ELECTORAL (VOTER REGISTRATION) REGULATIONS, 2013 FORM VR.4 Proviso to Section 25(1)(b) of ELECTORAL ACT [CHAPTER 2:13] TRANSFER TO A CONSTITUENCY WHERE ONE IS NOT ORDINARILY RESIDENT (Form VR4) (TO BE COMPLETED BY A PROSPECTIVE MEMBER OF PARLIAMENT WHO DOES NOT RESIDE IN THE CONSTITUENCY) PART A (TO BE COMPLETED IN BLOCK LETTERS IN DUPLICATE) ⚠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 a Constituency where I am not ordinarily 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 I ORDINARILY RESIDE AT: (Circle the Appropriate and Attach proof of residence) HOUSE/STAND/PLOT/VILLAGE NAME STREET/FARM/HEADMAN SUBURB/FARMING AREA/MINE/CHIEF TOWN/DISTRICT I WOULD LIKE TO BE TRANSFERRED TO THE ADDRESS BELOW BECAUSE I INTEND TO BE A CANDIDATE FOR ELECTION AS A MEMBER OF PARLIAMENT IN THAT CONSTITUENCY: (Provide address where you shall be deemed to be resident) 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 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. NUMBER: ……………………………………………………………….. SIGNATURE: ………………………………………………………………….. DATE STAMP: 92 Y Y