FORM - B

¨É½þÉ®úɹ]Åõ ¶ÉɺÉxÉ ®úÉVÉ{ÉjÉ +ºÉÉvÉÉ®úhÉ ¦ÉÉMÉ SÉÉ®ú-¤É, ¨ÉÉSÉÇ 22, 2017/SÉèjÉ 1, ¶ÉEäò 1939 Enclosure : Names of Members of the Gram Rakshak Dal Proposed. Sr. Name Address Sign Name and Signature Remarks No. of Witness, if the applicant has establish thumb impression (1) (2) (3) (4) (5) (6) FORM - B [See Rule 3 (2)] Application Form for to call Special Gram Sabha to establish Gram Rakshak Dal by Women Voters. To, Sub-Divisional Magistrate, …............................................ Dist. …................................... Subject.––To call special Gram Sabha to establish Gram Rakshak Dal. Dear Sir / Madam, With reference to above subject you are requested to call a special Gram Sabha to establish a Gram Rakshak Dal in our Village ...... Tal..... Dist........ The manufacturing and sell of illegal liquor has results increase misbehaviour of alcoholic persons, harassment of women which creates the social safety problem. Therefore to prevent it, special Gram Sabha should be called to pass the resolution to establish a Gram Rakshak Dal under the MaharashtraGram Rakshak Dal Rules, 2017. The list of women voters with signature is attached herewith. Yours Truly, Sr. Name Address Sign Name and Sign of Remarks No. the Witness, if the applicant has establish thumb impression (1) (2) (3) (4) (5) (6)