The Karnataka State Cricket AssociationM Chinnaswamy Stadium, Cubbon Road, Bengaluru - 560 001

i. Not more than three (3) Institutional Members to represent the Founder Institutional Members comprising of the Bangalore Urban, Bangalore Rural, Kolar, Chikkaballapur and Ramnagar Districts

ii. Not more than one (1) Institutional Member to represent the Founder Institutional Members in Mysore zone comprising of Mysore, Chamrajanagar and Mandya districts:

Nomination for Managing CommitteeFor the Term 2019-20 to 2021-22

Life Members for Managing Committee

Institutional Members for Managing Committee

Name of the Institutional Member

Name of theAuthorised

Representative

Signature of theAuthorised

Representative

Signature of the President/Secretary with

Offical Seal

Name of the Institutional Member

Name of theAuthorised

Representative

Signature of theAuthorised

Representative

Signature of the President/Secretary with

Offical Seal

Not more than two (2) members to represent the Life Members of the Association:

Name of the Life Member Signature

The Karnataka State Cricket AssociationM Chinnaswamy Stadium, Cubbon Road, Bengaluru - 560 001

iv. Not more than one (1) Institutional Member to represent the Founder Institutional Members in Mangalore zone comprising of South Kanara, Udupi and Kodagu District:

v. Not more than one (1) Institutional Member to represent the Founder Institutional Members in Dharawad zone comprising of Dharwad, Belgaum, Gadag, Haveri and North Kanara districts:

iii. Not more than one (1) Institutional Member to represent the Founder Institutional Members in Shimoga zone comprising of Shimoga, Chikmagalur and Hassan District:

Name of the Institutional Member

Name of theAuthorised

Representative

Signature of theAuthorised

Representative

Signature of the President/Secretary with

Offical Seal

Name of the Institutional Member

Name of theAuthorised

Representative

Signature of theAuthorised

Representative

Signature of the President/Secretary with

Offical Seal

Name of the Institutional Member

Name of theAuthorised

Representative

Signature of theAuthorised

Representative

Signature of the President/Secretary with

Offical Seal

Name of the Institutional Member

Name of theAuthorised

Representative

Signature of theAuthorised

Representative

Signature of the President/Secretary with

Offical Seal

vi. Not more than one (1) Institutional Member to represent the Founder Institutional Members in Tumkur zone comprising of Tumkur, Chitradurga, Davangere and Bellary districts:

vii. Not more than one (1) Institutional Member to represent the Founder Institutional Members in Raichur zone comprising of Raichur, Bijapur, Bidar, Bagalkot, Koppal, Gulbarga and Yadgir districts:

Name of the Institutional Member

Name of theAuthorised

Representative

Signature of theAuthorised

Representative

Signature of the President/Secretary with

Offical Seal

Signature of the Proposer

Name (in BLOCK letters) and Name (in BLOCK letters) and

Signature of the seconder

Membership No. Membership No.

The Karnataka State Cricket AssociationM Chinnaswamy Stadium, Cubbon Road, Bengaluru - 560 001

Place: Date:

Note:

1. Proposer and Seconder should be Life Member or Founder Institutional Member of the association and whose subscription is not in arrears.

2. Signature of the nominated Member should invariably be obtained in the form for having given the consent to stand for election.

3. Only Life Member and authorised representatives of Founder Institutional Member will have the right to participate and vote at the above meeting, provided they are not in arrears of any fees.

4. Life Members and Founder Institutional Members associated with any organisation prohibited by the BCCI are not eligible to contest the elections.