(Candidate/Election Agent/Authorized Representative) 10. Full names ................................................................................................................................ (Block letters) Residential address..................................................................................................................... National Registration No. .......................................................................................................... Signature .................................... Date..................................................................................... Signed in the presence of ........................................................................................................... (Candidate/Election Agent/Authorized Representative) Note.—Extra nominations may be made by attaching a separate sheet containing the same particulars and complying with same procedures as are here required of the minimum number of nominees. DECLARATION BY OR ON BEHALF OF CANDIDATE ...................................................................................................................................................... of (full name of candidate, in block letters) .......................................................................................................................................................... (address of candidate date, in block letters) Candidate’s telephone No. ................................................................................................................. I certify that: 1. The candidate is enrolled as a voter in the ........................................................................... ward. 2. The candidate meets the qualifications set out in section 119(1)/120 (1)* of the Act. 3. The candidate is not disqualified for election in terms of section 119(2)/120(2) and (3)* of the Act 4. Each of the persons nominating the candidate signed this nomination paper in the presence of the candidate or his/her election agent or his/her authorized representative. 5. The candidate accepts the nomination as a candidate for election to the local council. Date ............................................................. Signature ................................................................... Candidate/Candidate’s Election Agent (FINAL PAGE) DISTINCTIVE SYMBOL AND PARTY NAME AND ABBREVIATION (This part is to be completed if the candidate wishes a distinctive symbol 1 and/or Party identification to appear on the ballot) 1. Distinct Symbol The candidate wishes the following symbol to appear on the ballot paper in conjunction with his name: - 65 -