Fillable 130 Application to vote by proxy due to attendance on an educational course

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130 Application to vote by proxy due to attendance on an educational course

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Application to vote by proxy due to attendance
on an educational course
How do I apply to vote by proxy?
1
2
3
4
You must ask someone if they are 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.
You must get someone to support your application. You can find out who can do this below.
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 are entitled to vote by proxy. 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 due to attendance
on an educational course
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 if you or your spouse or civil
partner will be attending an educational course that
means you cannot vote in person on election day.
Who can support my application?
■ the director or tutor of your course
■ the principal or head of the educational
establishment where your course is taking place
■ an employee of the educational establishment
where your course is taking place who is
authorised to support your application
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 up to 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.
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 due to attendance
on an educational course
Only one person can apply to vote by proxy using this form. Write in black ink and use BLOCK LETTERS.
When you have filled in every section and signed the form yourself, send it to your local electoral registration
office. You can get the address at www.aboutmyvote.co.uk
About you
1
4B – I am the spouse/civil partner of (enter their name)
Surname
First names (in full)
My spouse/civil partner is attending an educational
course at (give name of educational establishment)
Course Title
Your address (where you are registered to vote)
From to
D M YD M Y Y YD M YD M Y Y Y
Postcode
Daytime telephone or mobile number (optional)
E-mail address (optional)
5
I am not able to go to the polling station on
election day for the following reason relevant to
my course or that of my spouse or civil partner:
About your proxy
2
Full name
Relationship to you (if any)
Full address
Postcode
How long do you want a proxy vote for?
3
I want to vote by proxy at all elections or
referendums (tick one box only):
until further notice (permanent proxy vote)
for the period
from
to
D
D
D
D
M
M
M
M
Y
Y
Y
Y
Y
Y
Y
Y
Why do you want a proxy vote?
4
Please complete either 4A or 4B.
4A – I am attending an educational course at
(give name of educational establishment):
Course Title
Your date of birth and declaration
6
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.
From to
D D M M Y Y Y Y D D M M Y Y Y Y
If you are unable to sign this form, please
contact your Electoral Registration Officer.
Application to vote by proxy due to attendance
on an educational course
Only one person can apply to vote by proxy using this form. Write in black ink and use BLOCK LETTERS.
When you have filled in every section and signed the form yourself, send it to your local electoral registration
office. You can get the address at www.aboutmyvote.co.uk
9A
Date of application
7
Today’s date
Supporter’s declaration if the applicant is
attending an educational course
D D M M Y Y Y Y
Support for this application
8
Read the notes to see who can support your
application. Please ask the person who supports your
application to give their name, address and position.
Supporter’s full name
Supporter’s address
Postcode
Supporter’s position
■ I am the director or tutor of the course referred
to at 4A,or the principal or head of the
institution, or an employee with authority to act
for the institution
■ I am over 18 years of age
■ I know the applicant
■ I am not the spouse, civil partner, parent,
grandparent, brother, sister, child or grandchild
of the applicant
■ I confirm that to the best of my knowledge and
belief, the applicant’s statements at 4A and 5
are true
Signature
D M YD M Y Y Y
Date
9B
Supporter’s declaration if the applicant is
the spouse civil/partner of a person
attending an educational course
■ I am the director or tutor of the course referred
to at 4B, or the principal or head of the
institution, or an employee with authority to act
for the institution
■ I am over 18 years of age
■ I know the person named at 4B who is the
spouse/civil partner of the applicant, but am not
their spouse, civil partner, parent, grandparent,
brother, sister, child or grandchild.
■ I confirm that to the best of my knowledge and
belief, the applicant’s statement at 4B is true
Signature
Date
D D M M Y Y Y Y
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130 Application to vote by proxy due to attendance on an educational course

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Completed 8 July 2020

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