(Candidate/Chief Election Agent/Authorized Representative) 11. Full names ...................................................................................................................... (Block letters) National Registration No. . .............................................................................................. Signature ............................................. Date ................................................................ Signed in the presence of ................................................................................................ (Candidate/Chief Election Agent/Authorized Representative) 12. Full names ...................................................................................................................... (Block letters) National Registration No. . .............................................................................................. Signature ............................................. Date ................................................................ Signed in the presence of ................................................................................................ (Candidate/Chief Election Agent/Authorized Representative) B. BULAWAYO: 1. Full names ...................................................................................................................... (Block letters) National Registration No. . .............................................................................................. Signature ............................................. Date ................................................................ Signed in the presence of ................................................................................................ (Candidate/Chief Election Agent/Authorized Representative) 2. Full names ...................................................................................................................... (Block letters) National Registration No. . .............................................................................................. Signature ............................................. Date ................................................................ Signed in the presence of ................................................................................................ (Candidate/Chief Election Agent/Authorized Representative) 3. Full names ...................................................................................................................... (Block letters) National Registration No. . .............................................................................................. Signature ............................................. Date ................................................................ Signed in the presence of ................................................................................................ (Candidate/Chief Election Agent/Authorized Representative) 4. Full names ...................................................................................................................... (Block letters) National Registration No. . .............................................................................................. Signature ............................................. Date ................................................................ Signed in the presence of ................................................................................................ (Candidate/Chief Election Agent/Authorized Representative) 5. Full names ...................................................................................................................... - 43 -