12. Full names ...................................................................................................................... (Block letters) National Registration No. . .............................................................................................. Signature ............................................. Date ................................................................ Signed in the presence of ................................................................................................ (Candidate/Chief Election Agent/Authorized Representative) D. MASHONALAND CENTRAL: 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 ...................................................................................................................... (Block letters) National Registration No. . .............................................................................................. Signature ............................................. Date ................................................................ Signed in the presence of ................................................................................................ (Candidate/Chief Election Agent/Authorized Representative) 6. Full names ...................................................................................................................... - 47 -