FORM 13-A [See rule 23 (1) (A)] Declaration by Elector Election to the ........................ (This side is to be used only when the elector signs the declaration himself). I hereby declare that I am the elector to whom the postal ballot paper bearing serial number .......... has been issued at the above election. Signature of elector Date.......... Address................ Attestation of signature The above has been signed in my presence by.......... (elector) who**is personally known to me /has been identified to my satisfaction by.............. (identifier) who is personally known to me. Signature of identifier, if any ........................................... Address................................................... Signature of Attesting Officer Designation........ Address ........... Date ............. (This side is to be used when the elector cannot sign himself). I hereby declare that I am the elector to whom the postal ballot paper bearing serial number .......... has been issued at the above election. Date ............ Signature of Attesting Officer on behalf of elector. Address of elector................................ Certificate I hereby certify that (1) The above named elector** is personally known to me/has been identified to my satisfaction by................ (identifier) who is personally known to me; (2) I am satisfied that the elector** is illiterate/suffers from ................ (infirmity) and is unable to record his vote himself or sign his declaration; (3) I was requested by him to mark the ballot paper and to sign the above declaration on his behalf; and (4) The ballot paper was marked and the declaration signed by me on his behalf in his presence and in accordance with the wishes. Signature of identifier, if any........ Address........... Signature of Attesting Officer, Designation ............ Address ............... Date ............... Here insert one of the following alternatives a may be appropriate: (1) Legislative Assembly from the ........ Constituency. (2) Legislative Council by the members of the Legislative .......... Assembly. (3) Legislative Council from the ........... Constituency. **Strike off the inappropriate alternative.
