# 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 M1
Corresponding Number List M2
Form of Postal Voting Statement (for use where there is joint issue and receipt of postal ballot papers)
Form of Postal Voting Statement (for use when a referendum poll is combined with another poll but the postal ballot papers are not combined)
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 M1
Corresponding Number List M2
Postal voting statement (for use where there is joint issue and receipt of postal ballot papers)
Front of form
Rear of form
Postal voting statement (for use when a referendum poll is combined with another poll but the postal ballot papers are not combined)
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 card
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
Rear of card
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

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Source: https://www.legislation.gov.uk/uksi/2012/323/schedule/5/part/8 (the official version)
Page: https://openlegislation.uk/local-authorities-conduct-of-referendumsengland-regulations-2012/schedule-5/part-8
Contains public sector information licensed under the Open Government Licence v3.0. Source: legislation.gov.uk, The National Archives.