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State of Goa - Section
Section 109 in The Goa Agricultural Produce Marketing (Development and Regulation) Rules, 2010
109. Repeal and saving.
| (1) | Name of the Constituency | : |
| (2) | Full name of Candidate | : |
| (3) | Father's/husband's name | : |
| (4) | Age | : |
| (5) | Sex | : |
| (6) | Community | : |
| (7) | Occupation and address | : |
| (8) | Full name of Proposer | : |
| (9) | Serial Number of the proposer in the list of voters | : |
| (10) | Signature of the Proposer | : |
| ............................| [Candidate] [Strike off if necessary.][Proposer of the Candidate] [Strike off if necessary.] |
| Serial No. | Name of the Candidate | Address of candidate | Symbol allotted to the candidate | |
| (1) | ||||
| (2) | ||||
| (3) | ||||
| (4) | ||||
| Etc. |
| Date:Signed before me. | Signature of Polling Agent |
| Date: | Presiding Officer |
| Votingpaper | Serial No. | Candidate's Name | Candidate's Symbol | Voters mark |
| Voter'sNo.on the listof voters | (1)(2)(3)(4)(5) |
| Serial No. of the entry | Name of the voter | Serial No. of the Voter in the list of voters | Address of the voter | Serial No. of tendered ballot paper | Serial No. of ballot paper issued to the personwho has already voted | Signature or thumb impression of the voter |
| (1) | (2) | (3) | (4) | (5) | (6) | (7) |
| Serial No. | Total No. | |||
| (1) | Number of ballot papers received by the Presiding Officer atthe Polling Station or if the Polling Station has more than onebooth at each booth | |||
| (2) | Number of ballot papers issued to voters | |||
| (3) | Number of unused ballot papers returned | |||
| (4) | Number of ballot papers cancelled | |||
| (5) | Number of tendered ballot papers used | |||
| (6) | Number of ballot papers in ballot boxes |
| Polling Station | Number of valid votes casted in favour | Number of | Number of Votes | Remarks | ||||||||
| Serial No. | Name | A | B | C | D | Etc. | Valid | Rejected Votes | Total Votes | Tendered votes for Polling Station | ||
| Serial No. | Name of Candidate | Number of valid votes given for the candidate |
| (1) | ||
| (2) | ||
| (3) | ||
| (4) | ||
| Etc. |
| Serial No. | Name and Address of Applicant | Date of Receipt of Application | Registration fee (Rs.) | District(s) for which Registration is granted | Period for which Registration is granted | No. and Date of issue of Registration | Signature | Remarks |
| Village | Survey No. | Area in Hectare | Taluka | District | State |
| Date | Delivery Point | Cost of Delivery |
| Date | Mode of payment | Place of payment |