Chapter DECLARATION OF IDENTITY

To be returned with the [ insert colour of ballot paper] coloured ballot paper No .

I hereby declare that I am the person to whom the [ insert colour of ballot paper] coloured ballot paper numbered as above was sent.

F1Except where the voter is a proxy: My date of birth is [DD/MM/YEAR].

Voter's signature

The voter, who is personally known to me, has signed this declaration in my presence.

Witness's signature

* Name of witness (WRITE CLEARLY)

* Address of witness (WRITE CLEARLY)

*(Returning officer to omit where ballot papers sent to an anonymous elector.)

SEE INSTRUCTIONS ON THE BACK OF THIS FORM