ELECTORAL (VOTER REGISTRATION) REGULATIONS, 2013 FORM VR. 3 Section 25(1)(a) of ELECTORAL ACT [CHAPTER 2:13] VOTER TRANSFER (Form VR3) PART A (TO BE COMPLETED IN BLOCK LETTERS) ⚠It is an offence to procure a false registration or to furnish false information to ZEC I am a registered voter and hereby apply for the transfer of my registration to another polling station where I am now resident: I.D. NUMBER SURNAME(as per ID) FORENAME(S) (as per ID) DATE OF BIRTH Day Month SEX M F Year (Tick Applicable) I was registered as a voter for ……………………………………………………………………… POLLING STATION in …………………………… DISTRICT and I am now resident at: (Circle the Appropriate and Attach proof of residence) HOUSE/STAND/PLOT/VILLAGE NAME STREET/FARM/HEADMAN SUBURB/FARMING AREA/MINE/CHIEF TOWN/DISTRICT PHONE/CELL NUMBER email address (If any) .................................................................. TICK THE APPROPRIATE BOX BELOW IF YOU HAVE ANY SPECIAL NEEDS. HEARING VISUAL AMPUTEE OTHER (Please specify) …………………………………………………………………….………………………. I declare that the above information is true to the best of my knowledge. SIGNATURE ……………………………………………...................................................... DATE D D M M M Y PART B (FOR OFFICE USE ONLY) ATTACH CERTIFICATE OF REGISTRATION AS A VOTER HERE VOTER REGISTRATION OFFICER’S DETAILS IN BLOCK LETTERS FULL NAME: ……………………………………………………………………………………………. I.D. ………………………………………………………………………………………….. SIGNATURE: …………………………………………………………………………………………….. DATE STAMP: 91 NUMBER: Y Y Y