Serial No. _______________

Nomination paper__________

Counterfoil________________

Name and address of the candidate_________________________________________

Serial No. of electoral roll__________________________________

Date of despatch _________________________________________

Initial of despatching officer       _______________________

Serial No._________

Name of candidate______________________________________

Qualifications and dates thereof Address or appointment _________

Date of registration and registration number__________________

Serial number of the candidate on the electoral roll______________

Name of proposer _______________________________________

Serial number of the proposer on the electoral roll ______________

Signature of the proposer__________________________________

Name of the seconder_____________________________________

Serial number of the seconder on the electoral roll______________

Signature of the seconder ___________________________

            DECLARATION BY CANDIDATE

I hereby declare that I agree to this nomination.

Date_______________Signature of the candidate___________________

Note.-This nomination paper will not be valid unless it is delivered to the President or any other person appointed by him to receive it at his office between the hours of eleven o’clock of the forenoon and three o’clock of the afternoon on or before 19____]

¹Substitued by Punjab Government, Health Department notification No. ___________ 2HE-54/37100, dated the 13^th July, 1954, for “Form III”.