FORM – 4

[ See rule 19 to 22 ]

NOTICE

(To be delivered in person in the office of the Gram Panchayat/ Panchayat Samiti/ Zilla Parishad concerned and an acknowledgement obtained on the office copy)

To

*  The Pradhan

*  The Pramukh

*  The Adhyakash

___________________ (Name of the Gram Panchayat/ Panchayat Samiti/ Zilla Parishad.

            I, ________________________ (name) Member ___________________ (name of Gram Panchayat/ Panchayat Samiti/ Zilla Parishad) hereby move a motion of no confidence against Shri. ____________________________________ (name) _______________________________ (designation) i.e. Pradhan/ Up-Pradhan/ Pramukh/ Up-Pramukh/ Adhyaksh/. Up-Adhyaksh of the concerned Panchayat).

Place :

Date :

                         Signature :

                                                 Name :

Name of Panchayat * *

* Score out whichever is not applicable.

* * Write the name of Gram Panchayat/ Panchayat Samiti/ Zilla Parishad.