Form V. 11 ELECTORAL ACT [CHAPTER 2:13] (Sections 4(1) and 64) ___________________ PARLIAMENTARY AND PRESIDENTIAL ELECTIONS: POLLING-STATION RETURN Polling Station at:…………………………………………………………….. PART A: BALLOT PAPER ACCOUNT Ordinary ballot papers received No. Nos. ________ to ________ inclusive Ordinary ballot papers accounted for 1. Ballot papers in ballot box…… 2. Ballot papers unused…………. No. Nos. ________ to _______ inclusive 3. Ballot papers spoilt…………… 4. Ballot papers unaccounted for… TOTAL Tendered ballot papers received TOTAL No. Nos. ________ to ________ inclusive Tendered ballot papers accounted for 1. Tendered ballot papers used…. 2. Tendered ballot papers No. unused…………. Nos. ________ to _______ inclusive 3. Tendered ballot papers spoilt………………………….. 4. Tendered ballot papers unaccounted for………………. TOTAL TOTAL I hereby certify that the above is a correct statement of all ballot papers received by me. (Signed)……………………………………….. Presiding Officer Dated this………………….…. day of……………………………………., 20…………… PART B: RESULT OF COUNTING Names of candidates Party /Independent Votes received A-L Votes received M - 31 - Votes received N-Z Total valid votes received