ELECTORAL (PRESCRIBED ASSOCIATIONS AND INSTITUTIONS) NOTICE, 2013 SECOND SCHEDULE (Section 3) ELECTION OF SENATORS TO REPRESENT PERSONS WITH DISABILITIES NOMINATION FORM FOR DELEGATES TO THE ELECTORAL COLLEGE FOR PERSONS WITH A DISABILITY Seventh Schedule of the Electoral Act [Chapter 2:13] Notes: 1. An association of disabled persons is required to nominate four delegates, two women and two men, to the Electoral College, 2. An institution is required to nominate two delegates, one woman and one man, to be delegates to the Electoral College. 3. A delegate must be a person with a disability, must be registered as a voter and must not be disqualified tinder the Fourth Schedule of the new Constitution. NOMINATION OF DELEGATE TO ELECTORAL COLLEGE FOR PERSONS WITH A DISABILITY Name of nominating body:____________________________________________________________ State whether nominating body is an association or an institution: _____________________________ Address of association/institution’s main office: ___________________________________________ __________________________________________________________________________________ The attached nomination forms are submitted in respect of ______ *delegates. * (State number of delegates nominated) Name of official submitting nominations on behalf of association/institution: ___________________________________________________________________________ Position held: ____________________________ Signature: __________________________ Date: ____________________________________ NOMINATION OF DELEGATE Full name of delegate: _________________________________________________________________________ Date of birth: _______________________ Sex: _______________________ I.D. No: _____________________ Telephone number: ___________________________ Email address: __________________________________ Nature of disability: __________________________________________________________________________ 102