ELECTORAL (VOTER REGISTRATION) REGULATIONS, 2013 SCHEDULE (Section 2) FORMS FORM VR.1 Section 24(1) of ELECTORAL ACT [CHAPTER 2:13] INITIAL VOTER REGISTRATION (Form VR1) 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 Zimbabwean citizen aged over 18 years and hereby apply to be registered as a voter: I.D. NUMBER SURNAME(as per ID) FORENAME(S) (as per ID) DATE OF BIRTH Day Month SEX M F Year (Tick Applicable) RESIDENTIAL ADDRESS (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 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: 87 NUMBER: Y Y