I claim to be entitled to be registered as a voter in the constituency in which I now reside. I declare that all statements made in this claim are true to the best of my knowledge and belief and that I have not previously applied for registration on the voters roll. Date: ……………………………….. Personal signature of claimant ………………………. WARNING: SEVERE PENALTIES ARE IMPOSED FOR GIVING FALSE INFORMATION PART D - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - -- - - - - - - - - - - - - -- - - - - - - - - - - - - CERTIFICATE OF REGISTRATION AS A VOTER Serial No. This is to certify that …………………………………………………… has been registered as a Voter on the Voter’s Roll for the Constituency of …………………………………………………………………. Block number: ……………………………………………………………………………………………. National registration number: ……………………………………………………………………………. Place of registration: ……………………………………………………………………………………… Name of Registrar in print form: ………���………………………………………………………………. Date: …………………………………………… Signature: ………………………………………. Form V2 ELECTORAL ACT [CHAPTER 2:13] (Section 24(1) proviso) _______________ CLAIM FORM FOR REGISTRATION AS A VOTER IN A CONSTITUENCY IN WHICH CLAIMANT IS NOT RESIDENT _______________ In terms of the proviso to section 23(1) of the Act, a claimant may only be registered in a constituency in which he or she is not resident if he or she intends to be a candidate for election as a member of Parliament in that constituency. _______________ THIS FORM MUST BE COMPLETED IN BLOCK LETTERS PART A 1. Type of registration code: 2. Surname …………………………………………………………………………………………….. 3. Forenames ………………………………………………………………………………………….. 4. Former names (if changed) ………………………………………………………………………… 5. Sex ………………………………………………………………………………………………….. 6. Date of Birth ………………………………………………………………………………………… 7. Place of Birth: (enter town, farm, mine, resettlement area or village and chief, if communal land)……………………………………………………………………………………………… 8. District of Birth …………………………………………………………………………………… 9. Country of Birth …………………………………………………………………………………… - 15 -