Loading...
Are you looking for a legal research tool ?
Get Started
Do check other products like LIBIL, a legal due diligence tool to get a litigation check report and Case Management tool to monitor and collaborate on cases.

Tamil Nadu Local Bodies Election Symbols (Reservation And Allotment) Order, 2022

Tamil Nadu Local Bodies Election Symbols (Reservation And Allotment) Order, 2022

Tamil Nadu Local Bodies Election Symbols (Reservation And Allotment) Order, 2022

 

[06th January 2022]

An order to provide for specifications, reservation, choice and allotment of symbols at elections to local bodies in the State of Tamil Nadu and for matters connected therewith.

Whereas, the superintendence, direction and control of all elections to local bodies in the State of Tamil Nadu are vested in the Tamil Nadu State Election Commission (hereinafter referred to as 'the State Election Commission') by the Constitution of India, the Tamil Nadu Panchayats Act, 1994 (Tamil Nadu Act 21 of 1994), the Chennai City Municipal Corporation Act, 1919 (Tamil Nadu Act IV of 1919), the Madurai City Municipal Corporation Act, 1971 (Tamil Nadu Act XV of 1971), the Coimbatore City Municipal Corporation Act, 1981 (Tamil Nadu Act XXV of 1981), the Tiruchirapalli City Municipal Corporation Act, 1994 (Tamil Nadu Act 27 of 1994), the Tirunelveli City Municipal Corporation Act, 1994 (Tamil Nadu Act 28 of 1994), the Salem City Municipal Corporation Act, 1994 (Tamil Nadu Act 29 of 1994), Tiruppur City Municipal Corporation Act, 2008 (Tamil Nadu Act 7 of 2008), the Erode City Municipal Corporation Act, 2008 (Tamil Nadu Act 8 of 2008), the Vellore City Municipal Corporation Act, 2008 (Tamil Nadu Act 26 of 2008), the Thoothukudi City Municipal Corporation Act, 2008 (Tamil Nadu Act 27 of 2008), the Thanjavur City Municipal Corporation Act, 2013 (Tamil Nadu Act 24 of 2013), the Dindigul City Municipal Corporation Act, 2013 (Tamil Nadu Act 25 of 2013), the Hosur City Municipal Corporation Act, 2019 (Tamil Nadu Act 10 of 2019), the Nagercoil City Municipal Corporation Act, 2019 (Tamil Nadu Act 11 of 2019), the Avadi City Municipal Corporation Act, 2019 (Tamil Nadu Act 24 of 2019), the Cuddalore City Municipal Corporation Ordinance, 2021 (Tamil Nadu Ordinance 1 of 2021), the Kancheepuram City Municipal Corporation Ordinance, 2021 (Tamil Nadu Ordinance 2 of 2021), the Sivakasi City Municipal Corporation Ordinance, 2021 (Tamil Nadu Ordinance 3 of 2021), the Karur City Municipal Corporation Ordinance, 2021 (Tamil Nadu Ordinance 4 of 2021), the Tambaram City Municipal Corporation Ordinance, 2021 (Tamil Nadu Ordinance 5 of 2021), the Kumbakonam City Municipal Corporation Ordinance, 2021 (Tamil Nadu Ordinance 7 of 2021) and the Tamil Nadu District Municipalities Act, 1920 (Tamil Nadu Act V of 1920) (hereinafter referred to as 'the Acts');

AND Whereas, it is necessary and expedient to provide in the interest of purity of elections to the local bodies in the State of Tamil Nadu and in the interest of the conduct of such elections in a fair and efficient manner, for the specification, reservation, choice and allotment of symbols and for matters connected therewith:

NOW, Therefore, in exercise of the powers conferred by Articles 243-K and 243-ZA of the Constitution of India read with relevant sections of the Acts and rules 33, 34 and 35 of the Tamil Nadu Panchayats (Elections) Rules, 1995, rules 31, 32 and 33 of the Tamil Nadu Town Panchayats, Municipalities and Corporations (Elections) Rules, 2006 and in supersession of the State Election Commission's S.O.No. 14/2019/TNSEC/EG-1, dated 6.9.2019 published at pages 1 to 16 of Part VI-Section 2, Notification No.VI(2)/87(a)/2019 of the Tamil Nadu Government Gazette, Extraordinary No. 362, dated 13.9.2019, and as amended, from time to time, the State Election Commission hereby makes the following order:-

Order - 1. Short title, application and commencement.

(1)     This Order may be called the Tamil Nadu Local Bodies Election Symbols (Reservation and Allotment) Order, 2022.

(2)     It shall apply to all elections held under the Acts.

(3)     It shall come into force at once.

Order - 2. Definition and Interpretation.

(1)     In this Order, unless the context otherwise requires, -

(a)      "Contested election" means an election where a poll is taken;

(b)      "Election" means an election held under the Acts;

(c)      "Form" means a form appended to this Order;

(d)      "Free symbol" means a symbol other than a reserved symbol;

(e)      "Government" means the Government of Tamil Nadu;

(f)       "Local bodies" means and includes all the Village Panchayats, Panchayat Unions, District Panchayats, Town Panchayats, Municipalities and Municipal Corporations;

(g)      "Ordinary election" means an election held to fill up a vacancy occurring by efflux of time;

(h)     "Political party" means an association or a body of individual citizens of India registered with the Election Commission of India as a political party under Section 29A of the Representation of the People Act, 1951;

(i)       "Reserved symbol" means a symbol which is reserved by the Election Commission of India for exclusive allotment to a contesting candidate set up by a recognised political party;

(j)       "Recognised political parties" means and includes every political party which has been recognised by the Election Commission of India as a National Party or as a State Party in the State of Tamil Nadu under the Election Symbols (Reservation and Allotment) Order, 1968; and

(k)      "Registered - Unrecognised political party" means and includes

(i)       every political party which had previously been recognised by the Election Commission of India as a National Party under the Election Symbols (Reservation and Allotment) Order, 1968 and subsequently lost its status as National Party;

(ii)      every political party which has been recognised by the Election Commission of India as a State Party in any State other than Tamil Nadu under the Election Symbols (Reservation and Allotment) Order, 1968;

(iii)     every political party having its head office in the State of Tamil Nadu which is registered with the Election Commission of India but not recognised either as a National Party or as a State Party in Tamil Nadu by the Election Commission of India under the Election Symbols (Reservation and Allotment) Order, 1968; and

(iv)    political parties registered with the Election Commission of India and having their head office in other States and have not been recognized either as a National Party or as a State Party by the Election Commission of India under the Election Symbols (Reservation and Allotment) Order, 1968; provided such parties should make an application to the State Election Commission with its office address in Tamil Nadu, bye-laws, office bearers, etc.

(2)     Words and expressions used but not defined in this Order but defined in the Tamil Nadu Panchayats Act, 1994 (Tamil Nadu Act 21 of 1994) or the rules made there under or in the Chennai City Municipal Corporation Act, 1919 (Tamil Nadu Act IV of 1919) or in the Madurai City Municipal Corporation Act, 1971 (Tamil Nadu Act XV of 1971) or in the Coimbatore City Municipal Corporation Act, 1981 (Tamil Nadu Act XXV of 1981) or in the Tiruchirapalli City Municipal Corporation Act, 1994 (Tamil Nadu Act 27 of 1994) or in the Tirunelveli City Municipal Corporation Act, 1994 (Tamil Nadu Act 28 of 1994) or in the Salem City Municipal Corporation Act, 1994 (Tamil Nadu Act 29 of 1994) or in the Tiruppur City Municipal Corporation Act, 2008 (Tamil Nadu Act 7 of 2008) or in the Erode City Municipal Corporation Act, 2008 (Tamil Nadu Act 8 of 2008) or in the Vellore City Municipal Corporation Act, 2008 (Tamil Nadu Act 26 of 2008) or in the Thoothukudi City Municipal Corporation Act, 2008 (Tamil Nadu Act 27 of 2008) or in the Thanjavur City Municipal Corporation Act, 2013 (Tamil Nadu Act 24 of 2013) or in the Dindigul City Municipal Corporation Act, 2013 (Tamil Nadu Act 25 of 2013) or the Hosur City Municipal Corporation Act, 2019 (Tamil Nadu Act 10 of 2019) or the Nagercoil City Municipal Corporation Act, 2019 (Tamil Nadu Act 11 of 2019) or the Avadi City Municipal Corporation Act, 2019 (Tamil Nadu Act 24 of 2019) or the Cuddalore City Municipal Corporation Ordinance, 2021 (Tamil Nadu Ordinance 1 of 2021) or the Kancheepuram City Municipal Corporation Ordinance, 2021 (Tamil Nadu Ordinance 2 of 2021) or the Sivakasi City Municipal Corporation Ordinance, 2021 (Tamil Nadu Ordinance 3 of 2021) or the Karur City Municipal Corporation Ordinance, 2021 (Tamil Nadu Ordinance 4 of 2021) or the Tambaram City Municipal Corporation Ordinance, 2021 (Tamil Nadu Ordinance 5 of 2021) or the Kumbakonam City Municipal Corporation Ordinance, 2021 (Tamil Nadu Ordinance 7 of 2021) or in the Tamil Nadu District Municipalities Act, 1920 (Tamil Nadu Act V of 1920) or rules made there under shall have the meaning respectively assigned to them in those Acts and rules.

(3)     In the absence of such definitions, the Tamil Nadu General Clauses Act, 1891 (Tamil Nadu Act 1 of 1891) shall, as far as may be, apply in relation to the interpretation of this Order as it applies in relation to the interpretation of a Tamil Nadu Act.

Order - 3. Notification by the State Election Commission of elections to be held on party-basis.


For the purposes of this Order, the State Election Commission shall, in consultation with the Government, notify from time to time the election or elections which shall be held on party-basis and the election or elections which shall not be held on party-basis.

Order - 4. Notification by the State Election Commission of the list of recognised political parties and their symbols, the list of registered - unrecognised political parties and the list(s) of free symbols.

The State Election Commission shall notify from time to time a list of recognised political parties, the symbols respectively reserved for them and a list of registered - unrecognised political parties and the list or lists of free symbols.

Order - 5. Allotment of Symbols.


In every contested election, a symbol shall be allotted to a contesting candidate in accordance with the provisions of this Order and different symbols shall be allotted to different contesting candidates.

Order - 6. Allotment of Symbols in Elections not held on party-basis.

(1)     In every contested election not held on party basis, symbols shall be allotted to the candidates in the sequence of the symbols in the list of free symbols meant for that election by drawing lots.

Example.-If election of member of a ward of a Village Panchayat is not held on party-basis and if there are five candidates and if the first five symbols in the list are, say, (1) "Key", (2)" Comb", (3) "Cot", (4) "Car" and (5) "Conch", then these five symbols should be taken for allotment and assigned to the five candidates by drawing lots. The candidate whose name is drawn first shall get the symbol "Key" and the candidate whose name is drawn next shall get the symbol "Comb" and so on. If there had been only three candidates in the above example, only "Key", "Comb" and "Cot" could be allotted in that order.

(2)     In such election, the allotment of symbol shall be done only by drawing lots even if the contesting candidates agree among themselves upon their symbols.

Order - 7. Allotment of Symbols in Elections held on party basis.

(1)     Allotment of symbols to National Parties and Recognised Parties of Tamil Nadu In an election held on party-basis, a candidate set up by a recognised political party shall choose, and shall be allotted, the symbol reserved for that party and no other symbol:

Provided that when there are conflicting claims for any such reserved symbol due to defect of substantial character either in the nomination paper or in Form B or Form C filed, none of the claimants shall be allotted that reserved symbol and all the claimants shall be treated as independent candidates and allotted the free symbols left after allotting to all other candidates in that election:

Provided further that no reserved symbol shall be sought or allotted in an election, to any candidate other than a candidate set up by a recognised political party to which that symbol has been reserved, even if no candidate has been set up by that recognised political party in that election.

(2)     A. Concession to candidates set up by a State Party at elections in other States or Union Territories If a Political Party which is recognized as a State Party in some other State or States or Union Territories sets up a candidate at an election in a ward in any Local Body which are held on party basis, then such candidate may, to the exclusions of all other candidates in the said election be allotted the symbol reserved for that party in the State or States in which it is a recognised State Party, notwithstanding that such symbol is not specified in the list of free symbols for such election, on the fulfilment of each of the following conditions, namely:-

(a)      that an application is made to the State Election Commission by the said party for exclusive allotment of that symbol to the candidate set up by it, not later than the third day after the publication in the Official Gazette of the Notification calling the election or within three days from the date of issue of this order;

(b)      that the said candidate has made a declaration in his nomination paper that he has been set up by that party at the election and that the party has also fulfilled the requirements of clauses (b), (c) and (d) of paragraph 8; and

(c)      that in the opinion of the State Election Commission there is no reasonable ground for refusing the application for such allotment.

Provided that nothing contained in the paragraph shall apply to a candidate set up by the said party at an election in any Ward/Local Body where the same symbol is already reserved for some other National or State Party of Tamil Nadu.

B. Concession to candidates set up by unrecognised party which was earlier recognised as a National or State party If a Political Party, which is unrecognized at present but was a Recognised National or State Party in the State of Tamil Nadu not earlier than six years from the date of notification of the election sets up a candidate at an election in a ward in any Local body which are held on party basis then such candidate may, to the exclusion of all other candidates in the said election, be allotted the symbol reserved earlier for that party when it was a Recognised National or State party in Tamil Nadu notwithstanding that such symbol is not specified in the list of free symbols for such election, on the fulfilment of each of the following conditions, namely:-

(a)      that an application is made to the State Election Commission by the said party for the exclusive allotment of that symbol to the candidate set up by it, not later than the third day after the publication in the Official Gazette of the Notification calling the election;

(b)      that the said candidate has made a declaration in his nomination paper that he has been set up by that party of the election and that the party has also fulfilled the requirements of clauses (b), (c) and (d) of paragraph 8; and

(c)      that in the opinion of the State Election Commission there is no reasonable ground for refusing the application for such allotment.

Provided that nothing contained in the paragraph shall apply to a candidate set up by the said party at an election in any Ward/Local Body where the same symbol is already reserved for some other National or State Party.

C. Concession to candidates set up by registered (unrecognised) political parties and to unrecognized parties which were earlier recognised parties more than 6 years back If a registered unrecognized political party has been allotted with a common symbol in the elections conducted by the Election Commission of India and not cancelled subsequently, the said registered unrecognized political party may request the State Election Commission to continue to allot the same common symbol in the Local Body Elections conducted by the State Election Commission also subject to the following conditions:

Provided that if a common symbol allotted by Election Commission of India to one or more registered political parties in different elections prior to Local Body Elections, that common symbol shall be considered for allotment to the party to whom the common symbol were allotted by the Election Commission of India in the recently held Election;

Provided further that an application is made to the State Election Commission by the said party for the concession for the allotment of common symbol to the candidates set up by it, not later than the third day after the publication in the Official Gazette of the notification calling the election along with the details of No. of wards / offices in which the said party wishes to get concession for the allotment of common symbol;

Provided further that the free symbol allotted as a common symbol shall not be entitled for the candidates set up by the party other than those wards / offices for which the details has been furnished as per para 3 to the State Election Commission under this provision;

Provided further that if the party does not set up candidates as furnished, the party shall be liable for such action as the the State Election Commission may consider appropriate as per existing laws;

Provided further that the free symbol allotted as a common symbol to the candidates of a party under this paragraph shall be available for allotment to candidates set up by the other party or independent candidates in those other wards in which that party has not set up its candidates; and

Provided also that notwithstanding anything contained in paragraph 7(1) B, a political party which was earlier a recognized political party and which lost its recognition more than 6 (six) years back will also be eligible under this paragraph to the concession of allotment of the symbol which was earlier reserved for the party as above.

(3)     Choice of symbol by candidates set up by registered - unrecognised political parties and by independent candidates .- Every independent candidate, shall declare in the nomination paper first filed by him or on his behalf, his choice of three free symbols from the list of free symbols for that election indicating the order of his preference. Every candidate who is set up by the registered - unrecognised political party shall declare in the nomination paper first filed by him or on his behalf, his choice of three free symbols collectively from the list of free symbols notified for the party based elections. The symbols shall be allotted in accordance with the procedure laid down below:-

(a)      The allotment of symbols shall be considered in the order of preference made by the candidates, that is to say, the first preference of the candidates will be considered first, the second preference next and the third preference last:

Provided that the allotment of symbols to candidates set up by the registered - unrecognised political parties shall be completed first and only thereafter the allotment of symbol to the independent candidates shall be taken up and allotted from among the remaining free symbols.

(b)      Where a free symbol has been sought for by only one candidate set up by a registered-unrecognised political party, as his first choice, it shall be allotted to that candidate and to no one else. If any free symbol has been sought for by more than one candidate set up by the registered-unrecognised political parties, the allotment of that symbol shall be decided by drawing a lot among these candidates and the candidate whose name is drawn first shall be allotted that symbol.

(c)      If any candidate set up by registered - unrecognised political party could not be allotted the symbol sought for in his first preference in the lot, he shall be considered for allotment of the free symbol sought for, as his second preference. Should the second choice of symbol could also not be allotted, due to conflicting claims for that symbol and failure in the lot, he shall be considered for the allotment of the free symbol of his third preference. Even if this could not be allotted, he should be allotted by drawing a lot, any one of the free symbols left after allotting to other candidates set up by the registered - unrecognised political parties in accordance with the procedure set out above.

(d)      After completing the allotment of free symbols to all the candidates set up by the registered - unrecognised political parties, the remaining free symbols shall be allotted to the independent candidates in accordance with their choice and preference by adopting the procedures for allotment of symbols to candidates set up by the registered - unrecognised political parties.

Order - 8. When a candidate shall be deemed to be set up by a political party.

(1)     For the purposes of this Order, a candidate shall be deemed to be set up by the political party if, and only if -

(a)      the candidate has enclosed a declaration to that effect in Form C along with the nomination paper;

(b)      a notice in writing in Form B to that effect has, not later than 3.00 p.m. on the last date for withdrawal of candidature, been delivered to the Returning Officer;

(c)      the said notice is either signed by the President/Secretary or any other office bearer and who has been authorised by the party in this behalf or any other person who has been authorised by such office bearer, to send the notice; and

(d)      the communication in Form A with regard to the name and specimen signature of such authorised person are delivered to the Returning Officer not later than 3.00 p.m. on the last date for withdrawal of candidature.

(2)     (a) The communication in Form A shall be signed by the President/Secretary or any other office bearer and who has been authorised by the party in this behalf to send such communication:

Provided where the notice in Form B is signed by any such office bearer authorised by the Party, Form A need not be insisted upon.

(b) Form C shall be signed in ink, while printed/cyclostyled/photocopies of Forms A and B with facsimile signature can be presented.

Order - 9. When splinter groups or rival groups claim to be that party.


If in an election to the local bodies held on party-basis, rival sections or groups of a recognised political party claim to be that party, the State Election Commission may decide on allotment of symbols to the candidates sponsored by such sections or groups and the State Election Commissions decision shall be final.

Order - 10. When two or more recognised political parties amalgamate into a new party.


If in an election to the local bodies held on party-basis, two or more recognised political parties join together to form a new political party but the recognition for it under the Election Symbols (Reservation and Allotment) Order, 1968, is pending before the Election Commission of India, the new party may be allotted by the State Election Commission any of the reserved symbols already allotted to the constituent parties, provided a request in writing for such an allotment is made jointly by the Chief Executive Officers of all the constituent recognised parties.

Order - 11. Power of State Election Commission to issue instructions and directions.


The State Election Commission may issue instructions and directions-

(a)      for the clarification of any of the provisions of this Order;

(b)      for the removal of any difficulty which may arise in relation to the implementation of any such provision; and

(c)      in relation to any matter with respect to the reservation and allotment of symbols for which this Order makes no provision or makes insufficient provision, and the provision is, in the opinion of the State Election Commission, necessary for the smooth and orderly conduct of elections.

 

FORM A

COMMUNICATION WITH REGARD TO AUTHORISED PERSONS TO INTIMATE NAME OF CANDIDATE SET UP BY THE RECOGNISED POLITICAL PARTY / REGISTERED - UNRECOGNISED POLITICAL PARTY

[See paragraph 8 (1) (d) and 8 (2) (a) of the Tamil Nadu Local Bodies Election Symbols (Reservation and Allotment) Order, 2022]

 

From

The President / Secretary / Office bearer,

...........................Party,

......................................................

......................................................

To

The Returning Officer for the

...........................Ward No. ........................... Panchayat Union/District Panchayat.

...........................Ward No........................... Town Panchayat/Municipality/Municipal Corporation.

Sir,

Subject: Elections to ........................... Allotment of Symbols -Authorisation of persons to intimate names of candidates.

* * *

In pursuance of sub-paragraphs (1) (d) and (2) (a) of paragraph 8 of the Tamil Nadu Local Bodies Election Symbols (Reservation and Allotment) Order, 2022, I hereby communicate that the following person(s) has/have been authorised by the party, which is a Recognised Political Party, to intimate the name(s) of the candidate(s) proposed to be set up by the party at the election(s) cited above.

 

 

 

 

 

 

 

 

 

 

 

 

Name of person authorised to send notice.

 

Name of Office held in the party.

 

The local body/ local bodies in respect of which he has been authorised.

 

Specimen signature of the person authorised to send notice in Form  B.




 

(1)

 

(2)

 

(3)

 

(4)




 

 

 

 

 

 

 

(i) ... ... ... ... ...




 

1.

(ii) ... ... ... ... ...




 

 

(iii) ... ... ... ... ...




 

 

 

 

 

 

 

(i) ... ... ... ... ...




 

2.

(ii) ... ... ... ... ...




 

 

(iii) ... ... ... ... ...




 

 

 

 

 

 

 

(i) ... ... ... ... ...




 

3.

(ii) ... ... ... ... ...




 

 

(iii) ... ... ... ... ...




 

 

 

 

 

 

 

(i) ... ... ... ... ...




 

4.

(ii) ... ... ... ... ...




 

 

(iii) ... ... ... ... ...




 

 

 

 

 

 

 

(i) ... ... ... ... ...




 

5.

(ii) ... ... ... ... ...




 

 

(iii) ... ... ... ... ...




 

Place:.................

Seal of the party

Date::.................

Yours faithfully,

President/Secretary/Office bearer

:.................:.................Party

(N.B.: This shall be delivered to the Returning Officer not later than 3.00 P.M. on the last date for withdrawal of candidature)

 

FORM B

NOTICE AS TO NAME OF CANDIDATE SET UP BY THE RECOGNISED POLITICAL PARTY / REGISTERED - UNRECOGNISED POLITICAL PARTY

[See Paragraph 8 (1) (b) (c) of the Tamil Nadu Local Bodies Election Symbols (Reservation and Allotment) Order, 2022]

 

From

.................

..................................Party,

..................................

..................................

To

The Returning Officer for the

..................................Ward No. .................Panchayat Union/District Panchayat / ................. Ward No................. Town Panchayat/Municipality/Municipal Corporation.

Sir,

Subject: Election(s) to ................. - Name(s) of candidate(s) - Intimated.

In pursuance of sub-paragraphs (1) (b) and (1) (c) of paragraph 8 of the Tamil Nadu Local Bodies Election Symbols (Reservation and Allotment) Order, 2022, I hereby give notice that the following person(s) has / have been set up by our party as its candidate(s) at the ensuing Local Bodies Election.

(1)     Name of the ward/ local body ...................................................

(2)     Name of the approved Candidate ...................................................

(3)     Fathers/ Husbands name of approved candidate. ...................................................

(4)     Postal address of approved Candidate. ..................................

...................................................

...................................................

(5)     Name of the substitute candidate ...................................................

(6)     Fathers/Husbands name of substitute candidate ..................................

(7)     Postal address of substitute candidate. ...................................................

...................................................

...................................................

It is certified that each of the candidates whose name is mentioned above, is a member of this political party and his name is duly borne on the rolls of the members of this party.

Place:.................

Date:.................

Yours faithfully,

President/Secretary/Office bearer/Authorised Person

..................................Party

N.B.: (1) A substitute candidate shall step-in in the event of the approved candidates nomination being rejected on scrutiny or his withdrawing from the contest.

(2) This shall be delivered to the Returning Officer not later than 3.00 P.M. on the last date for withdrawal of candidature.

 

FORM C

DECLARATION BY A CANDIDATE SET UP BY THE RECOGNISED POLITICAL PARTY / REGISTERED UNRECOGNISED POLITICAL PARTY

[See paragraph 8 (1) (a) of the Tamil Nadu Local Bodies Election Symbols (Reservation and Allotment) Order, 2022]

 

I, .................................. a candidate for the election of Member/ Councillor to the Ward No ................. of .................................. Panchayat Union / District Panchayat / Town Panchayat / Municipality / Municipal Corporation hereby declare that I have been set up at this election by .................................. Party, which is a recognised political party/ registered - unrecognised political party.

Signature of the Candidate

Place:

Date:

N.B.: Form shall be signed in ink.