FIRST SCHEDULE (Section 2) FORMS Form V.1 ELECTORAL ACT [CHAPTER 2:13] (Section 24) _______________ CLAIM FORM FOR REGISTRATION AS A VOTER _______________ THIS FORM MUST BE COMPLETED IN BLOCK LETTERS PART A 1. Type of registration code: 2. Surname …………………………………………………………………………………………….. 3. Forenames ………………………………………………………………………………………….. 4. Sex ………………………………………………………………………………………………….. 5. Date of Birth ………………………………………………………………………………………… 6. Place of Birth: (enter town, farm, mine, resettlement area or village and chief, if communal land)……………………………………………………………………………………………… 7. District of Birth …………………………………………………………………………………… 8. Country of Birth …………………………………………………………………………………… 9. Citizenship status code: (State if your are a citizen by 1. Birth, 2. Descent, 3. Registration or 4. Non-citizen resident) ………………………………………………………………………………… 10. If non-citizen permanent resident:: (State residence permit number and/or number of years lived in Zimbabwe) ……………………………………………………………………………………. 11. National registration number ………………………………………………………………… 12. Occupation: …………………………………………………………………………………… 13. Present residential address (in full) (Communal dwellers must give name of village, headman and chief) ……………………………………………………………………………………………. 14. Postal address (in full) …………………………………………………………………………… PART B TO BE COMPLETED BY REGISTRATION OFFICER ONLY 15. Voter number (national registration number) ……………………………………………………… 16. Block number ………………………………………………………………………………………. 17. Constituency ………………………………………………………………………………………… 18. District ……………………………………………………………………………………………… 19. Place of registration: …………………………………………………………………...…………… PART C DECLARATION BY CLAIMANT - 14 -