ELECTORAL REGULATIONS, 2005 I hereby confirm that this return is a correct statement of the collated results for the National Assembly constituency election. Name Name of political party Independent candidate Designation 1. 2. 3. 4. 5. Distribution of National Assembly constituency return: The constituency return is to be completed and distributed as follows: 1. Affix copy outside National Assembly constituency centre. 2. Provide copy to each election agent and observer present at polling station. 3. Send copy to Provincial Elections Officer. 4. Send copy to Chief Elections Officer at National Command Centre. [Form substituted by s.i 87 of 2013] 25 Date Signature