ELECTORAL REGULATIONS, 2005 Declaration by candidates/ election agents I hereby confirm that this return is a correct statement of the collated results at Presidential constituency centre. Name Name of political party Independent candidate Designation 1. 2. 3. 4. 5. Distribution of Presidential constituency return: The Presidential constituency return is to be distributed as follows: 1. Affix copy outside constituency centre. 2. Provide copy to each election agent and observer present at polling station. 3. Send copy to the Provincial Elections Officer. 4. Send copy to the Chief Elections Officer. [Form substituted by s.i 87 of 2013] ____________________________ 27 Date Signature