ELECTORAL ACT ____________________________________________________________________________________ 12. Full names ................................................................................................................ (Block letters) National Registration No. .......................................................................................... Signature ……......................................................... .. Date .................................... Signed in the presence of .......................................................................................... (Candidate/Chief Election Agent/Authorized Representative) C. MANICALAND: 1. Full names ................................................................................................................ (Block letters) National Registration No. ................ of (Residential Address): .................................................................................................................................. 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) 169