ELECTORAL (VOTER REGISTRATION) REGULATIONS, 2013 FORM VR.9 AFFIDAVIT OF RESIDENCE VOTER REGISTRATION I, ……………………………………………………………………………………………………… , (Full names) do hereby swear to this affidavit for the purpose of my application to register as a voter. 1. My national registration number is ……………………………………………………………. 2. I have been informed and I realise that in terms of section 10 of the Justices and Peace and Commissioners of Oaths Act [Chapter 7:09], it is an offence to declare false information in this document and that if I give false information I will be liable for prosecution and imprisonment for the offence of perjury. 3. I reside at: (Select and complete only one of the four subparagraphs 3(a), (b), (c) or (d) (a) Village name/Resettlement area: Name of village head: Headman: Chief: District: (b) House No./Stand No.: Street: Suburb: Town: (c) Name of school/ hospital/mine or other institution: Name of head or manager of the school/hospital/mine or other institution: (d) Other: (Deponent to give full details): I make the above statement sincerely and knowing the same to be true. Signed: …………………………………………… DEPONENT Thumbprint Sworn before me at …………………………… on this …………… day of ……………….. 20 . ………………………………………………. (full names) ……………………………………………….. COMMISSIONER OF OATHS 98