Australian Capital Territory Representation Regulations (Amendment) (Cth)
I, THE
GOVERNOR-GENERAL of the Commonwealth of Australia, acting with the advice of
the Federal Executive Council, hereby make the following Regulations under the
Dated 15 September 1983.
N. M. STEPHEN
Governor-General
By His Excellency’s Command,
K. C. BEAZLEY
Special Minister of State
––––––
FORM 2 Regulation 15
AUSTRALIAN CAPITAL TERRITORY
ELECTORAL CLAIM
Fill in this form if—
(a) you are claiming enrolment on an electoral roll; or
(b) you need to change your name, address or other details on an electoral roll.
Please post it in the prepaid envelope, or deliver it, to the Australian Electoral Office.
Your claim will be acknowledged.
PERSONAL PARTICULARS | Australian Capital Territory To the Electoral Registrar, Division of | ||||
Please use BLOCK LETTERS only. Please use blue Please use blue or black ink only. | My name is | Surname | |||
Please include all names by which you are generally known. | Christian or given names | ||||
Residential address—you can only be enrolled for your residential address. Please give your full address. If you live in a rural area show sufficient detail to identify your place of living. | I live at | Flat /Street number | Street/Road | ||
Suburb/Town/Locality | |||||
Postal address—if the same as residential address put ‘As above’. | My postal address is | Postal address | Postcode | ||
Your postal address will not appear on the roll. | My occupation is | Occupation | (delete one) and I am Male/Female | ||
The remaining details are necessary for identification but will not appear on the roll. | I was born on | day month year ...... /...... /...... | Town | Country | |
Complete former address only if you have moved since your last enrolment. | My former address was | Street | Suburb/Town | State/Territory | |
Complete former name only if you have changed your name (for example by marriage) since your last enrolment | My former name was | Former name | |||
FORM
DECLARATION | I am entitled to enrolment because— | |
Upon enrolment you will be entitled to vote at elections for the House of Representatives and the Senate. | (a) I am not under 18 years of age; (b) I have lived continuously in Australia for at least 6 months; (c) I am an Australian citizen or other British subject;
and I claim enrolment for the Division. | |
You must sign this declaration in the presence of a person who is enrolled, or entitled to be enrolled, on an electoral roll kept for the purposes of a House of Representatives election. | I declare that the statements made in this claim, including my personal particulars set out above, are true to the best of my knowledge and belief. | |
A person who is unable to sign his name in writing may make his mark as his personal signature. | ...................................................................................... /....... /......................................................... Personal Signature of Claimant Date | |
WITNESS | I saw this claim signed by the claimant and am satisfied that the statements contained in the claim are true. | |
As the person to witness this claim you must be satisfied from personal knowledge or enquiry of the claimant or otherwise that the information declared is true.
| I am enrolled, or entitled to be enrolled, on an electoral roll kept for the purposes of a House of Representatives election. | |
Surname Christian or given names | ||
Address | ||
You may not witness this claim unless you are able to sign your name in writing. | Full address of witness | ...................................................................................... /....... /......................................................... Signature of witness Date |
1. Notified in the
Commonwealth of Australia Gazette on 22 September 1983.2. Statutory Rules 1974 No. 62 as amended to date. For previous amendments
see Note 2 to Statutory Rules 1983 No. 115 andsee also
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