Fillable 132 Application to vote by proxy due to employment

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132 Application to vote by proxy due to employment

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Application to vote by proxy due to employment
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 employment
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 your employment or
your spouse or civil partner’s employment means
that you cannot vote in person.
Who can support my application?
■ if you have an employer, your employer or
another authorised person at your workplace
■ if you are self-employed, a person who is aged
18 years or over, who knows you and is not
related to you
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 employment
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
Surname
First names (in full)
Your current full 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
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
About you Why do you want a proxy vote?
1
4
Complete 4A if you are applying as an employed
person; 4B if you are self-employed; 4C if you are
applying as the spouse/civil partner of an employed
person; or 4D if you are the spouse/civil partner of a
self-employed person.
4A. Employed
i) I am employed by (give employer’s name and
address):
ii) As (give job title):
iii) I am not able to go to the polling station on
election day for the following reason relevant to my
employment:
4B. Self-employed
i) I am self-employed as (give job title):
iii) I am not able to go to the polling station on
election day for the following reason relevant to my
occupation:
from
to
D M YD M Y Y Y
D D M M Y Y Y Y
Application to vote by proxy due to employment
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
4C. Spouse/civil partner of an employed person
i) I am the spouse/civil partner of (enter their name)
My spouse/civil partner is employed by (give their
employer's name and address):
ii) As (give their job title):
iii) I am not able to go to the polling station on
election day for the following reason relevant to
their employment:
4D. Spouse/civil partner of a self-employed
person
i) I am the spouse/civil partner of (enter their name)
My spouse/civil partner is employed as (give their
job title:
Your date of birth and declaration
5
Declaration: 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.
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.
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.
If you are unable to sign this form, please contact
your Electoral Registration Officer.
iii) I am not able to go to the polling station on
election day for the following reason relevant to
their occupation:
Date of application
6
Today’s date
D D M M Y Y Y Y
Application to vote by proxy due to employment
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
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 and to then complete either 8A if you are
employed, 8B if you are self-employed, 8C if you are
the spouse or civil partner of an employed person,
or 8D if you are the spouse or civil partner of a self-
employed person.
Supporter’s full name
Supporter’s address
Postcode
Supporter’s position
Support for this application
7
Supporter’s declaration (if the applicant
is employed)
8A
■ I am the applicant’s employer or an employee
with authority to act for the employer
■ I am aged 18 years or over
■ I know 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 statements in 4A are true.
Signature
Today’s date
D M YD M Y Y Y
Supporter’s declaration (if the applicant
is self-employed)
8B
■ I am aged 18 years or over
■ I know 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 statements in 4B are true.
Signature
Today’s date
D D M M Y Y Y Y
Application to vote by proxy due to employment
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
Supporter’s declaration (if the applicant is
the spouse or civil partner of an employed
person)
8C
■ I am the employer, or an employee with
authority to act for the employer, of the person
named in 4C who is the spouse/civil partner of
the applicant
■ I am aged 18 years or over
■ I know the employed person named in 4C 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 statements in 4C(i) and
4C(ii) are true.
Signature
Today’s date
D M YD M Y Y Y
8D
Supporter’s declaration (if the applicant is
the spouse or civil partner of a self-employed
person)
■ I am aged 18 years or over
■ I know the self-employed person named in 4D
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 statements in 4D(i)
are true.
Signature
Today’s date
D D M M Y Y Y Y
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Completed 8 July 2020

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