Polls were held in the house during the second sitting of the Sindh Assembly, which was chaired by the newly elected Speaker of the house, Agha Siraj Khan Durrani. Qaim Ali Shah emerged successful with 86 votes against MQM's Syed Sardar Ahmed who secured 48 votes and PML-F's Imtiaz Shaikh who bagged only 18 votes. Four PTI lawmakers abstained from voting, and as many as 152 members of the assembly took part in the election.
Qaim Ali Shah later addressed the assembly, promising that his government would accelerate its efforts for peace in the city. Acknowledging the worsening of the law and order situation in the city, he said that the city's law and order needed to be restored on a priority basis.
He thanked his party's co-chairperson Asif Ali Zardari for nominating him as the leader of the house, saying: "I am thankful to him (Zardari) for nominating me as the chief minister for a third time". Highlighting his government's achievements, he said that the previous provincial government had distributed 100,000 acres of land among landless peasants, besides providing them with seeds for cultivation. He asserted that he would follow in the ootsteps of PPP's founding leader, Zulfikar Ali Bhutto "to serve the nation".
He said his previous government had also set up nine universities in the province at a cost of Rs 4 billion. Latter, Qaim Ali Shah and a seven-member cabinet along with an adviser were administered oaths by Governor Sindh Dr Ishratul Ibad Khan during a ceremony at the Governor's House. The Sindh cabinet includes Nisar Khuhro, Makhdoom Jamiluz Zaman, Sharjeel Memon, Manzoor Wasan, Mir Hazar Khan Bijarani, Ali Nawaz Mehar and Sikandar Mandhro. Former Sindh Finance Minister Murad Ali Shah was appointed as the adviser on finance to the chief minister.