ELECTORAL (PRESCRIBED ASSOCIATIONS AND INSTITUTIONS) NOTICE, 2013 Ward in which registered as voter: ____________________________ Province: _________________________ DECLARATION BY OR ON BEHALF OF DELEGATE I, ____________________________________________________________________________________________ declare that I have accepted nomination to be a delegate at the meeting of the Electoral College for Persons with a Disability and that I will attend the meeting. Date: _____________________________________________ Signature: _____________________________ NOMINATION OF DELEGATE Full name of delegate: _________________________________________________________________________ Date of birth: _______________________ Sex: _______________________ I.D. No: _____________________ Telephone number: ___________________________ Email address: __________________________________ Nature of disability: __________________________________________________________________________ Ward in which registered as voter: ____________________________ Province: _________________________ DECLARATION BY OR ON BEHALF OF DELEGATE I, ____________________________________________________________________________________________ declare that I have accepted nomination to be a delegate at the meeting of the Electoral College for Persons with a Disability and that I will attend the meeting. Date: _____________________________________________ Signature: _____________________________ NOMINATION OF DELEGATE Full name of delegate: _________________________________________________________________________ Date of birth: _______________________ Sex: _______________________ I.D. No: _____________________ Telephone number: ___________________________ Email address: __________________________________ Nature of disability: __________________________________________________________________________ Ward in which registered as voter: ____________________________ Province: _________________________ DECLARATION BY OR ON BEHALF OF DELEGATE 103