Electoral Registration Form

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North Norfolk District Council
Electoral Registration Form
Only one person for each form. Please read the notes carefully before filling in this form. If you need help
completing it please phone 01263 516046/516317. Please write in BLACK INK and BLOCK CAPITALS.
1
Current address
3
Other information about you
Address where you were previously registered to
vote
Previous local council (if known)
Date you moved in
4
Absent voting
Day
Month
Year
2
About you
Please tick the box if you would like a postal
First name(s) (in full)
vote application sent to you
Surname
Please tick the box if you would like a proxy
vote application sent to you
Title (Mr, Mrs, Ms, Miss, Dr, Other)
5
Your declaration
If you are a European Union citizen (other than
Please read the following statement carefully as
British or Irish), state which country you are from.
you can be fined for making a false statement.
As far as I know, the details on this form are true
If you are 16 or 17 years old please give your date
and accurate. I am a British citizen, a citizen of
of birth.
another Commonwealth country, a citizen of the
Republic of Ireland or a citizen of another
European Union country. I am currently living at
the address shown in part 1.
Signature - Please sign in the box below within
Day
Month
Year
the border using BLACK INK
Tick here if you are 70 years old or over.
Tick here if you do not want your name to be
included on the edited register, which is
available for general sale.
Daytime telephone, mobile number or email
Date
You do not have to give this information, but it may
help us to contact you if there is a query about this
form.

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