FORM III - Nomination form for elections of Board of Directors - Multi-State Cooperative Societies Rules, 2002

FORM III Nomination form for elections of Board of Directors [See paragraph 3 (a) of the Schedule] 1. Name of the Multi-State Cooperative : Society and Address 2. Name of the candidate in case of an Individual member or name of the delegate and the member cooperative Society or multi-state cooperative society which he is representing : 3. Serial no. in the register of members : 4. Father s or husband s name (in case of individual member) : 5. Address : 6. 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 : 7. Serial no. of the proposer in the : Register of members 8. Signature of the proposer : 9. Name of the seconder when the seconder is an individual member and name of the society : 10. Serial no. of the seconder in the register of members : 11. Signature of the seconder : CANDIDATES DECLARATION I declare that I am willing to stand for election 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 This nomination paper was presented to me in person by ___________/ received by registered post on _____ at _____ hrs. Place _________ Date _________ Signature of Returning Officer Or person authorized by him