ELECTORAL ACT [CHAPTER 2:13] (Section 25(1) proviso) _______________ APPLICATION BY REGISTERED VOTER FOR TRANSFER FROM ONE CONSTITUENCY TO ANOTHER OF WHICH HE HAS BECOME RESIDENT 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 …………………………………………………………………………………… 10. Citizenship status code: (State if your are a citizen by 1. Birth, 2. Descent, 3. Registration or 4. Non-citizen resident) ………………………………………………………………………………… 11. If non-citizen permanent resident:: (State residence permit number and/or number of years lived in Zimbabwe) ……………………………………………………………………………………. 12. National registration number ………………………………………………………………… 13. Occupation: …………………………………………………………………………………… 14. State Constituency in which you are presently registered …………………………………… 15. State Constituency to which you want to be transferred …………………………………… 16. State reasons for requesting transfer: ………………………………………………………………………………………………………… . (if space is insufficient please attach a sheet containing reasons) 17. Address where you wish to be deemed to be resident ……………………………………………. 18. Postal address (in full): …………………………………………………………………………… PART B TO BE COMPLETED BY REGISTRATION OFFICER ONLY 19. Voter number (national registration number): ……………………………………………………… 20. Deleted from (Constituency): ……………………………………………………………………….. 21. Forwarded to (Constituency): ……………��……………………………………………………… 22. Block number: …………………………………………………………………………………. 23. District ……………………………………………………………………………………………… 24. Place of registration: …………………………………………………………………...…………… - 17 -