Honorable, Mr. Chairman 19th Tewariganj Union Parishad. Sadar Laxmipur Date of application: Case No: - Subject: A. Complainant's name, father's name and address: B. Defendant's name, father's name and address: C. Witness name, father's name and address: D. Event place and time: E. Brief description of the case and its just claim and remedy of the candidate: - F. Signature and date of the applicant: -