mptc

🗳️ MPTC & ZPTC Elections PO Filled Forms + Colour Covers Guide
Laxmi Puram MPTC & Bheemunipatnam ZPTC | Visakhapatnam Dist. | PO: K. Sanyasi Naidu

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MPTC & ZPTC ELECTIONS — VISUAL GUIDE TO COLOUR COVERS (PAGES 104 & 105) ZPTC: BHEEMUNIPATNAM ZPTC | MPTC: LAXMI PURAM MPTC | District: VISAKHAPATNAM | PO: K. Sanyasi Naidu ✉️ (a) SELF-PRINTED BROWN COVERS (5 OPEN COVERS) Handed over at Reception Counter (Not put in Big Packet): 1. Cover for Ballot Paper Account (Form-XXV) (MPTC Pink & ZPTC White) — Small (5"×11") [Statutory] 2. Cover for PO Declarations Before & After Poll (Annex-10) — Medium (12"×10") [Non-Statutory] 3. Cover for Paper Seal Account (Annex-8) — Small (5"×11") [Non-Statutory] 4. Cover for PO's Diary (Annex-19) — Small (5"×11") [Non-Statutory] 5. Cover for Visit Sheet (Annex-23) — Small (5"×11") [Non-Statutory] ✉️ (b) STATUTORY COVERS — GREEN COLOUR (1 BIG + 7 INNER) Big Green Cover (16"×12") contains 7 sealed Green Covers: 1. Marked Copy of Electoral Roll (MPTC/ZPTC) — Medium (12"×10") 2. Signed but Unused Ballot Papers with counterfoils — Medium 3. Other Unused Ballot Papers with counterfoils — Medium 4. Tendered Ballot Papers & List in Form-XXIV (Annex-28) — Small 5. Ballot Papers Cancelled for Voting Procedure Violation — Small 6. Other Cancelled / Spoilt Ballot Papers — Small 7. Counterfoils of Used Ballot Papers (MPTC & ZPTC) — Medium ✉️ (c) NON-STATUTORY COVERS — YELLOW COLOUR (1 BIG YELLOW COVER 16"×12" + 10 INNER YELLOW COVERS) 1. Other Copies of Electoral Roll (Working Copies) — Medium (2) 2. Appointment Letters of Polling Agents (Form-XII / Annex-22) — Medium (2) 3. Election Duty Certificates (Form-XV & XVI / Annex-26 & 27) — Small (1) 4. Cover for Challenged Votes (Form-XXI / Annex-24) — Small (2) 5. List of Blind & Infirm Electors (Form-XXIII / Annex-25) & Companion Declarations (Form-XXII / Annex-16) — Small (2) 6. Declarations of Electors as to Age (Annex-2) & Lists (Annex-14 & 15) — Small (2) 7. Receipt Book & Cash for Challenged Votes (Annex-12) — Medium (2) 8. Unused and Damaged Paper Seals — Small (2) 9. Any other paper PO decides to keep (SHO Letter Annex-13 / Specimen Signatures Annex-30) — Medium (2) 10. Plain Covers (Yellow) — Medium (2) ✉️ (d) BLUE COLOURED COVER — BIG SIZE (16"×12") — 1 No. Contains 6 Polling Station Articles: 1. Handbook for Presiding Officers 2. Indelible Ink Set (stopper secured with molten wax) 3. Self-inking Pads (Purple) 4. Metal Seal of Presiding Officer 5. Arrow Cross Mark Rubber Stamp 6. Distinguishing Mark Rubber Stamp ✉️ (e) EMPTY COVER — WHITE COLOUR (BIG SIZE 16"×12") Purpose: • Used when any printed cover is smaller or unavailable (purpose written in red ink). • Used for keeping PO Reference Checklists, Material Lists, Postal Ballot RO Copy & SEC-EMS App Circular (`Annex-4, 5, 18, 21, 31`). 📏 COVER SIZES (Page 105): BIG = 16" × 12" | MEDIUM = 12" × 10" | SMALL = 5" × 11"  |  MPTC Ballot = PINK  |  ZPTC Ballot = WHITE

Cover Guide - Page 1

MASTER INDEX OF ALL MPTC & ZPTC FORMS — COVER COLOUR & STATUTORY STATUS MPTC: LAXMI PURAM | ZPTC: BHEEMUNIPATNAM | District: VISAKHAPATNAM | PO: K. Sanyasi Naidu PDF Page Annexure / Form No. Name of the MPTC / ZPTC Form Statutory / Non-Statutory (Page 103) Envelope Colour & Size (Pages 104–105) Cover Ref. 95 Annexure-2 Form of Declaration by Elector about Age Non-Statutory (C-3) YELLOW (Small) D(c)(6) 100-101 Annexure-4 Check Memo for Presiding Officers Non-Statutory Memo WHITE (Big) D(e) 102-105 Annexure-5 Material Required, Statutory Forms & Covers List Non-Statutory List WHITE (Big) D(e) 116 Annexure-8 Record & Account of Paper Seals Used (MPTC/ZPTC) Non-Statutory (C-7) BROWN (Small) D(a)(3) 118-121 Annexure-10 (I–III) Declarations by PO Before Poll, 2nd Box & End of Poll Non-Statutory (C-2) BROWN (Medium) D(a)(2) 123 Annexure-12 Receipt for Challenge Fee (Book & Cash) Non-Statutory (C-5) YELLOW (Medium) D(c)(7) 124 Annexure-13 Letter of Complaint to SHO (Police) Non-Statutory (C-6) YELLOW (Medium) D(c)(9) 125 Annexure-14 List of Voters from whom Age Declaration Obtained Non-Statutory (C-4) YELLOW (Small) D(c)(6) 126 Annexure-15 List of Electors who Refused Age Declaration Non-Statutory (C-4) YELLOW (Small) D(c)(6) 127 Annexure-16 (Form-XXII) Declaration by Companion of Blind/Infirm Voter Statutory Form (B-7) YELLOW (Small) D(c)(5) 129 Annexure-18 Items of Election Papers Sealed in Separate Packet Statutory Checklist GREEN (Big) D(b) 130-132 Annexure-19 Presiding Officer's Diary (7 AM to 5 PM MPTC/ZPTC) Non-Statutory (C-9) BROWN (Small) D(a)(4) 133-134 Annexure-20 (Form-XXV) Ballot Paper Account (Part-I & Part-II) Statutory Form (B-6) BROWN (Small) D(a)(1) 135 Annexure-21 (Form-XIV) Application for Postal Ballot Paper (MPTC/ZPTC) Statutory RO Record WHITE (Big) D(e) 136 Annexure-22 (Form-XII) Appointment of Polling Agent (MPTC/ZPTC) Statutory Form (B-2) YELLOW (Medium) D(c)(2) 137 Annexure-23 Visit Sheet (7:00 AM to 5:00 PM Poll) Non-Statutory (C-8) BROWN (Small) D(a)(5) 138 Annexure-24 (Form-XXI) List of Challenged Votes Statutory Form (B-3) YELLOW (Small) D(c)(4) 139 Annexure-25 (Form-XXIII) List of Illiterate, Blind or Infirm Voters Statutory Form (B-4) YELLOW (Small) D(c)(5) 140 Annexure-26 (Form-XV) Application for Election Duty Certificate (EDC) Statutory EDC Form YELLOW (Small) D(c)(3) 141 Annexure-27 (Form-XVI) Election Duty Certificate (EDC) Statutory EDC Form YELLOW (Small) D(c)(3) 142 Annexure-28 (Form-XXIV) List of Tendered Votes & Tendered Ballot Papers Statutory Form (B-5) GREEN (Small) D(b)(4) 146 Annexure-30 Specimen Signatures of MPTC & ZPTC Candidates/Agents Non-Statutory Sheet YELLOW (Medium) D(c)(9) 147-150 Annexure-31 APSEC Circular on SEC-EMS Mobile App (MPTC/ZPTC) Non-Statutory Circular WHITE (Big) D(e)

Cover Guide - Page 2

THIS FORM IS KEPT IN YELLOW COLOUR ENVELOPE (SMALL SIZE - 5" × 11") [ITEM D(c)(6)] THIS IS A NON-STATUTORY FORM (CONTAINED INSIDE THE BIG YELLOW NON-STATUTORY PACKET) ANNEXURE-2 FORM OF DECLARATION BY ELECTOR ABOUT AGE I hereby solemnly declare and affirm that my age was more than 18 years on the first date of January, 2026, i.e., the qualifying date with reference to which the existing electoral roll of the constituency was prepared/revised. I am aware of the penal provisions of Section 216 of Bharatiya Nyaya Samhita, 2023, for making any false declaration in connection with the inclusion of any name in the electoral roll or the preparation, revision or correction of the electoral roll. Signature/Thumb impression of the Elector K. Paidithalli (Karri Paidithalli) ________________________________________ Father/Mother/Husband's Name S/o K. Appanna ________________________________________ Part number of elector roll Part No. 04 (Laxmi Puram MPTC / Bheemunipatnam ZPTC) ________________________________________ Dated: 17-02-2026 Serial number of elector Sl. No. 118 ________________________________________ Certified that the above declaration was made and subscribed by the elector above named before me. Dated: 17-02-2026 Signature of the Presiding Officer K. Sanyasi Naidu (K. Sanyasi Naidu) ________________________________________ Number and name of polling station PS No. 04 - MPUP School, Laxmi Puram MPTC, Bheemunipatnam ZPTC, Visakhapatnam ZPP ________________________________________

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THIS FORM IS KEPT IN WHITE COLOUR ENVELOPE (BIG SIZE - 16" × 12") [ITEM D(e)] THIS IS A NON-STATUTORY FORM (PRESIDING OFFICER'S REFERENCE CHECK MEMO) ANNEXURE-4 CHECK MEMO FOR PRESIDING OFFICERS ZPP: VISAKHAPATNAM | ZPTC: BHEEMUNIPATNAM | MPTC: LAXMI PURAM | PO: K. Sanyasi Naidu Item No. (1) Action of be taken (2) Remarks (3) 1. Obtaining and keeping in possession all relevant instructions from the Returning Officer. Whether obtained and kept? Yes, Obtained from RO (MPTC/ZPTC) 2. Familiarisation with the other members of the polling party and maintenance of close relationship with them. Whether done? Yes, Done 3. Collection of election materials Whether ensured that all the election materials and that too in sufficient quantities and numbers have been collected? Yes, Collected for MPTC & ZPTC 4. Checking up of ballot papers, ballot boxes, marked copies of the electoral roll, arrow cross mark rubber stamps, distinguishing mark etc. Whether done? Yes, Checked MPTC (Pink) & ZPTC (White) 5. Separate entrance and exit for voters at polling stations. Whether ensured? Yes, Ensured 6. Display of notice specifying the polling area and the numbers of electors assigned and also a copy of the list of contesting candidates; Whether displayed? Yes, Form-IX (MPTC & ZPTC) Displayed 7. Address tag to be put inside the ballot box Whether done? Yes, Done 8. Declaration to be made at the Commencement of the poll. Whether made? Yes, Made at 06:50 AM 9. Signing of ballot papers and affixing the distinguishing mark. Whether done? Yes, Signed in Green Ink & Stamped 10. Shuffling of bundles of ballot papers Whether done? Yes, Done 11. Reading out the provisions of the Section 217 of APPR Act, 1994 with regard to the secrecy of voting to be done by the Presiding Officer at the beginning of poll. Whether done? Yes, Read out at 06:55 AM

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THIS FORM IS KEPT IN WHITE COLOUR ENVELOPE (BIG SIZE - 16" × 12") [ITEM D(e)] THIS IS A NON-STATUTORY FORM (PRESIDING OFFICER'S REFERENCE CHECK MEMO - CONT.) 12. Allowing polling agents to see the bundles of ballot papers and note the first and last serial number of ballot paper. Whether allowed? Yes, Allowed (MPTC: 01201–01650; ZPTC: 05201–05650) 13. Marking of indelible ink on left forefinger and obtaining the signature / thumb impression on the counterfoils of ballot papers Whether being properly done? Yes, Properly Done for all 378 Electors 14. Declaration from under-aged electors Whether obtained? Yes, Obtained from 02 Electors 15. Maintenance of Presiding Officer's diary Whether events are recorded from time to time as and when they occur? Yes, Recorded from 7:00 AM to 5:00 PM 16. Ballot paper account Whether attested copies given to all the polling agents? Yes, Furnished to all MPTC/ZPTC Agents 17. Declaration to be made at the close of poll Whether made? Yes, Made at 05:05 PM 18. Sealing of election papers Whether done according to instructions? Yes, Sealed in Green & Yellow Covers Place: Laxmi Puram MPTC (PS No. 04) Date: 17-02-2026 K. Sanyasi Naidu Signature of Presiding Officer Name: K. Sanyasi Naidu

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THIS FORM IS KEPT IN WHITE COLOUR ENVELOPE (BIG SIZE - 16" × 12") [ITEM D(e)] THIS IS A NON-STATUTORY FORM (CHECKLIST OF POLLING MATERIAL REQUIRED AT POLLING STATION) ANNEXURE-5 MATERIAL REQUIRED AT POLLING STATION A.    POLLING MATERIAL:- (All material, except Indelible Ink and Paper Seals for Ballot Boxes, are to be provided / procured locally by the District administration). 1. Ballot Boxes 1 or 2 (Recd: 1) 2. Ballot Papers (MPTC Pink & ZPTC White) As per requirement (450+450) 3. Marked Copies of Electoral Rolls 4 (Recd: 4) 4. Indelible Ink Phial (10 C.C.) As per requirement (2) 5. Paper Seals for Ballot boxes 4 (Recd: 4) 6. Address Tags for Ballot Boxes 4 (Recd: 4) 7. Label for Ballot Boxes 4 (Recd: 4) 8. Arrow Cross Mark Rubber Stamp 1 (Recd: 1) 9. Distinguishing Mark Rubber Stamp 1 (Recd: 1) 10. Stamp Pad (Purple) 2 (Recd: 2) 11. Purple Ink Bottle 1 (Recd: 1) 12. Pusher 1 (Recd: 1) 13. Metal Seal for Presiding Officer 1 (Recd: 1) 14. Match Box 1 (Recd: 1) 15. Material for making voting compartment (Card Board) 1 (Recd: 1) 16. Poster Notice specifying polling area 1 (Recd: 1) SIGN BOARDS: 1. Presiding Officer 1 (✓) 2. Polling Officers 4 (✓) 3. Entry 1 (✓) 4. Exit 1 (✓) 5. Polling Agents 1 (✓) STATIONERY: 1. Ordinary Pencil 1 (✓) 2. Ball Pen 2 Blue + 1 Red (✓) 3. Plain Foolscap Paper 2 sheets (✓) 4. Pins 10 pieces (✓) 5. Drawing Pins 20 pieces (✓) 6. Sealing Wax 2 sticks (✓) 7. Gum Bottle 1 small (✓) 8. Blade 1 (✓) 9. Candle sticks 2 (✓) 10. Thin Twine Thread 20 mtrs (✓) 11. Sutli (Country twine) 20 mtrs (✓)

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THIS FORM IS KEPT IN WHITE COLOUR ENVELOPE (BIG SIZE - 16" × 12") [ITEM D(e)] THIS IS A NON-STATUTORY FORM (CHECKLIST OF STATUTORY & NON-STATUTORY FORMS) 12. Flexible Wire 5 pieces (✓) 13. Sewing thread 20 mtrs (✓) 14. Needle 1 (✓) 15. Flat Metal Rule 1 (✓) 16. Carbon Paper 2 (✓) 17. Cloth or rag for removing oil, etc. 1 (✓) 18. Packing paper sheet 1 (✓) 19. Cup/Empty tin/Plastic for holding Indelible ink bottle 1 (✓) 20. Rubber Bands 10 (✓) 21. Cello Bands 1 (✓) 22. Canvas Bag 1 (✓) 23. Ribbon or Tape for tying sealed Ballot Boxes 6 (✓) 24. Gunny Bag 1 (✓) 25. Checklist for Polling Material 2 (✓) B.    STATUTORY FORMS:- (TO BE SUPPLIED BY STATE ELECTION COMMISSION) 1. List of Contesting Candidates (Form-IX) (MPTC & ZPTC) (Big Poster for display at Polling Station) 2 (✓) 2. Appointment of Polling Agent (Form-XII) 20 (✓) 3. List of Challenged Votes (Form-XXI) 2 (✓) 4. List of Blind and Infirm Voters (Form-XXIII) 2 (✓) 5. List of Tendered Votes (Form-XXIV) 2 (✓) 6. Ballot Paper Account (Form-XXV) 10 (✓) 7. Declaration by the companion of blind and inform voter (Form XXII) 3 (✓) C.    NON-STATUTORY FORMS:- (TO BE SUPPLIED BY STATE ELECTION COMMISSION) 1. Entry Passes/ID cards for Polling Agents 20 (✓) 2. Declaration by the Presiding Officer before the Commencement of Poll and at the end of poll (Part I to III) 2 (✓) 3. Form of Declaration by Elector about Age 5 (✓) 4. Declaration by Presiding Officer & List of Electors who voted after giving declaration / refused to give declaration 2 (✓) 5. Receipt Book for deposit of challenged votes fee 1 (✓) 6. Letter to SHO 3 (✓) 7. Paper Seal Account 2 (✓) 8. Visit Sheet 2 (✓) 9. Presiding Officer's Diary 2 (✓)

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THIS FORM IS KEPT IN WHITE COLOUR ENVELOPE (BIG SIZE - 16" × 12") [ITEM D(e)] THIS IS A NON-STATUTORY FORM (OFFICIAL SEC LIST OF BROWN, GREEN, YELLOW & BLUE COVERS) D.    STATUTORY & NON-STATUTORY COVERS:- (TO BE SUPPLIED BY STATE ELECTION COMMISSION) S.No. Cover Name Requirement a. The following self printed BROWN coloured covers: 1. Cover for Ballot Paper Account Small size 1 (✓) 2. Cover for Declarations by Presiding Officer before and after poll Medium size 1 (✓) 3. Cover for Paper Seal Account Small size 1 (✓) 4. Cover for the diary of the Presiding Officer Small size 1 (✓) 5. Cover for Visit Sheet Small size 1 (✓) b. The STATUTORY COVERS (coloured GREEN): Should contain the following sealed covers which shall also be as the same colour GREEN: Big size 1 (✓) 1. Cover containing the Marked Copy of Electoral Roll Medium size 1 (✓) 2. Cover containing the signed but unused ballot papers with counterfoils Medium size 1 (✓) 3. Cover containing other unused ballot papers with counterfoils Medium size 1 (✓) 4. Cover containing the tendered ballot papers and the list in Form-XXIV Small size 1 (✓) 5. Cover containing the ballot papers cancelled for violation of voting procedure Small size 1 (✓) 6. Cover (s) containing other cancelled ballot papers Small size 1 (✓) 7. Cover containing counterfoils of used ballot papers including of tendered ballot papers Medium size 1 (✓) c. The NON-STATUTORY COVERS (coloured YELLOW): Should contain the following sealed covers which shall also be as the same colour YELLOW: Big size 1 (✓) 1. Cover containing the copy or copies of electoral roll (other than the marked copy) Medium size 2 (✓) 2. Cover for appointment letters of polling agents Medium size 2 (✓) 3. Cover for election duty certificate Small size 1 (✓) 4. Cover for challenged votes Small size 2 (✓) 5. Cover for list of blind and infirm electors and the declarations of the companions Small size 2 (✓) 6. Cover for declarations obtained from electors as to their age and the list of such electors Small size 2 (✓) 7. Cover for receipt book and cash, if any, in respect of challenged votes Medium size 2 (✓) 8. Cover for unused and damaged paper seals Small size 2 (✓) 9. Cover for any other paper that the PO has decided to keep in the sealed cover Medium size 2 (✓) 10. Plain covers Medium size 2 (✓) d. Cover (coloured BLUE) for following items: Big size 1 (✓) 1. Handbook for Presiding Officers 2. Indelible ink set (with stopper having been secured on each phial effectively with molten candle or wax

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THIS FORM IS KEPT IN WHITE COLOUR ENVELOPE (BIG SIZE - 16" × 12") [ITEM D(e)] THIS IS A NON-STATUTORY FORM (OFFICIAL SEC LIST OF BLUE & WHITE COVERS AND SIZES) applied thereon to prevent leakage or evaporation) 3. Self-inking pads ✓ 4. Metal seal of the Presiding Officer ✓ 5. Arrow cross mark rubber stamp ✓ 6. Distinguishing mark rubber stamp ✓ e. Empty Cover (coloured WHITE): (Wherever the covers / envelopes are smaller in size, the packing paper may be used and where the relevant printed cover / envelope is not available, plain envelope can be used and purpose may be indicated with red ink) Big size 1 (✓) * Size of Covers: Big – 16” x 12”; Medium – 12” x 10”; Small – 5” x 11”; Verified All Covers & MPTC/ZPTC Polling Material: Polling Station: PS No. 04 - Laxmi Puram MPTC / Bheemunipatnam ZPTC, Visakhapatnam ZPP K. Sanyasi Naidu Signature of Presiding Officer (K. Sanyasi Naidu)

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THIS FORM IS KEPT IN BROWN COLOUR ENVELOPE (SMALL SIZE - 5" × 11") [ITEM D(a)(3)] THIS IS A NON-STATUTORY FORM (SELF-PRINTED BROWN COVER FOR PAPER SEAL ACCOUNT) ANNEXURE-8 RECORD OF PAPER SEALS USED AT ELECTION TO MEMBER, MANDAL PRAJA PARISHAD / ZILLA PRAJA PARISHAD Part – I Name of the Member, Territorial Constituency of : LAXMI PURAM MPTC & BHEEMUNIPATNAM ZPTC Mandal Parishad / Zilla Parishad: BHEEMUNIPATNAM Mandal Praja Parishad / VISAKHAPATNAM Zilla Praja Parishad Polling Station Name and Number: PS No. 04 – MPUP School Building, Laxmi Puram Serial number of ballot box used (1) Serial number of paper seal used (2) Remarks (3) 1.   VSP-BHM-BOX-042 AP-SEC-884120 Used on Main Ballot Box (MPTC & ZPTC) 2.   NIL (No 2nd Box used) NIL Not Applicable Part – II ACCOUNT OF PAPER SEALS 1. Serial numbers of paper seals     supplied from AP-SEC-884120 to AP-SEC-884123 : AP-SEC-884120 to AP-SEC-884123 2. Total numbers supplied with Sl.Nos. : 04 (Four) [884120, 884121, 884122, 884123] 3. Number of paper seals used with Sl.Nos. : 01 (One) [Sl. No. AP-SEC-884120] 4. Number of unused paper seals     returned to Returning Officer     (Deduct item 3 from item 2) with Sl.Nos. : 03 (Three) [Sl. Nos. AP-SEC-884121, 884122 & 884123] (Kept in Yellow Cover D-c-8) 5. Serial number of damaged     paper seals if any : NIL (00) Date : 17-02-2026 Place : Laxmi Puram (PS No. 04) K. Sanyasi Naidu Signature of Presiding Officer. (K. Sanyasi Naidu)

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THIS FORM IS KEPT IN BROWN COLOUR ENVELOPE (MEDIUM SIZE - 12" × 10") [ITEM D(a)(2)] THIS IS A NON-STATUTORY FORM (SELF-PRINTED BROWN COVER FOR PO DECLARATIONS BEFORE & AFTER POLL) ANNEXURE-10 DECLARATION BY THE PRESIDING OFFICER PART-I Declaration by the Presiding Officer before the commencement of the Poll / Election to BHEEMUNIPATNAM ZPTC & LAXMI PURAM MPTC ZPTC / MPTC Constituency Serial No. and name of Polling Station PS No. 04 – MPUP School Building, Laxmi Puram, Bheemunipatnam Mandal, Visakhapatnam Dist. Date of Poll 17-02-2026 I hereby declare: (1)    that I have demonstrated to the polling agents and other persons present that the ballot box(es) to be used for the poll is/are empty and I have allowed them to note down the serial numbers of the ballot box (es); *(2)   that on the paper seal used for securing the ballot box I have affixed my own signature and obtained thereon the signatures of such of the polling agents as are present and desirous of affixing the same;        *(in applicable where paper seal is not used) (3)    that I have demonstrated to the polling agents and others present that the marked copy of the electoral roll to be used during the poll does not contain any marks other than those used for issuing postal ballot papers and election duty certificates; and (4)    that I have allowed the polling agents to note the first and the last of the serial number of the ballot papers which will be used at the polling station. Signature K. Sanyasi Naidu Presiding Officer (K. Sanyasi Naidu) Signature of polling agents: 1.    S.Ch. Appanna    (of candidate Sri K. Trinadha Rao - MPTC Laxmi Puram) 2.    V. Sanyasi Rao    (of candidate Smt. V. Padmavathi - MPTC Laxmi Puram) 3.    P. Appalaraju    (of candidate Sri G. Ramana Murthy - MPTC Laxmi Puram) 4.    M. Suryanarayana    (of candidate Sri B.N. Venkata Rao - ZPTC Bheemunipatnam) 5.    K. Demudu Babu    (of candidate Smt. Y. Lakshmi Devi - ZPTC Bheemunipatnam) The following polling agents(s) declined to affix his/her signature(s) on this declaration:

118

THIS FORM IS KEPT IN BROWN COLOUR ENVELOPE (MEDIUM SIZE - 12" × 10") [ITEM D(a)(2)] THIS IS A NON-STATUTORY FORM (DECLARATION BEFORE COMMENCEMENT OF POLL - CONTINUED) 1.    NIL    (of candidate NIL) 2.    NIL    (of candidate NIL) 3.    NIL    (of candidate NIL) 4.    NIL    (of candidate NIL) 5.    NIL    (of candidate NIL) Date 17-02-2026 Signature K. Sanyasi Naidu Presiding Officer (K. Sanyasi Naidu)

119

THIS FORM IS KEPT IN BROWN COLOUR ENVELOPE (MEDIUM SIZE - 12" × 10") [ITEM D(a)(2)] THIS IS A NON-STATUTORY FORM (DECLARATION AT THE TIME OF USE OF SUBSEQUENT BALLOT BOX) PART-II Declaration by the Presiding Officer at the time use of subsequent Ballot Box (es) Election to BHEEMUNIPATNAM ZPTC / LAXMI PURAM MPTC ZPTC / MPTC constituency Serial No. and name of Polling Station PS No. 04 – MPUP School, Laxmi Puram Date of Poll 17-02-2026 I hereby declare: (1)    that I have demonstrated to the polling agents and other persons present that the second/third ( N/A - No 2nd Box Used ) ballot box to be used for the poll is empty; and *(2)   that on the paper seal used for securing the ballot box I have affixed my own signature and obtained thereon the signatures of such of the polling agents as are present and desirous of affixing the same; *(in applicable where paper seal is not used) Signature K. Sanyasi Naidu Presiding Officer (K. Sanyasi Naidu) Signature of polling agents: 1.    NIL (No Subsequent Ballot Box Used)    (of candidate N/A) 2.    NIL    (of candidate N/A) 3.    NIL    (of candidate N/A) 4.    NIL    (of candidate N/A) 5.    NIL    (of candidate N/A) The following polling agents(s) declined to affix their signature(s), on this declaration: 1.    NIL    (of candidate N/A) 2.    NIL    (of candidate N/A) 3.    NIL    (of candidate N/A) 4.    NIL    (of candidate N/A) 5.    NIL    (of candidate N/A) Date 17-02-2026 Signature K. Sanyasi Naidu Presiding Officer (K. Sanyasi Naidu)

120

THIS FORM IS KEPT IN BROWN COLOUR ENVELOPE (MEDIUM SIZE - 12" × 10") [ITEM D(a)(2)] THIS IS A NON-STATUTORY FORM (DECLARATION AT THE END OF POLL) PART-III Declaration of the end of poll I have furnished to the polling agents, who were present at the polling station at the close of the poll and whose signatures are affixed below, an attested copy of each of the entries in the ballot paper account in Form XXV as required under rule 52(2) of the Conduct of Election Rules, 2006. Signature of polling agents: Signature K. Sanyasi Naidu Presiding Officer (K. Sanyasi Naidu) 1.    S.Ch. Appanna    (of candidate Sri K. Trinadha Rao - MPTC Laxmi Puram) 2.    V. Sanyasi Rao    (of candidate Smt. V. Padmavathi - MPTC Laxmi Puram) 3.    P. Appalaraju    (of candidate Sri G. Ramana Murthy - MPTC Laxmi Puram) 4.    M. Suryanarayana    (of candidate Sri B.N. Venkata Rao - ZPTC Bheemunipatnam) 5.    K. Demudu Babu    (of candidate Smt. Y. Lakshmi Devi - ZPTC Bheemunipatnam) The following polling agents who were present at the close of the polling declined to received an attested copy of the ballot paper account and to give a receipt therefore and so an attested copy of the ballot paper account, was not supplied to them: 1.    NIL    (of candidate NIL) 2.    NIL    (of candidate NIL) 3.    NIL    (of candidate NIL) 4.    NIL    (of candidate NIL) 5.    NIL    (of candidate NIL) Date 17-02-2026 (05:10 PM) Signature K. Sanyasi Naidu Presiding Officer. (K. Sanyasi Naidu)

121

THIS FORM IS KEPT IN YELLOW COLOUR ENVELOPE (MEDIUM SIZE - 12" × 10") [ITEM D(c)(7)] THIS IS A NON-STATUTORY FORM (COVER FOR RECEIPT BOOK AND CASH IN RESPECT OF CHALLENGED VOTES) ANNEXURE-12 RECEIPT FOR CHALLENGE FEE Book No. 01        Page No. 01 (Counterfoil - Deposit Forfeited) Office of the Presiding Officer for Polling Station No. 04 (MPUP School, Laxmi Puram) of Member LAXMI PURAM MPTC / BHEEMUNIPATNAM ZPTC Territorial Constituency of BHEEMUNIPATNAM Mandal Praja Parishad / VISAKHAPATNAM Zilla Praja Parishad. Received a sum of Rs.5/- (Rupees five only) in cash from Sri M. Suryanarayana Candidate/Election Agent/Polling Agent on account of deposit for challenge under rule 43 of the Conduct of Election Rules, 2006. Date 17-02-2026 K. Sanyasi Naidu Presiding Officer (K. Sanyasi Naidu) Forfeited to Government: Yes, Rs. 5/- Forfeited (Challenge Rejected for Sl.No. 142) K. Sanyasi Naidu Presiding Officer (K. Sanyasi Naidu) Received back the amount of Rs.5 (Rupees five only) under rule 43 of the Conduct of Election Rules, 2006 Rs. 5/- Refunded for Challenge #2 (Sl.No. 289 Uphold) Date 17-02-2026 K. Demudu Babu (Polling Agent - ZPTC) Name and Signature of Candidate/Election Agent/Polling Agent RECEIPT FOR CHALLENGE FEE Book No. 01        Page No. 01 (Outer Foil Issued to Agent) Received a sum of Rs. 5 (Rupees five only) in cash from Shri M. Suryanarayana Candidate/Election Agent of Sri B.N. Venkata Rao (ZPTC) / Polling Agent on account of deposit for challenge under rule 43 of the Conduct of Elections Rules, 2006. Date 17-02-2026 K. Sanyasi Naidu Presiding Officer (K. Sanyasi Naidu) for Polling Station No. 04 (Laxmi Puram) of Member Laxmi Puram MPTC / Bheemunipatnam ZPTC territorial constituency of Bheemunipatnam Mandal Parishad / Visakhapatnam Zilla Parishad.

123

THIS FORM IS KEPT IN YELLOW COLOUR ENVELOPE (MEDIUM SIZE - 12" × 10") [ITEM D(c)(9)] THIS IS A NON-STATUTORY FORM (OTHER PAPER KEPT BY PO IN SEALED YELLOW COVER) ANNEXURE-13 LETTER OF COMPLAINT TO THE STATION HOUSE OFFICER (POLICE) To The Station House Officer, Bheemunipatnam Police Station, Visakhapatnam District. Sub:- Election to the Sarpanch/ Member of Ward No. .... of .... Gram Panchayat / Member, LAXMI PURAM MPTC & BHEEMUNIPATNAM ZPTC Territorial constituency of BHEEMUNIPATNAM Mandal Parishad / VISAKHAPATNAM Zilla Parishad – Impersonation at polling station PS No. 04 – MPUP School, Laxmi Puram (Number and name) date of poll 17-02-2026. I am to report to that, Sri NIL (No case of police handover occurred; dummy specimen entry: V. Apparao) S/o Sri V. Ramulu at resident of Laxmi Puram, Bheemunipatnam Mandal has challenged the identity of the person who is being handed over to PC-1428 (Bandobust Constable). This person claimed to be V. Paidithalli who's names appears at serial no. 289 in section/ part no. Part-04 of the electoral roll of Gram Panchayat / Laxmi Puram MPTC, Bheemunipatnam Mandal Parishad / Visakhapatnam Zilla Parishad he could not prove himself to be the elector. In my opinion he is an imposter. I am to report to this under section 174 of the Bharatiya Nyaya Sanhita, 2023. Place: Laxmi Puram (PS No. 04) Date: 17-02-2026 Yours faithfully, K. Sanyasi Naidu Signature of the Presiding Officer (K. Sanyasi Naidu) Copy forwarded to the Returning / Assistant Returning Officer of Gram Panchayat / Bheemunipatnam Mandal Parishad / Visakhapatnam Zilla Parishad K. Sanyasi Naidu Signature of the Presiding Officer (K. Sanyasi Naidu) Receipt The above letter and the person preferred to therein where handover to me at N/A (No Imposter Handed Over) (hour) on 17-02-2026 (date) by the presiding officer. NIL Signature

124

THIS FORM IS KEPT IN YELLOW COLOUR ENVELOPE (SMALL SIZE - 5" × 11") [ITEM D(c)(6)] THIS IS A NON-STATUTORY FORM (COVER FOR DECLARATIONS OBTAINED FROM ELECTORS AS TO AGE) ANNEXURE-14 LIST OF VOTERS FROM WHOM DECLARATION AS TO THEIR AGE HAVE BEEN OBTAINED Election to Member, LAXMI PURAM MPTC & BHEEMUNIPATNAM ZPTC Territorial Constituency of BHEEMUNIPATNAM Mandal Praja Parishad / VISAKHAPATNAM Zilla Praja Parishad. No. and Name of Polling Station PS No. 04 – MPUP School Building, Laxmi Puram Sl. No. Name of Elector Part No. and Serial No. in Electoral Roll Age as entered in Electoral Roll Age as assessed by the Presiding Officer 1 2 3 4 5 (1) K. Paidithalli (S/o Appanna) Part-04, Sl.No. 118 19 Years 18+ Years (2) M. Bhavani (D/o Raju) Part-04, Sl.No. 246 18 Years 18 Years (3) NIL - - - (4) NIL - - - etc. Total: 02 (Two Electors Only) - - - Date: 17-02-2026 K. Sanyasi Naidu Signature of Presiding Officer (K. Sanyasi Naidu)

125

THIS FORM IS KEPT IN YELLOW COLOUR ENVELOPE (SMALL SIZE - 5" × 11") [ITEM D(c)(6)] THIS IS A NON-STATUTORY FORM (COVER FOR LIST OF ELECTORS REGARDING AGE DECLARATION) ANNEXURE-15 LIST OF ELECTORS WHO HAVE REFUSED TO MAKE DECLARATIONS AS TO THEIR AGE Election to Member, LAXMI PURAM MPTC & BHEEMUNIPATNAM ZPTC Territorial Constituency of BHEEMUNIPATNAM Mandal Praja Parishad / VISAKHAPATNAM Zilla Praja Parishad. No. and Name of Polling Station PS No. 04 – MPUP School Building, Laxmi Puram Sl. No. Name of Elector Part No. and Serial No. of Electoral Roll Age as entered in Electoral Roll Age as assessed by the Presiding Officer 1 2 3 4 5 (1) NIL NIL NIL NIL (2) NIL - - - (3) NIL - - - (4) NIL - - - Etc. NIL (No Elector Refused) - - - Date: 17-02-2026 K. Sanyasi Naidu Signature of Presiding Officer (K. Sanyasi Naidu)

126

THIS FORM IS KEPT IN YELLOW COLOUR ENVELOPE (SMALL SIZE - 5" × 11") [ITEM D(c)(5)] THIS IS A STATUTORY FORM [SECTION B(7)] KEPT IN THE YELLOW COVER FOR BLIND/INFIRM DECLARATIONS ANNEXURE-16 FORM XXII [See Rules 48(1) & 80(1)] DECLARATION BY THE COMPANION OF BLIND OR INFIRM VOTER Election to the Sarpanch/ Member of Ward No. .... of .... Gram Panchayat / Member, LAXMI PURAM MPTC & BHEEMUNIPATNAM ZPTC Territorial Constituency of BHEEMUNIPATNAM Mandal Praja Parishad / VISAKHAPATNAM Zilla Praja Parishad. (Number and name of Polling Station PS No. 04 – MPUP School Building, Laxmi Puram MPTC) I B. Srinivasa Rao Son of B. Appalaswamy Aged 46 Years, resident of D.No. 4-15, Main Street, Laxmi Puram, Bheemunipatnam Mandal, Visakhapatnam District hereby declare that – 2.   I have not acted as companion of any other elector at any Polling Station today the 17th February, 2026 (17-02-2026) ; and 3.   I will keep secret the vote recorded by me on behalf of Smt. B. Narayanamma (Sl. No. 064, Part-04, Laxmi Puram MPTC). B. Srinivasa Rao Signature of the Companion Date: 17-02-2026 Place: Laxmi Puram MPTC (PS No. 04) Verified before me: K. Sanyasi Naidu Signature of Presiding Officer (K. Sanyasi Naidu)

127

THIS FORM IS KEPT IN GREEN COLOUR ENVELOPE (BIG SIZE - 16" × 12") [ITEM D(b)] THIS IS A STATUTORY PACKET CHECKLIST (ITEMS SEALED IN SEPARATE GREEN STATUTORY PACKETS) ANNEXURE-18 ITEMS OF ELECTION PAPERS TO BE SEALED IN SEPARATE PACKET AFTER CLOSE OF THE POLL (See Rule 51) (i)     The tendered ballot papers; — Sealed in Green Cover D(b)(4) [MPTC: 01, ZPTC: 01] (ii)    The unused ballot papers; — Sealed in Green Covers D(b)(2) & D(b)(3) [MPTC: 70, ZPTC: 70] (iii)   The spoilt and returned ballot papers; — Sealed in Green Cover D(b)(6) [MPTC: 01, ZPTC: 01] (iv)   The marked copy of the electoral roll; — Sealed in Green Cover D(b)(1) [01 Copy] (v)    The list of tendered votes; — Form-XXIV Sealed in Green Cover D(b)(4) (vi)   The list of challenged votes; — Form-XXI Sealed in Yellow Cover D(c)(4) (vii)  The counterfoils of used ballot papers; — Sealed in Green Cover D(b)(7) [MPTC: 380, ZPTC: 380] (viii) The ballot papers cancelled for violation of voting procedure; and — Green Cover D(b)(5) [NIL] (ix)   Any other papers directed by the State Election Commission to be kept in a sealed cover / packet. — Sealed in Yellow Cover D(c)(9) Polling Station: PS No. 04 – Laxmi Puram MPTC ZPTC: Bheemunipatnam ZPTC, Visakhapatnam ZPP Date: 17-02-2026 All 7 Statutory Green Packets Sealed: K. Sanyasi Naidu Signature of Presiding Officer (K. Sanyasi Naidu)

129

THIS FORM IS KEPT IN BROWN COLOUR ENVELOPE (SMALL SIZE - 5" × 11") [ITEM D(a)(4)] THIS IS A NON-STATUTORY FORM (SELF-PRINTED BROWN COVER FOR PRESIDING OFFICER'S DIARY) ANNEXURE-19 PRESIDING OFFICER'S DIARY 1. Name of the Territorial Constituency : LAXMI PURAM MPTC & BHEEMUNIPATNAM ZPTC 2. Name of the Mandal Parishad/ Zilla Parishad : BHEEMUNIPATNAM MPP / VISAKHAPATNAM ZPP 3. Date of poll : 17-02-2026 (07:00 AM to 05:00 PM) 4. Number & Name of the polling station : Whether located in- (i) Government or quasi-government building; (ii) Private building; (iii) Temporary structure; PS No. 04 – MPUP School Building, Laxmi Puram ✓ (i) Yes – Government School Building (ii) No (iii) No 5. Number of polling officers recruited locally, if any : NIL (00) 6. Appointment of polling officer made in the absence of duly appointed polling officer, if any, and the reasons for such appointment : NIL (All duly appointed Polling Officers attended duty on time) 7. Number of ballot boxes used : 01 (One Ballot Box – Sl.No. VSP-BHM-BOX-042) 8. (i) Number of paper seals used : (ii) Sl. Nos. of paper seals used : 01 (One) AP-SEC-884120 9. Number of polling agents and the number who arrived late : 05 Polling Agents (MPTC & ZPTC); Arrived Late: NIL (00) 10. Number of candidates who had appointed polling agents at the polling station : 05 Contesting Candidates (3 MPTC + 2 ZPTC) 11. (i) Number of ballot papers issued to voters according to marked copy of the electoral roll (ii) Number of ballot papers actually issued at the polling stations ( including tendered ballot papers, cancelled ballot papers, etc. ) (i) 378 Voters (MPTC: 378 + ZPTC: 378) (ii) MPTC: 380; ZPTC: 380 (378 in Box + 1 Spoilt + 1 Tendered each) M. Venkata Ramana Signature of first Polling Officer Ch. Suryanarayana Signature of Polling Officer in-charge of ballot papers 12.    Number of electors who voted ( tendered votes should not be included here )         Men 184      Women 194      Total 378 (Out of 420 Electors = 90.00%) 13.    Challenged vote-

130

THIS FORM IS KEPT IN BROWN COLOUR ENVELOPE (SMALL SIZE - 5" × 11") [ITEM D(a)(4)] THIS IS A NON-STATUTORY FORM (PRESIDING OFFICER'S DIARY - PAGE 2 CONTINUED) (i) Number allowed ( i.e. where the challenge was upheld and the persons were not allowed to vote ) (ii) Number rejected ( i.e. where the challenge was rejected and the voters were allowed to vote ) (iii) Amount forfeited Rs { This should tally with the figure obtained by multiplying ( Rs. 5 with item (ii)} (i) 01 (One - Debarred) (ii) 01 (One - Allowed to Vote) (iii) Rs. 5/- (Rupees Five Only) 14. Number of persons who have voted on production of Election Duty Certificate (EDC) : 01 (One - Sri P. Rambabu) 15. Number of electors who voted with the help of companions : 02 (Two Blind/Infirm Voters) 16. Number of tendered votes : Men ........... Women ........... Total ........... % of tendered votes to total votes polled. Men: 00 | Women: 01 | Total: 01 Percentage: 0.26% 17. No. of electors- (i) from whom declarations as to their age obtained (ii) who refused to give such declaration (i) 02 (Two) (ii) NIL (00) 18. Whether it was necessary to adjourn the poll and if so, the reasons for such adjournment : NO (Poll was not adjourned) 19. Number of votes cast (MPTC/ZPTC 7:00 AM to 5:00 PM): From 7 a.m. to 9 a.m. from 9 a.m. to 11 a.m. from 11 a.m. to 1 p.m. from 1 p.m. to 3 p.m. from 3 p.m. to 5 p.m. 74 Votes (Cumulative: 74 - 17.62%) 98 Votes (Cumulative: 172 - 40.95%) 88 Votes (Cumulative: 260 - 61.90%) 64 Votes (Cumulative: 324 - 77.14%) 54 Votes (Cumulative: 378 - 90.00%) 20. No. of slips issued at the closing hour of the poll (5:00 PM): 03 Slips issued at 05:00 PM 21. Electoral offences with details : Number of cases of- (a) canvassing within one hundred metres of the polling station : (b) impersonation of voters : (c) fraudulent defacing, destroying or removal of the list of notice or other document at the polling station. (a) NIL (00) (b) NIL (00) (c) NIL (00)

131

THIS FORM IS KEPT IN BROWN COLOUR ENVELOPE (SMALL SIZE - 5" × 11") [ITEM D(a)(4)] THIS IS A NON-STATUTORY FORM (PRESIDING OFFICER'S DIARY - PAGE 3 CONCLUSION) (d) bribing of voters : (e) intimidation of voters and other persons : (d) NIL (00) (e) NIL (00) 22. Was the poll interrupted or obstructed by- (1) riot : (2) open violence : (3) natural calamity : (4) booth capturing: (5) any other cause : Please give details of the above. (1) NO (2) NO (3) NO (4) NO (5) NO MPTC/ZPTC Poll conducted peacefully. 23. Was the poll vitiated by – (1) any ballot box used at the polling station having been unlawfully taken out of the custody of the Presiding Officer:.   (a) accidentally or intentionally lost or destroyed :   (b) damaged or tampered with : (2) the ballot papers having been unlawfully marked by any person and deposited in the ballot box. Please give details (1) NO (a) NO (b) NO (2) NO Not Applicable (NIL) 24. Serious complaints, if any, made by the candidate/agents : NIL 25. Number of cases of breach of law and order : NIL (00) 26. Report of mistakes and irregularities committed, if any, at the polling station : NIL (None) Place Laxmi Puram MPTC (PS No. 04) Date 17-02-2026 K. Sanyasi Naidu Presiding Officer (K. Sanyasi Naidu) This diary should be forwarded to the Returning Officer along with the ballot boxes and other sealed papers.

132

THIS FORM IS KEPT IN BROWN COLOUR ENVELOPE (SMALL SIZE - 5" × 11") [ITEM D(a)(1)] THIS IS A STATUTORY FORM [SECTION B(6)] KEPT IN SELF-PRINTED BROWN COVER FOR BALLOT PAPER ACCOUNT ANNEXURE-20 FORM-XXV [See Rules 52 & 56] Part-I BALLOT PAPER ACCOUNT Election to the Sarpanch / Member of Ward No. .... of .... Gram Panchayat / Member, LAXMI PURAM MPTC (Pink Ballot) & BHEEMUNIPATNAM ZPTC (White Ballot) Territorial Constituency of BHEEMUNIPATNAM Mandal Praja Parishad / VISAKHAPATNAM Zilla Praja Parishad. MPTC / ZPTC Constituency: LAXMI PURAM MPTC / BHEEMUNIPATNAM ZPTC (Visakhapatnam District) No. and Name of the Polling Station: PS No. 04 – MPUP School Building, Laxmi Puram Particulars Serial No(s). [MPTC Pink / ZPTC White] Total (Each) From To 1 Ballot Papers received MPTC: 01201 ZPTC: 05201 MPTC: 01650 ZPTC: 05650 450 450 2 Ballot Papers unused (i.e. not issued to Voters): (a) With the signature of Presiding Officer MPTC: 01581 ZPTC: 05581 MPTC: 01590 ZPTC: 05590 10 10 (b) Without the signature of Presiding Officer MPTC: 01591 ZPTC: 05591 MPTC: 01650 ZPTC: 05650 60 60 Total (a) + (b) 01581 / 05581 01650 / 05650 70 3* Ballot Papers used at the Polling Station (1 minus 2 = 3) 01201 / 05201 01580 / 05580 380 4 Ballot Papers used at the Polling Station, but NOT INSERTED INTO THE BALLOT BOX: (a) Cancelled for violation of voting procedure under Rule 47 (6) NIL NIL 00 (b) Cancelled for other reasons (Spoilt & Returned) MPTC: 01314 ZPTC: 05314 MPTC: 01314 ZPTC: 05314 01 (c) Used as Tendered Ballot Papers MPTC: 01580 ZPTC: 05580 MPTC: 01580 ZPTC: 05580 01 * Total (a) + (b) + (c) 02 5* Ballot Papers to be found in the Ballot Box (3 minus 4 = 5) MPTC: 378 | ZPTC: 378 378 * Serial numbers need not be given Date : 17-02-2026 Place : Laxmi Puram (PS No. 04) K. Sanyasi Naidu Signature of the Presiding Officer (K. Sanyasi Naidu)

133

THIS FORM IS KEPT IN BROWN COLOUR ENVELOPE (SMALL SIZE - 5" × 11") [ITEM D(a)(1)] THIS IS A STATUTORY FORM [SECTION B(6)] (PART-II OF FORM-XXV BALLOT PAPER ACCOUNT) Part-II (of Form-XXV) RESULT OF INITIAL COUNTING (to be used when the counting of votes is done by mixing) 1.   Total number of ballot papers found in the ballot box(es) used at the polling station:      MPTC (Laxmi Puram): 378 | ZPTC (Bheemunipatnam): 378 2.   Discrepancy, if any, between the total number as shown against Item 1 in this Part and the total number of ballot papers to be found in the ballot box(es) shown in Item 5 of Part-I   NIL (No Discrepancy – 378 Tallied Exactly with Item 5 of Part-I) Date: 19-02-2026 (Counting Day) B. Appala Naidu (Counting Supervisor - Table 04) Signature of Counting Supervisor M. Rama Rao (Returning Officer - MPTC/ZPTC Bheemunipatnam) Signature of the Returning Officer Part-I Handed Over by Presiding Officer: K. Sanyasi Naidu (K. Sanyasi Naidu)

134

THIS FORM IS KEPT IN WHITE COLOUR ENVELOPE (BIG SIZE - 16" × 12") [ITEM D(e) / RO FILE] THIS IS A STATUTORY RO APPLICATION FORM (APPLICATION FOR POSTAL BALLOT PAPER - MPTC/ZPTC) ANNEXURE-21 FORM-XIV [See Rule 25 (1)] APPLICATION FOR POSTAL BALLOT PAPER To The Returning Officer, Gram Panchayat / Laxmi Puram MPTC, Bheemunipatnam Mandal Praja Parishad / Bheemunipatnam ZPTC, Visakhapatnam Zilla Praja Parishad. I intend to cast my vote by post at the ensuing election to the office of the Sarpanch/Member of Ward No. .... of .... Gram Panchayat / Member, LAXMI PURAM MPTC / BHEEMUNIPATNAM ZPTC Territorial Constituency of BHEEMUNIPATNAM Mandal Praja Parishad / VISAKHAPATNAM Zilla Praja Parishad. My name is entered at S.No. 082 in Section No. Part-04 of the electoral roll for Laxmi Puram MPTC Constituency of Bheemunipatnam Mandal Praja Parishad, Visakhapatnam Zilla Praja Parishad. The Ballot paper may be sent to me at the following address: Sri D. Simhachalam (SGT, Election Duty PO), D.No. 4-48, Temple Street, Laxmi Puram, Bheemunipatnam Mandal, Visakhapatnam District – 531163. Place : Laxmi Puram Date : 10-02-2026 Yours faithfully D. Simhachalam Marked 'PB' in Marked Copy of MPTC/ZPTC Roll at PS-04: Verified by PO: K. Sanyasi Naidu (K. Sanyasi Naidu)

135

THIS FORM IS KEPT IN YELLOW COLOUR ENVELOPE (MEDIUM SIZE - 12" × 10") [ITEM D(c)(2)] THIS IS A STATUTORY FORM [SECTION B(2)] KEPT IN THE YELLOW COVER FOR APPOINTMENT LETTERS OF POLLING AGENTS ANNEXURE-22 FORM-XII [See Rule 19] APPOINTMENT OF POLLING AGENT Election to Sarpanch / Member of Ward No. .... of .... Gram Panchayat / Member, LAXMI PURAM MPTC / BHEEMUNIPATNAM ZPTC Territorial Constituency of BHEEMUNIPATNAM Mandal Praja Parishad / VISAKHAPATNAM Zilla Praja Parishad. I, Sri K. Trinadha Rao a candidate / the election agent of Self (Contesting Candidate for Member, Laxmi Puram MPTC) who is a candidate at the above election, do hereby appoint (name and address) Sri S.Ch. Appanna, S/o S. Ramulu, D.No. 4-12, Laxmi Puram, Bheemunipatnam Mandal as a polling agent to attend Polling Station No. 04 (MPUP School Building, Laxmi Puram) fixed for the poll on 17-02-2026 at 07:00 AM. Place : Laxmi Puram Date : 17-02-2026 K. Trinadha Rao Signature of Candidate/Election Agent I agree to act as such polling agent. S.Ch. Appanna Signature of Polling Agent Declaration of polling agent to be signed before Presiding Officer I hereby declare that at above election I will not do anything forbidden by section 217 of the Andhra Pradesh Panchayat Raj Act, 1994, which I have read / has been read over to me. Date: 17-02-2026 S.Ch. Appanna Signature of Polling Agent Signed before me Date: 17-02-2026 K. Sanyasi Naidu Presiding Officer (K. Sanyasi Naidu)

136

THIS FORM IS KEPT IN BROWN COLOUR ENVELOPE (SMALL SIZE - 5" × 11") [ITEM D(a)(5)] THIS IS A NON-STATUTORY FORM [SECTION C(8)] (SELF-PRINTED BROWN COVER FOR VISIT SHEET) ANNEXURE-23 VISIT SHEET Date of Poll : 17-02-2026 (07:00 AM to 05:00 PM) Name of the Member, Territorial Constituency of : LAXMI PURAM MPTC & BHEEMUNIPATNAM ZPTC Name of the Mandal Praja Parishad/Zilla Praja Parishad : BHEEMUNIPATNAM MPP / VISAKHAPATNAM ZPP Name and Number of Polling Station : PS No. 04 – MPUP School Building, Laxmi Puram Number of Electors : 420 (Men: 205, Women: 215) Sl.No Name & Designation of the Officer visiting (Observer/DEA/RO/ ARO/Zonal Officer) Time of visit Brief description of polling process (peaceful/incidents, if any) Number of votes polled till the time of visit % polled till the time of visit Remarks if any Signature of visiting Officer 1 Sri M. Rama Rao, Returning Officer (MPTC/ZPTC) 08:15 AM Poll started on time; Peaceful 52 12.38% Good M. Rama Rao 2 Sri K.V. Ramana, Zonal Officer (Zone-02, Bheemunipatnam) 11:20 AM Smooth & Peaceful Polling 186 44.28% Verified K.V. Ramana 3 Smt. P. Padmavathi, MPDO, Bheemunipatnam MPP 02:10 PM Peaceful, Queue orderly 295 70.24% Satisfactory P. Padmavathi 4 Sri Ch. Narayana, Route Officer (Route-01) 04:30 PM Peaceful closing arrangements 368 87.62% All OK Ch. Narayana   K. Sanyasi Naidu Signature of Presiding Officer (K. Sanyasi Naidu) (with date: 17-02-2026)

137

THIS FORM IS KEPT IN YELLOW COLOUR ENVELOPE (SMALL SIZE - 5" × 11") [ITEM D(c)(4)] THIS IS A STATUTORY FORM [SECTION B(3)] KEPT IN THE YELLOW COVER FOR CHALLENGED VOTES ANNEXURE-24 FORM-XXI [See Rule 43 (2)(c)] LIST OF CHALLENGED VOTES Election to the Sarpanch / Member of Ward No. .... of .... Gram Panchayat / Member, LAXMI PURAM MPTC & BHEEMUNIPATNAM ZPTC Territorial Constituency of BHEEMUNIPATNAM Mandal Praja Parishad / VISAKHAPATNAM Zilla Praja Parishad. Number and Name of Polling Station PS No. 04 – MPUP School Building, Laxmi Puram MPTC S.No No. of Elector on Electoral Roll / Section Number Name of Elector Signature or thumb impression of the person challenged and his address Name of Challenger Signatures or thumb impression and address of identifier, if any Order of Presiding Officer Signature of Challenger on receiving refund of deposit (1) (2) (3) (4) (5) (6) (7) (8) 1 Sl.No. 142, Part-04, Laxmi Puram MPTC K. Narasinga Rao K. Narasinga Rao, D.No. 4-28, Laxmi Puram M. Suryanarayana (ZPTC Agent) S. Appanna, D.No. 4-29, Laxmi Puram Challenge Rejected; Allowed to Vote. Rs.5/- Forfeited. Deposit Forfeited to Govt. 2 Sl.No. 289, Part-04, Laxmi Puram MPTC V. Paidithalli LTI of Claimant, Main Road, Laxmi Puram K. Demudu Babu (ZPTC Agent) NIL (No Identifier) Challenge Upheld; Not Allowed to Vote. Rs.5/- Refunded. K. Demudu Babu (Recd Rs.5/-)   Place : Laxmi Puram MPTC (PS No. 04) Date : 17-02-2026 K. Sanyasi Naidu Signature of Presiding Officer (K. Sanyasi Naidu)

138

THIS FORM IS KEPT IN YELLOW COLOUR ENVELOPE (SMALL SIZE - 5" × 11") [ITEM D(c)(5)] THIS IS A STATUTORY FORM [SECTION B(4)] KEPT IN THE YELLOW COVER FOR LIST OF BLIND AND INFIRM ELECTORS ANNEXURE-25 FORM-XXIII [See Rules 48(2) & 80(2)] LIST OF ILLITERATE, BLIND OR INFIRM VOTERS Election to the Sarpanch/ Member of Ward No. .... of .... Gram Panchayat / Member, LAXMI PURAM MPTC & BHEEMUNIPATNAM ZPTC Territorial Constituency of BHEEMUNIPATNAM Mandal Praja Parishad / VISAKHAPATNAM Zilla Praja Parishad. (Number and Name of Polling Station PS No. 04 – MPUP School Building, Laxmi Puram MPTC) Section No. and Sl. No. of Elector Full Name of Elector Full Name of Companion Address of companion Signature of Companion Part-04, Sl.No. 064 Smt. B. Narayanamma (Blind Voter) Sri B. Srinivasa Rao D.No. 4-15, Main Street, Laxmi Puram B. Srinivasa Rao Part-04, Sl.No. 198 Sri G. Yellayya (Infirm Voter) Sri G. Govinda Rao D.No. 4-54, Weaver St., Laxmi Puram G. Govinda Rao   Date: 17-02-2026 K. Sanyasi Naidu Signature of Presiding Officer (K. Sanyasi Naidu)

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THIS FORM IS KEPT IN YELLOW COLOUR ENVELOPE (SMALL SIZE - 5" × 11") [ITEM D(c)(3)] THIS IS A STATUTORY EDC FORM KEPT IN THE YELLOW COVER FOR ELECTION DUTY CERTIFICATES ANNEXURE-26 FORM-XV [See Rule 25 (2)] APPLICATION FOR ELECTION DUTY CERTIFICATE To The Returning Officer, Gram Panchayat / Laxmi Puram MPTC, Bheemunipatnam Mandal Praja Parishad / Bheemunipatnam ZPTC, Visakhapatnam Zilla Praja Parishad. Sir, I intend to cast my vote in person at the ensuing election to the office of the Sarpanch / Member of Ward No. .... of .... Gram Panchayat / Member, LAXMI PURAM MPTC & BHEEMUNIPATNAM ZPTC Territorial Constituency of BHEEMUNIPATNAM Mandal Praja Parishad / VISAKHAPATNAM Zilla Praja Parishad. I have been posted on election duty elsewhere than the polling station at which I am entitled to vote. My name is entered at S.No. 115 in Section No. Part-02 of the electoral roll for Laxmi Puram MPTC / Bheemunipatnam ZPTC comprised in the Bheemunipatnam Mandal Praja Parishad Visakhapatnam Zilla Praja Parishad. I request that an Election Duty Certificate in Form-XVI may be issued to enable me to vote at the polling station where I may be on duty on the polling day. It may be sent to me at the following address. Sri P. Rambabu (Polling Officer - PS No. 04), D.No. 2-19, School Road, Laxmi Puram, Bheemunipatnam Mandal, Visakhapatnam District – 531163. Place : Laxmi Puram Date : 14-02-2026 Yours faithfully P. Rambabu EDC Collected at PS No. 04 by PO: K. Sanyasi Naidu (K. Sanyasi Naidu)

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THIS FORM IS KEPT IN YELLOW COLOUR ENVELOPE (SMALL SIZE - 5" × 11") [ITEM D(c)(3)] THIS IS A STATUTORY EDC FORM KEPT IN THE YELLOW COVER FOR ELECTION DUTY CERTIFICATES ANNEXURE-27 FORM-XVI [See Rule 25 (2)(a)] ELECTION DUTY CERTIFICATE Certified that Sri P. Rambabu (S/o P. Apparao, Polling Officer) is an elector in the Gram Panchayat, Laxmi Puram MPTC, Bheemunipatnam Mandal Praja Parishad, Bheemunipatnam ZPTC, Visakhapatnam Zilla Praja Parishad and his electoral roll number being Sl. No. 115 in Part No. 02 of Laxmi Puram MPTC Constituency that by reason of his being on election duty he is unable to vote at the polling station where he is entitled to vote and that he is therefore hereby authorised to vote at any polling station (in the Ward No. .... of .... Gram Panchayat/ LAXMI PURAM MPTC & BHEEMUNIPATNAM ZPTC Territorial Constituency of Bheemunipatnam Mandal Praja Parishad / Visakhapatnam Zilla Praja Parishad, as the case may be) he may be on duty on the date of poll. Place : Bheemunipatnam Date : 15-02-2026 Signature M. Rama Rao Returning Officer (SEAL - RO MPTC/ZPTC Bheemunipatnam) Voted at PS No. 04 on production of this EDC on 17-02-2026: Countersigned by PO: K. Sanyasi Naidu (K. Sanyasi Naidu)

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THIS FORM IS KEPT IN GREEN COLOUR ENVELOPE (SMALL SIZE - 5" × 11") [ITEM D(b)(4)] THIS IS A STATUTORY FORM [SECTION B(5)] SEALED INSIDE THE BIG GREEN STATUTORY PACKET ANNEXURE-28 FORM-XXIV [See Rule 50 (2)] LIST OF TENDERED VOTES Election to the Sarpanch / Member of Ward No. .... of .... Gram Panchayat / Member, LAXMI PURAM MPTC & BHEEMUNIPATNAM ZPTC Territorial Constituency of BHEEMUNIPATNAM Mandal Praja Parishad / VISAKHAPATNAM Zilla Praja Parishad. Number and Name of Polling Station PS No. 04 – MPUP School Building, Laxmi Puram MPTC. S. No. Name of the Elector No. in Electoral Roll / Section No. / Constituency Serial No. of Tendered Ballot Paper vote Signature of elector or thumb impression of person tendering Serial No. of ballot paper issued to the person who had already voted (1) (2) (3) (4) (5) (6) 1 Smt. Ch. Mahalakshmi (W/o Ch. Ramu) Sl.No. 315, Part-04, Laxmi Puram MPTC MPTC: 01580 ZPTC: 05580 Ch. Mahalakshmi MPTC: 01412 ZPTC: 05412   Place : Laxmi Puram MPTC (PS No. 04) Date : 17-02-2026 K. Sanyasi Naidu Signature of Presiding Officer. (K. Sanyasi Naidu)

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THIS FORM IS KEPT IN YELLOW COLOUR ENVELOPE (MEDIUM SIZE - 12" × 10") [ITEM D(c)(9)] THIS IS A NON-STATUTORY FORM (SPECIMEN SIGNATURES SHEET KEPT IN OTHER PAPERS YELLOW COVER) ANNEXURE - 30 FORMAT FOR SPECIMEN SIGNATURE OF CONTESTING CANDIDATES AND THEIR ELECTION AGENTS Election to Member, LAXMI PURAM MPTC & BHEEMUNIPATNAM ZPTC Territorial Constituency of BHEEMUNIPATNAM Mandal Praja Parishad/ VISAKHAPATNAM Zilla Praja Parishad. The specimen signatures of contesting candidates and their election agents are given below for the purpose of verification of their signatures by the Presiding Officer in the letters of appointment of Polling Agents at the time of poll :- Sl.No Name of the Contesting Candidate (MPTC / ZPTC) Specimen Signature Name of his/her Election Agent Specimen Signature 1. Sri/Smt./Ms. (Candidate No.1) Sri K. Trinadha Rao (MPTC Laxmi Puram - Fan) K. Trinadha Rao Shri/Smt./Ms. Sri S.Ch. Appanna S.Ch. Appanna 2. Sri/Smt./Ms. (Candidate No.2) Smt. V. Padmavathi (MPTC Laxmi Puram - Cycle) V. Padmavathi Shri/Smt./Ms. Sri V. Sanyasi Rao V. Sanyasi Rao 3. Sri/Smt./Ms. (Candidate No.3) Sri G. Ramana Murthy (MPTC Laxmi Puram - Glass Tumbler) G. Ramana Murthy Shri/Smt./Ms. Sri P. Appalaraju P. Appalaraju 4. Sri/Smt./Ms. (Candidate No.4) Sri B.N. Venkata Rao (ZPTC Bheemunipatnam - Fan) B.N. Venkata Rao Shri/Smt./Ms. Sri M. Suryanarayana M. Suryanarayana 5. Sri/Smt./Ms. (Candidate No.5) Smt. Y. Lakshmi Devi (ZPTC Bheemunipatnam - Cycle) Y. Lakshmi Devi Shri/Smt./Ms. Sri K. Demudu Babu K. Demudu Babu 6. Sri/Smt./Ms. (Candidate No.6) Sri R. Satyanarayana (ZPTC Bheemunipatnam - Hand) R. Satyanarayana Shri/Smt./Ms. Sri T. Nageswara Rao T. Nageswara Rao 7. Sri/Smt./Ms. (Candidate No.7) NIL - Shri/Smt./Ms. NIL - Place: Bheemunipatnam Date: 15-02-2026 M. Rama Rao Signature of the Returning Officer (SEAL) Verified at PS-04 by PO: K. Sanyasi Naidu (K. Sanyasi Naidu)

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THIS FORM IS KEPT IN WHITE COLOUR ENVELOPE (BIG SIZE - 16" × 12") [ITEM D(e)] THIS IS A NON-STATUTORY FORM (APSEC CIRCULAR ON SEC-EMS POLL MANAGEMENT MOBILE APPLICATION) ANNEXURE-31 A.P. STATE ELECTION COMMISSION 1st Floor, New HODs Building, M.G. Road, Vijayawada-520010. CIRCULAR No.71/SEC-B2/2026 Date: 26.03.2026 Sub:    APSEC - Ordinary Elections to Local Bodies -Poll Management System under SEC-EMS - Circular on Mobile Applications - Issued - Reg. ***** The A.P. State Election Commission has developed the Software Modules and Mobile Applications based on the IT initiatives of Election Commission of India and other State Election Commissions and after obtaining due feedback from the field functionaries at various levels and senior officers of the Panchayat Raj and Municipal Administration Departments. These Software Modules and Mobile Applications, collectively known as the SEC-Election Management System (SEC-EMS), have been designed to streamline and standardize election-related processes in both Rural Local Bodies (RLBs) and Urban Local Bodies (ULBs).The SEC-EMS consists of three main components, namely: 1.    Electoral Roll Management System (ERMS) 2.    Election Process Management System (EPMS) 3.    Poll Management System (PMS) Poll Management System (PMS) The Poll Management System includes a Mobile Application for Presiding Officers to manage Polling Stations, report poll turnout, and record poll-related incidents with a simple questionnaire. Mobile app is also developed for the Zonal Officers, Route Officers and Micro Observers to monitor the real time status. All the Presiding Officers, Zonal Officers, Route Officers and Micro Observers have to login in to the Mobile Application with their login credentials. The user credentials are as follows. Officer Gram Panchayat MPTC/ZPTC ULB Presiding Officers po_gp_xx_xxxxxx po_mpp_xx_xxxx po_mpp_04_4812 po_ulb_xx_xxxxxx Zonal Officers zo_gp_xx_xxxx zo_mpp_xx_xxxx zo_mpp_02_4812 zo_ulb_xx_xxxxxx Route Officers ro_gp_xx_xxxx ro_mpp_xx_xxxx ro_mpp_01_4812 ro_ulb_xx_xxxxxx Micro Observers mo_gp_xx_xxxxxx mo_mpp_xx_xxxx mo_mpp_04_4812 mo_ulb_xx_xxxxxx Note : xxxx represents LGD code of Mandal Praja Parishad (Bheemunipatnam MPP LGD: 4812), xx represents Polling Station Number (PS-04, Laxmi Puram MPTC) in respect of PO & MO and Zone/Route Numbers in respect of ZO & RO. After login the Officers have to verify the pre populated information about the Local Body details and enter their name (K. Sanyasi Naidu), Official designation and Election Type (MPTC & ZPTC Ordinary Elections).

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THIS FORM IS KEPT IN WHITE COLOUR ENVELOPE (BIG SIZE - 16" × 12") [ITEM D(e)] THIS IS A NON-STATUTORY FORM (SEC-EMS MOBILE APP QUESTIONNAIRE FOR PRESIDING OFFICER - MPTC/ZPTC) Each login consists of two sections: “Before Poll Day” and “Poll Day.” Upon entering either section, a questionnaire is displayed, with most questions presented as simple “Yes” or “No” (balloon-style) options. Mobile Application for Presiding Officer (K. Sanyasi Naidu — Laxmi Puram MPTC / Bheemunipatnam ZPTC) Questionnaire for Before Poll Day 1 Have you reported at Distribution Centre? Yes/No — Yes 2 Have you received Election Kit? Yes/No — Yes 3 Have you started for Polling Station with your team? Yes/No — Yes 4 Have you reached Polling Station? Yes/No — Yes 5 Have you completed Pre-Poll arrangements? Yes/No — Yes 6 In the Polling Station: a) Whether installed Web camera is functioning? Yes/No/Not installed — Yes b) Whether Videographer has reported? Yes/No/Not arranged — Yes c) Whether Micro Observer is present? Yes/No/Not appointed — Yes Questionnaire for Poll Day (MPTC & ZPTC Poll: 07:00 AM to 05:00 PM) 7 Are appointment letters of Polling Agents verified and ID Cards issued? Yes/No — Yes If Yes, No. of ID Cards issued Entry: 05 8 Is Ballot Box demonstrated / Mock Poll (EVM) conducted? Yes/No — Yes 9 Have the Candidates / Polling Agents attended the demonstration / Mock Poll? Yes/No — Yes If Yes, No. of Candidates / Polling Agents attended Entry: 05 10 Has the Ballot box / EVM been sealed for actual poll? Yes/No — Yes 11 Whether the declaration made before commencement and poll commenced? Yes/No — Yes (07:00 AM) 12 Total Voter strength Display: 420 13 Bi-hourly poll report: No. of votes polled %of VotesPolled   (a) Up to 09:00 AM Entry: 74 Auto Display: 17.62%   (b) Up to 11:00 AM Entry: 172 Auto Display: 40.95%   (c) Up to 01:00 PM Entry: 260 Auto Display: 61.90%   (d) Up to 03:00 PM Entry: 324 Auto Display: 77.14%   (e) Up to 05:00 PM Entry: 378 Auto Display: 90.00%   (f) Close of Poll Entry: 378 Auto Display: 90.00% 14 Is poll interrupted at any time? Yes/No — No 15 Whether any subsequent Ballot Box(es) / EVM used? If yes, declaration made? Yes/No — No 16 No. of tokens issued to voters standing in the queue at the hour fixed for closure of poll (5:00 PM) Entry: 03 17 End of Poll: (a) Peaceful? (b) Declarations made? (c) Sealing done? (d) Form-XXV copies given? Yes/No — Yes (All 4) 18 Voter Turnout (MPTC & ZPTC) Male 184 Female 194 Others / Total 00 / 378 Poll Percentage 90.00%

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THIS FORM IS KEPT IN WHITE COLOUR ENVELOPE (BIG SIZE - 16" × 12") [ITEM D(e)] THIS IS A NON-STATUTORY FORM (SEC-EMS MOBILE APP QUESTIONNAIRES FOR ZO, RO & MICRO OBSERVER) 18 (a) Is the Voter Turnout same for both Sarpanch & Ward Member or MPTC & ZPTC? (If No, Sl.No. 18 is to be considered for ZPTC and Col.18(b) table is to be displayed for entry of MPTC turnout) Yes/No — Yes (378 Both MPTC & ZPTC) 19 Is Presiding Officer's Diary and other forms prepared? Yes/No — Yes 20 Have you and your team reached safely at reception Centre and handed over the polled material? Yes/No — Yes Mobile Application for Zonal Officers (Zone-02, Bheemunipatnam MPP) 1 Have you familiarized yourself with Poll Parties? Yes/No — Yes 2 Are Basic Minimum Facilities available at all Polling Stations? Yes/No — Yes If No, indicate details of such Polling Stations and action taken thereto. Entry — All Available 3 Have you collected reserve Polling Material? Yes/No — Yes 4 Have you observed any Law & Order problem and intimated the same to RO/SHO, if any? Yes/No/No incidents — No incidents 5 Have voters of vulnerable areas turned up? Yes/No/No such voters — Yes 6 Has remuneration been paid to all polling personnel? Yes/No — Yes Mobile Application for Route Officers (Route-01, Laxmi Puram MPTC) BEFORE POLL DAY & END OF POLL 1 Have you obtained Route Maps? Yes/No — Yes 2 Have you familiarized yourself with locations of all Polling Stations and established contact with Zonal Officer? Yes/No — Yes 3 Have you familiarized yourself with Polling Parties at Distribution Center? Yes/No — Yes 4 Has the Route Opening Party (in troubled areas) cleared the route? Yes/No — Yes 5 Have all the Poll Parties boarded the vehicle? Yes/No — Yes 6 Have you noticed any obstacle in the route and informed to ZO/RO/SHO? Yes/No — No 7 Have all the Polling Parties been dropped at the allotted Polling Stations? Yes/No — Yes 8 Have you picked up all the Polling Parties with polled material? Yes/No — Yes 9 Have all the Polling Parties reached the Reception Center safely? Yes/No — Yes Mobile Application for Micro Observer A. POLL PROCESS 1 Have you reached Polling Station location? Yes/No — Yes 2 Are Candidates / Polling Agents present during demonstration and preparation of Ballot Box / Mock Poll (EVM)? Yes/No — Yes 3 Has the entry pass system been enforced properly? Yes/No — Yes 4 Is Indelible ink being properly applied? Yes/No — Yes 5 Has the Ballot Box / EVM been sealed according to instructions? Yes/No — Yes 6 Has the PO provided copies of Ballot Paper Account (Ballot Box) / Yes/No — Yes

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THIS FORM IS KEPT IN WHITE COLOUR ENVELOPE (BIG SIZE - 16" × 12") [ITEM D(e)] THIS IS A NON-STATUTORY FORM (SEC-EMS MOBILE APP CIRCULAR - CONCLUSION PAGE) Account of Votes Recorded (EVM) to Polling Agents? Yes 7 Any serious complaints on election process received? Yes/No — No If yes, indicate details Entry — NIL B. COUNTING PROCESS (In case of Gram Panchayat Elections — N/A for MPTC/ZPTC Polling Station Day) 8 Whether Counting Agents attended? N/A (MPTC/ZPTC Counting at Mandal Reception/Counting Centre) 9 Is counting conducted as per laid down procedure? N/A 10 Any serious complaints on counting process received? N/A 11 Has election of Upa-Sarpanch been conducted as per laid down procedure? N/A (MPTC & ZPTC Election Only) 12 Has the Report (Checklist for Micro Observers) on election process been prepared and handed over? Yes/No — Yes This initiative empowers the entire election machinery with real-time poll monitoring at their fingertips. It is set to play a significant role in enabling efficient, transparent, and technology-driven Local Body Elections across the State. State Election Commissioner To The Commissioner of Panchayat Raj & Election Authority. The Commissioner & Director of Municipal Administration & Election Authority. All the Collectors & District Election Authorities. All the Chief Executive Officers of Zilla Praja Parishads. All the District Panchayat Officers. All the Commissioners of Urban Local Bodies. All the Revenue Divisional Officers (through Collectors & DEAs). All the Divisional Panchayat Officers (through DPOs). All the Mandal Parishad Development Officers (through CEOs of ZPPs). All the Extension Officers (PR & RD) (through DPOs). All the Panchayat Secretaries (through DPOs). Copy to: The Special Chief Secretary to Government, PR & RD Department. The Principal Secretary to Government, MA & UD Department. MPTC & ZPTC Polling Station Record Completed & Verified: MPTC: LAXMI PURAM MPTC (PS No. 04) | ZPTC: BHEEMUNIPATNAM ZPTC Mandal Parishad: BHEEMUNIPATNAM MPP | Zilla Parishad: VISAKHAPATNAM ZPP K. Sanyasi Naidu Signature of Presiding Officer Name: K. Sanyasi Naidu

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