# Electoral Law Act (Northern Ireland) 1962, 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.
Except 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

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Source: https://www.legislation.gov.uk/apni/1962/14/schedule/5/part/VII/chapter/n14 (the official version)
Page: https://openlegislation.uk/electoral-law-act-northern-ireland-1962/schedule-5/part-VII/chapter-n14
Contains public sector information licensed under the Open Government Licence v3.0. Source: legislation.gov.uk, The National Archives.