# The Local Authorities (Conduct of Referendums)(England) Regulations 2012, Part 8: Appendix of Forms

Extent: E+W

Note:—The forms contained in this Appendix may be adapted so far as circumstances require.
Form of Ballot Paper: Question in referendum as specified in paragraph 1 of Schedule 1
Form of Ballot Paper: Question in referendum as specified in paragraph 2 of Schedule 1
Form of Ballot Paper: Question in referendum as specified in paragraph 3 of Schedule 1
Form of Ballot Paper: Question in referendum as specified in paragraph 4 of Schedule 1
Form of Ballot Paper: Question in referendum as specified in paragraph 5 of Schedule 1
Form of Ballot Paper: Question in referendum as specified in paragraph 6 of Schedule 1
Corresponding Number List L1
Corresponding Number List L2
Form of Postal Voting Statement
Official Poll Card (to be sent to a voter voting in person)
Official Postal Poll Card (to be sent to a voter voting by post)
Official Proxy Poll Card (to be sent to an appointed proxy voting in person)
Official Proxy Postal Poll Card (to be sent to an appointed proxy voting by post)
Ballot Paper Refusal List
Form of directions for the guidance of the voters and proxies in voting
Form of Certificate of Employment
Declaration to be made by the companion of a voter or proxy with disabilities
Form of Ballot Paper: Question in referendum as specified in paragraph 1 of Schedule 1
Form of Ballot Paper: Question in referendum as specified in paragraph 2 of Schedule 1
Form of Ballot Paper: Question in referendum as specified in paragraph 3 of Schedule 1
Form of Ballot Paper: Question in referendum as specified in paragraph 4 of Schedule 1
Form of Ballot Paper: Question in referendum as specified in paragraph 5 of Schedule 1
Form of Ballot Paper: Question in referendum as specified in paragraph 6 of Schedule 1
Corresponding Number List - L1
Corresponding Number List - L2
Postal voting statement
Front of form
Rear of form
Official Poll Card (to be sent to a voter voting in person)
Front of form
Rear of form
Official postal poll card (to be sent to a voter voting by post)
Front of card
Rear of form
Official Proxy Poll Card (to be sent to an appointed proxy voting in person)
Front of form
Rear of form
Official proxy postal poll card (to be sent to an appointed proxy voting by post)
Front of card
Back of card
Ballot paper refusal list
Form of directions for the guidance of the voters and proxies in voting
Certificate of employment
Declaration to be made by the companion of a voter or proxy with disabilities

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Source: https://www.legislation.gov.uk/uksi/2012/323/schedule/3/part/8 (the official version)
Page: https://openlegislation.uk/local-authorities-conduct-of-referendumsengland-regulations-2012/schedule-3/part-8
Contains public sector information licensed under the Open Government Licence v3.0. Source: legislation.gov.uk, The National Archives.