Fillable 126 Application to vote by proxy at a particular election or referendum

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126 Application to vote by proxy at a particular election or referendum

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Application to vote by proxy at a particular election or referendum
How do I apply to vote by proxy?
1
2
3
4
You must ask someone who is willing and able to be your proxy and vote on your behalf.
Please note that a person can only be the proxy for close relatives and up to two other people
at the same election or referendum.*
Fill in the proxy vote application form. You must give a reason why you want to vote by proxy,
for example you may be abroad on holiday on election day.
Make sure you complete all sections of the form and supply your date of birth and signature.
Return your form to your local electoral registration office. You can find their details at
www.aboutmyvote.co.uk.
Only electors who are (or will be) registered individually for a particular election or referendum are entitled
to vote by proxy at that election or referendum. In addition, the person you wish to appoint as your proxy
can only act as proxy if they are (or will be) registered individually. Contact your electoral registration
office for further information.
Please do not return your form to the Electoral Commission. Please note: your application form must
arrive at your electoral registration office by 5pm 11 working days before an election or referendum when
changing or cancelling an existing proxy, postal or postal proxy vote and by 5pm 6 working days before
an election or referendum when applying for a new proxy vote.
* By referendum we mean: Neighbourhood Planning Referendums, Council Tax Referendums, Mayoral & Governance
Arrangements Referendums and Local Authority Advisory polls. If you wish to apply to vote by post for a different type of
referendum, please contact your Electoral Registration Officer.
Application to vote by proxy at a particular election or referendum
Voting by proxy
If you cannot vote at an election or referendum in
person, you can apply to vote by proxy (someone
else voting on your behalf). You can use this form
to apply to vote by proxy for one particular election
only.
What happens after I’ve returned
this form?
■ Your proxy must go to your local polling station
to vote. If your proxy cannot get to the polling
station, they can apply to vote for you by post.
They can apply to do this by 5pm 11 working
days before election day. They should contact
the electoral registration office for more details.
■ Your proxy will be sent a proxy poll card, telling
them where and when to vote on your behalf.
■ You should let your proxy know how you want
them to vote on your behalf, for example, which
candidate, party, or outcome.
■ If it turns out that you are able to go to the polling
station on election day, you can vote in person
as long as your proxy has not already done so
or has not applied to vote for you by post.
■ You will need to give your date of birth
and signature on this application form. This
information is needed to prevent fraud. If you
are unable to sign this form, please contact
your Electoral Registration Officer.
Voting as proxy
A person can only be a proxy for close relatives
and up to two other people at an election or
referendum.
Close relatives are the spouse, civil partner, parent,
grandparent, brother, sister, child or grandchild of
the applicant.
The person you wish to appoint as your proxy can
only act as proxy if they are 18 or over and they are
(or will be) registered individually for that election or
referendum.
More information
If you have any questions about voting by proxy,
go to
www.aboutmyvote.co.uk or contact your
electoral registration office.
In England and Wales, the electoral registration
office is based at your local council. In Scotland,
it may be a separate office.
For contact details, go to www.aboutmyvote.co.uk
This form does not apply in Northern Ireland.
Visit
www.eoni.org.uk for more information.
Electoral Registration Officers will only use the
information you provide for electoral purposes. They
will look after personal information securely and will
follow the Data Protection Act 1998. Electoral
Registration Officers will not give personal
information about you to anyone else or another
organisation unless they have to by law.
Application to vote by proxy at a particular election or referendum
Only one person can apply to vote by proxy using this form. Please write in black ink and use
BLOCK LETTERS. When you have completed every section and signed the form yourself, send
it to your electoral registration office. You can get the address at
www.aboutmyvote.co.uk
About you
1
Why do you want a proxy vote?
4
Surname Please explain why you are not able to go to your
polling station on election day:
First names (in full)
Your address (where you are registered to vote)
Postcode
Daytime telephone or mobile number (optional)
E-mail address (optional)
About your proxy
2
Full name
Relationship to you (if any)
Full address
Your date of birth and declaration
5
Declaration: I have asked the person I have named as
my proxy and confirm that he/she is willing and able to
be appointed to vote on my behalf.
As far as I know, the details on this form are true and
accurate. I understand that to provide false information
on this form is an offence, punishable on conviction
by imprisonment of up to 2 years and/or a fine.
Date of birth: Please write your date of birth
‘DD MM YYYY’ in the black boxes below,
using black ink.
Signature: Sign below, keeping within the grey border.
Postcode
At which election or referendum do you
want a proxy vote?
3
I want to vote by proxy at all election(s) and the
referendum(s) held on:
D D M M Y Y Y Y
If you are unable to sign this form, please contact
your Electoral Registration Officer.
Date of application
6
Today’s date
D D M M Y Y Y Y
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126 Application to vote by proxy at a particular election or referendum

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Completed 8 July 2020

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