candidate ................................................)

3. .................................... .(of candidate ................................................)

4........................................(of candidate ................................................)

Signature of Presiding Ofﬁ cer

TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY

PART-II

DECLARATION AT THE END OF POLL

I have furnished to the polling agents, who were present at the polling station at the close of the poll and whose

signatures are afﬁ xed below, an attested copy each of the entries in the ballot paper account in Form 20.

Date: Signature of Presiding Ofﬁ cer

Received an attested copy of the entries made in the ballot paper account.

Signature of polling agents:

1. ..................................... (of candidate ................................................)

2. ......................... ........... (of candidate ................................................)

3. ................................... ..(of candidate ................................................)

4........................................(of candidate ................................................)

5. ......................................(of candidate ................................................)

6. ..................................... (of candidate ................................................)

7. ..................................... (of candidate ................................................)

8. ..................................... (of candidate ................................................)

9. ..................................... (of candidate ................................................)

The following polling agents who were present at the close of the poll declined to receive an attested copy of the ballot

paper account and to give a receipt therefor and so an attested copy of the ballot paper account was not supplied to them.

1. ..................................... (of candidate .................................................)

2. ......................... ........... (of candidate .................................................)

3. ..................................... (of candidate .................................................)

4........................................(of candidate .................................................)

5. ......................................(of candidate .................................................)

6. ..................................... (of candidate .................................................)

7. ..................................... (of candidate .................................................)

8. ..................................... (of candidate .................................................)

9. ..................................... (of candidate .................................................)

Date: Signature of Presiding Ofﬁ cer

TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY

FORM 13

LIST OF CHALLENGED VOTES

[See rule 43(2)(c), 66(2)(c)]

Election of the Councillor to Ward / Division No…….. of .......................................................... Town Panchayat / Municipality / Corporation.

No.and Name of Polling Station :

Date of Poll:

Sl.

No.

Name of

Elector.

Serial No. of

part of roll or

street in which

the elector’s

name appears.

Sl. No. of

the Elector’s

name in that

part or street.

Signature or

thumb impress-

sion of the person

challenged.

Name and

address of

identiﬁ er, if

any.

Name and

address of

challenger and his

signature or thumb

impression.

Order of

Presiding

Ofﬁ cer.

Signature of

challenger,

on receiving

refund of

deposit.

Amount forfeited

and to be

handed over to

the Returning

ofﬁ cer.

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

Date: ………………..

Signature of Presiding Ofﬁ cer.

TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY

FORM 14

BALLOT PAPER

[See rule 47(1)]

............................................. Town Panchayat / Municipality / Corporation ......................... Ward / Division No...............

Electoral Roll Part No. .................. / Street No. ......................

Sl. No. of the Elector...................................

……………...................................................

Signature or thumb impression of the elector

------------------------------------------------------------------------------------------------------------------------------------------------------------------

Ward / Division No. …………. of .................................................... Town Panchayat / Municipality / Corporation

NAME

SYMBOL

NAME

SYMBOL

NAME

SYMBOL

NAME

SYMBOL

NAME

SYMBOL

NAME

SYMBOL

TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY

FORM 15

APPLICATION BY AN ELECTOR ON ELECTION DUTY TO VOTE.

[See rule 50(1)]

The Returning Ofﬁ cer,

.............................................Town Panchayat / Municipality / Corporation.

Sir,

I have been posted for election duty at the ensuing election of the Councillor to Ward/Division No…………

of ............................. Town Panchayat / Municipality / Corporation at the polling station No................. situated in the ............

..................................... Town Panchayat / Municipality / Corporation.

I hereby declare that I am an elector of Ward/Division No. ................ of the

.................... ........................................... Town Panchayat / Municipality / Corporation.

I have been enrolled under serial No. ...................... of part No./ street No. ............................................. in the electoral roll of

the Ward/Division No............. of .............................................. Town Panchayat / Municipality / Corporation.

I request that a certiﬁ cate in Form 16 with a ballot paper may be sent to me to the address given below to enable me

to cast my vote at the above election.

My address:

........................................................................

.................................................................

.........................................................

Date: Signature of elector on election duty.

TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY

FORM 16

ELECTION DUTY CERTIFICATE

[See rule 50(1)]

Certiﬁ ed that Thiru./Tmt./Selvi.............................................................. is an elector in Ward / Division No............of ............

....................................................... Town Panchayat / Municipality / Corporation. His electoral roll particulars are given below:

Serial No.

Part No. / Street No.

Ward/Division No

Town Panchayat / Municipality /

Corporation

Certiﬁ ed also that by reason of being on election duty, he is unable to vote at the polling station where he / she is

entitled to vote and that he / she is, therefore, hereby authorised to vote through postal ballot paper in the manner laid down

in rule 50.

Date :

Returning Ofﬁ cer.

Seal

TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY

FORM 17

DECLARATION BY ELECTOR ON ELECTION DUTY

[See rule 50(2)]

Election of the Councillor to Ward / Division No. ................. of ................................ Town Panchayat / Municipality

/ Corporation.

I hereby declare that I am the elector to whom the postal ballot paper bearing Serial No. ................... has been issued

at the above election. I declare that I have marked my vote myself on the ballot paper.

Date :

Signature of Elector

Address .............................................

.......................................................

................................................

TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY

FORM 18

LIST OF BLIND AND INFIRM ELECTORS

[See rules 51(2) and 70(2)]

Election of the Councillor to Ward / Division No. ........... of .............................. Town Panchayat / Municipality /

Corporation.

No. and Name of the Polling Station:

Ward/

Division

No. and

serial No.

of elector

Full name of elector

Full name of

companion

Address of companion

Signature of companion

(1)

(2)

(3)

(4)

(5)

Date :

Signature of Presiding Ofﬁ cer

TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY

FORM 19

LIST OF TENDERED VOTES

[See rule 53(2)]

Election of the Councillor to Ward / Division No. ................. of .............................. Town Panchayat / Municipality

/ Corporation.

No. and Name of the Polling Station:

Sl.

No.

Serial No., Part No. / Street No.,

Ward / Division No. and Name

of Elector

Address of Elector

Serial No. of tendered

Ballot Paper

Signature or thumb-

impression of person

tendering vote

(1)

(2)

(3)

(4)

(5)

Date :

Signature of Presiding Ofﬁ cer

TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY

FORM 20

[See rules 56(4)(a), 86(2)]

Election of the Councillor to Ward / Division No. ................. of .............................. Town Panchayat / Municipality /

Corporation.

Part I

BALLOT PAPER ACCOUNT

Name of the Town Panchayat / Municipality / Corporation ................................. Ward / Division No................

No. and Name of Polling Station .....................................

(1)

Serial No.

Total No.

From

(2)

(3)

(4)

1. Ballot Papers received

2. Ballot papers unused (i.e. not issued to voters) -

(a) With the signature of Presiding Ofﬁ cer

(b) Without the signature of Presiding Ofﬁ cer

Total: (a+b)

3. * Ballot Papers used at the Polling Station

(1-2=3)

4. * Ballot Papers used at the Polling Station but NOT INSERTED

INTO THE BALLOT BOX:

(a)

Ballot Papers cancelled for violation of voting procedure

under rule 52

(b)

Ballot papers cancelled for other reasons

(c)

Ballot papers used at tendered Ballot Papers

Total : (a+b+c)

5. * Ballot Papers to be found in the Ballot Box (3-4=5)

(* Serial Nos. need not be given)

Date:......................

Signature of Presiding Ofﬁ cer

TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY

Part II

RESULT OF INITIAL COUNTING

1. Total No. of ballot papers that should be found in the Ballot Box(es) as shown in item 5 of Part I:

2. Total No. of ballot papers actually found in the Ballot Box(es) as per initial counting:

3. Discrepancy, if any, ..............................................

Date:......................

Signature of Counting Supervisor.

Signature of the Returning Ofﬁ cer.

TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY

FORM 21

REGISTER OF ELECTORS

[See rules 68, 69(7), 71]

Election of the Councillor to Ward / Division No. ................. of .............................. Town Panchayat / Municipality

/ Corporation.

No. and Name of Polling Station: ......................................................................

Sl. No.

(1)

Sl. No. of elector in the electoral roll

(2)

Signature/Thumb impression

of elector

(3)

Remarks

(4)

Date:......................

Signature of the Presiding Ofﬁ cer

TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY

FORM 22

LIST OF TENDERED VOTES

[See rules 72, 77]

Election of the Councillor to Ward / Division No. ............ of ............................. Town Panchayat / Municipality / Corporation.

No. and Name of Polling Station: ......................................................................

Sl.

No.

Name of elector

Sl. No. of

elector in

electoral roll

Sl. No. in Register of

electors (Form 21) of the

person who has already

voted in place of elector

Sl. No. of

tendered ballot

paper

Signature/

Thumb

impression of

elector

(1)

(2)

(3)

(4)

(5)

(6)

10.

11.

12.

Date:......................

Signature of the Presiding Ofﬁ cer

TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY

FORM 23

PART I

ACCOUNT OF VOTES RECORDED

[See rules 75 and 92AA]

Election of the Councillor to Ward / Division No. ........... of .............................. Town Panchayat / Municipality / Corporation.

Number and Name of Polling Station: ...............................................................................

Identiﬁ cation number of Control Unit of Voting Machine:...................................................

Balloting Unit of Voting Machine used at the Polling Station:............................................

Total Number of electors assigned to the Polling Station

Total Number of electors as entered in the Register for electors (Form 21)

Number of electors deciding not to record votes under rule 71

Number of electors not allowed to vote under rule 69

Total Number of votes recorded as per voting machine

Whether the total Number of votes as shown against item 5 tallies with the total Number of electors as shown

against item 2 minus Number of electors deciding not to record votes as against item 3 minus Number of electors as against

item 4 (2-3-4) or any discrepancy noticed.

7. Number of electors to whom tendered ballot papers were issued under rule 72.

8. Number of tendered Ballot papers

Sl. Nos.

From

(a) received for use ..........................................................................

(b) issued to electors ........................................................................

9. Account of paper seals

Sl. Nos.

From

Signature of Polling Agents

TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY

1. Serial Numbers of paper seals supplied From ..............

to ...............

2. Total Numbers supplied

3. Number of paper seals used

4. Number of unused paper seals returned to Returning Ofﬁ cer

(Deduct item 3 from item 2)

5. Serial number of damaged paper seal, if any

Date:......................

Signature of Presiding Ofﬁ cer

Polling Station No. ...................

PART II

RESULT OF COUNTING

Sl. No.

Name of Candidates

Number of votes recorded

Total

Whether the total number of votes shown above tallies with the total number of votes shown against item 5 of Part-I

or any discrepancy noticed between the two total.

Date:......................

Signature of Counting Supervisor

Name of candidate / election

agent / counting agent

Full signature

Date:......................

Signature of Returning Ofﬁ cer

TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY

FORM 24

APPOINTMENT OF COUNTING AGENTS

[See rule 81]

Election of the Councillor to Ward / Division No. ................. of .............................. Town Panchayat / Municipality

/ Corporation.

The Returning Ofﬁ cer,

I, Thiru. / Tmt. / Selvi. .......................................................... a candidate / the election agent of .................................

......................................... who is a candidate at the above election do hereby appoint the following person as my counting

agent to attend the counting of votes at ..................................................

Name of the counting agent

Address of the counting agent

His recent photograph, duly attested by me is pasted below:--

Date:

Signature of candidate or election agent

I agree to act as such counting agent.

Place: ..........................

Signature of counting agent

Date: ...........................

TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY

Declaration of counting agent to be signed before the Returning Ofﬁ cer

I hereby declare that at the above election I will not do anything forbidden by the relevant section of the Act, which

I have read/ has been read over to me.

Date:

Signature of counting agent

Signed before me.

Date:

Signature of Returning Ofﬁ cer

----------------------------------------------------

-------------------------------------------------------------------------

(To be handed over to the counting agent for production at the counting centre.)

Relevant provision of the Act

“Every ofﬁ cer, clerk, agent or other person performing any duty in connection with the recording or counting of votes at

an election who, except for some purpose authorised by law, communicates to any person any information showing directly

or indirectly for which candidate any voter has voted, and every person, who by any improper means procures any such

information, shall be punished with imprisonment [of either description]* which may extend to six months or with ﬁ ne, or with

both”.

*only in the case of Chennai Corporation vide section 66 of the Chennai City Municipal Corporation Act, 1919

TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY

FORM 25

RESULT SHEET

[See rules 86(2), 88(1), 88(4)(b), 88(5) and 89(d)]

Election of the Councillor to Ward / Division No. ............ of .............................. Town Panchayat / Municipality /

Corporation.

Sl.

No.

Name of the candidate

Votes secured

through postal ballot

Votes secured at

the polling stations

Total

(1)

(2)

(3)

(4)

(5)

...

Total No. of valid votes polled

Rejected votes

Tendered votes

TOTAL

Place: ..........................

Signature of Returning Ofﬁ cer

Date: ...........................

TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY

FORM 26

RETURN OF ELECTION

[See rule 89(a)]

.......................................................... Town Panchayat / Municipality / Corporation.

Election of the Councillor to Ward/Division No. .............. of .................................... Town Panchayat / Municipality /

Corporation.

Sl. No.

Name of the candidate

No. of valid votes polled

(1)

(2)

(3)

...

Total No. of valid votes polled

Total No. of rejected votes

I declare that Thiru / Tmt. / Selvi .............................................................. has been duly elected as Member / Councillor

of the ..................... Ward/Division of ......................................... ........................................ Town Panchayat / Municipality /

Corporation.

Place: ..........................

Returning Ofﬁ cer

Date: ...........................

TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY

FORM 27

DECLARATION OF THE RESULT OF ELECTION

[See rules 30(2) and 91]

Election of the Councillor to Ward / Division No...........of ................................. Town Panchayat / Municipality / Corporation.

DECLARATION

In pursuance of the provisions contained in rule 91 of the Tamil Nadu Town Panchayats, Municipalities and Corporations

(Elections) Rules, 2006, I declare that—

Thiru / Tmt. / Selvi ............................................. (Name)

.....................................................................................(Address)

has been duly elected as Member / Councillor from Ward / Division No...................... of ..................................................

....................... Town Panchayat / Municipality / Corporation.

Place: ..........................

(Signature) ...........................

Date: ...........................

Returning Ofﬁ cer

TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY

FORM 28

NOMINATION FORM

[See rule 100(1)]

Election of Chairman / Vice-Chairman / Mayor / Deputy Mayor of ............................................ Town Panchayat / Municipality

/ Corporation

Election of Chairman of .................. Wards Committee of ....................... Municipality/ Corporation

Election of ................................ Committee members of ................................... Town Panchayats/ Municipality/ Corporation.

I, Thiru. / Tmt. /Selvi ..................................................... Member / Councillor from Ward/Division No.................. hereby

nominate Thiru / Tmt. / Selvi ............................................. Member/Councillor from Ward/Division No......................., as a

candidate for the election of Chairman / Vice-Chairman / Mayor / Deputy Mayor / Chairman of Wards Committee/ Member

of ........................................ Committee of the ................................................. Town Panchayat/ Municipality/ Corporation.

Place: ..........................

Signature of the Proposer

Date: ...........................

I, Thiru. / Tmt. / Selvi ..................................................................... Member / Councillor from Ward/Division No. ..........

.................................., hereby second the above nomination.

Place: ..........................

Signature of the Seconder.

Date: ...........................

Declaration of the Candidate

I, Thiru. / Tmt. / Selvi .......................................................... member / Councillor from Ward/Division No. .....................

................, hereby .............................. ................................... assent to this nomination.

* I am a Member of the ...................................................................... caste/ tribe which is a Scheduled Caste/ Tribe in

the State of Tamil Nadu in relation to ........................................................ (area).

Place: ..........................

Signature of the Candidate

Date: ...........................

* needs to be made only for Chairman / Mayor election by a SC/ST candidate.

TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY

FORM 29

BALLOT PAPER

[See rule 106]

--------------------------------------------------------------------------------------------------------------------------------------------------------------------

Election of Chairman/Vice-Chairman/Mayor/Deputy Mayor/Chairman/Member of the .............................. .......................

Wards Committee .................... .......... Statutory Committee of ..................... ................................ Town Panchayat/ Municipality/

Corporation.

------------------------------------------------------------------------------------------------------------------------------------------------------------------

Serial No.:

------------------------------------------------------------------------------------------------------------------------------------------------------------------

NAME

WARD/DIVISION No.

------------------------------------------------------------------------------------------------------------------------------------------------------------------

NAME

WARD/DIVISION No.

------------------------------------------------------------------------------------------------------------------------------------------------------------------

NAME

WARD/DIVISION No.

------------------------------------------------------------------------------------------------------------------------------------------------------------------

NAME

WARD/DIVISION No.

------------------------------------------------------------------------------------------------------------------------------------------------------------------

Returning Ofﬁ cer.”.

------------------------------------------------------------------------------------------------------------------------------------------------------------------

HARMANDER SINGH

Principal Secretary To Government

PRINTED AND PUBLISHED BY THE DIRECTOR OF STATIONERY AND PRINTING, CHENNAI

ON BEHALF OF THE GOVERNMENT OF TAMIL NADU