FORM V - Nomination form for election of office bearers
[See sub-paragraph (3) of paragraph 7 of the Schedule]
1. Name of the multi-state cooperative :
and address
2. Office for which contesting :
3. Name of the candidate in case on an :
individual member or name of the delegate and the member cooperative society or multi-state cooperative society which he is representing
4. Serial No. in the register of members :
5. Father’s or husband’s name (in case of : Individual member)
6. Address :
7. Name of the proposer in case the :
proposer is an individual member and the name of the society and the delegate in the case proposer is a delegate of a society
8. Serial No. of the proposer in the :
Register of members
9. Signature of the proposer :
10. Name of the seconder when :
the seconder is an individual member and name of the society and the delegate in case the seconder is a delegate of a society
11. Serial No. of the seconder in the :
register of members
12. Signature of the seconder :
CANDIDATE’S DECLARATION
I declare that I am willing to stand for election of office of the President/Chairperson/Vice-President/ Vice-Chairperson (specify for any other office) and that, to the best of my knowledge and belief I have not incurred any disqualification for membership of the board of ____________________ multi-state cooperative society in terms of the Act, the rules and the bye-laws of the multi-state cooperative society.
(Signature of the candidate)
Endorsement by the Returning Officer
The nomination paper was presented to me in person by ___________________/received by registered post on _____________ at ________hrs.
Place ___________
Signature of Returning Officer
Or person authorized by him