Application To Vote By Proxy Form - Tonbridge And Malling Borough Council Page 3
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4Tonbridge & Malling Borough Council
Application To Vote By Proxy
«ELECTOR_BARCOD
E»
Complete only one form for each person. Please read the notes carefully before
completing this form. If you need help filling in this form please phone 01732 876022.
Please write in BLACK INK and BLOCK CAPITALS.
1
Address where you are registered to vote
5
Name and Address of appointed proxy
First name(s) (in full)
Surname
Title (Mr, Mrs, Ms, Miss, Dr, Other)
Address
2
About you
Relationship to you (if any)
First name(s) (in full)
Surname
6
Your declaration
As far as I know, the details on this form are true and
Title (Mr, Mrs, Ms, Miss, Dr, Other):
accurate.
You can be fined for making a false
Daytime or mobile telephone or email (Optional)
statement on this form.
______________________________________________
Date of birth (e.g. 02 05 1965)
3
How long do you want to vote by proxy?
(a) Until further notice
D
D
M
M
Y
Y
Y
Y
(b) For elections on the following date
Day
Month
Year
Important – keep signature within the border
Day
Month
Year
If you fail to do this, the application will not be valid. If
(c) For elections between the following dates
you are unable to sign this form, please contact us.
From
Please SIGN in the box below using BLACK ink
Day
Month
Year
Until
Day
Month
Year
4
Proxy vote for which elections
All elections you are entitled to vote at
Local elections
Date of signing
Parliamentary or Assembly elections
PLEASE RETURN FORM TO
Electoral Services, TMBC, Gibson Building, Gibson Drive, Kings
Hill, West Malling, ME19 4LZ. Or scan the completed form and
email to: voting@tmbc.gov.uk
NOW COMPLETE SECTION 7 OVERLEAF, GIVING THE REASON FOR YOU APPLICATION
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