Fillable Application to vote by proxy at a particular (London School of Business & Finance)

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Application to vote by proxy at a particular (London School of Business & Finance)

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Application to vote by proxy at a
particular election or referendum
Voting by proxy
Proxy voting means that if you aren’t able to cast your vote in person, you can have someone you trust
cast your vote for you.
You can use this form to apply to vote by proxy for one particular election or referendum only.
Both you and your proxy must be registered and eligible to vote.
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.
How do I apply to vote by proxy?
You must ask someone who is willing and capable to be your proxy and vote on your behalf.
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 polling day.
Make sure you complete all sections of the form and supply your date of birth and signature. You
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 elections team at your council.
Return your form to your elections team at your council. You can find their details and more
information at electoralcommission.org.uk/voter.
Please do not return your form to the Electoral Commission.
When applying for a new proxy vote, you must return your proxy vote application form by 5pm,
6 working days before the poll.
The deadline for changing or cancelling an existing proxy, postal or postal proxy vote may vary
depending on which country you live in. Please visit electoralcommission.org.uk/proxyvote for
more information about deadlines.
If you are not already registered to vote, you must register before applying for a proxy vote. The
deadline to register to vote is midnight, 12 working days before the poll. Register to vote online at
gov.uk/register-to-vote
This form and these deadlines do not apply in Northern Ireland. Visit eoni.org.uk for more information.
What happens after I’ve returned this form?
Your proxy must go to your polling station to vote. If your proxy cannot get to the polling station,
they can apply to vote for you by post. The deadline for returning a postal vote application may vary
depending on which country you live in. Please visit electoralcommission.org.uk/postalvote for more
information about deadlines. Your proxy can contact the elections team at your council for more details
and to request a further application form. For contact details, go to electoralcommission.org.uk/voter.
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 polling 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.
Privacy statement
We collect information under the legal basis of a task carried out in the public interest, as set out in the
Representation of the People Act 1983 and related regulations. We will look after personal information
securely and follow data protection legislation.
If you opted-out of the open register we will only use the information you give us for electoral purposes,
including matching it against other sources of data to support the electoral register. We will not give
personal information to anyone else, unless we have to by law. The law requires us to share your
information with candidates, political parties and campaigners for democratic engagement purposes
and credit reference agencies to check your identity when you apply for credit.
If you have not opted-out of the open register your name and address can be bought by anyone and
used for lots of purposes, including direct marketing.
The Electoral Registration Officer is the Controller. For further information relating to the processing
of personal data you should refer to their privacy notice on their website. You can find their website
address and contact details at electoralcommission.org.uk/voter.
D M Y YD M Y Y
Application to vote by proxy at a
particular election or referendum
D M Y YD M Y Y
Only one person can apply to vote by proxy using this form
Please write in black ink and use CAPITAL LETTERS. When you have completed every section and
signed the form yourself, send it to your elections team at your council. You can find their address at
electoralcommission.org.uk/voter.
1 About you
Surname
First name(s) (in full)
Your address (where you are registered to vote)
Postcode
Phone number (optional)
Email (optional)
Providing an email and phone number gives a
quick and easy way to contact you about your
application.
2
About your proxy (the person you
have chosen to vote on your behalf)
Full name
Family relationship (if any)
Full address
Postcode
Phone number (optional)
Email (optional)
D M Y YD M Y Y
3
At which election(s) and referendum(s)
do you want a proxy vote?
I want to vote by proxy at the election(s)
and referendum(s) to be held on:
4 Why do you want a proxy vote?
Please explain why you are not able to go to
your polling station on polling day.
5 Your date of birth and declaration
Declaration: I have asked the person I have
named as my proxy and confirm that they are
willing and capable 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 two years and/or a fine.
Date of birth: Please write your date of birth
in the boxes below using black ink.
Signature: Sign below using black ink,
keeping within the grey border.
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If you are unable to sign this form, please
contact your elections team at your council.
6 Date of application
Today’s date
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Application to vote by proxy at a particular (London School of Business & Finance)

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Completed 27 April 2021

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