Fillable Application to vote by proxy due to attendance (Grampian Valuation Joint Board)

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Application to vote by proxy due to attendance (Grampian Valuation Joint Board)

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Application to vote by proxy due to
attendance on an educational course
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 if you or your spouse or civil partner will be attending an
educational course that means that you cannot vote in person.
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. Y
ou
must get someone to support your application. See notes below on who can support the application.
Make sure all sections of the form are complete 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 us.
Return your form to us by email at ero@grampian-ero.gov.uk or by post to Grampian Electoral
Registration Officer, Woodhill House, Westburn Road, Aberdeen, AB16 5GE
When applying for a new proxy vote, you must return your proxy vote application form by 5pm,
6 working days before the poll.
When changing or cancelling an existing proxy, postal or postal proxy vote, you must return your
proxy vote application form to reach us by 5pm, 11 working days before the poll.
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
www.gov.uk/register-to-vote
Who can support my application?
Your application can be supported by:
the director or tutor of the course
the principal or head of the educational establishment where the course is taking place
an employee of the educational establishment where the course is taking place who is authorised to
support your application.
Your supporter must be 16 or over to support your application for local elections and elections to the
Scottish Parliament. They must be 18 or over to support your application for elections to the UK
Parliament.
Y
our supporter must give their details in section 8 and complete the relevant declaration in section 9.
Page 1 of 5
Application to vote by proxy due to
attendance on an educational course
What happens after I’ve returned this form?
Your proxy must go to your polling station. If your proxy cannot get to the polling station, they can
apply to vote for you by post. They can apply to do this until 5pm, 11 working days before the poll.
An application form for your proxy to vote for you by post can be downloaded from
www.grampian-vjb.gov.uk/electoral-register/application-forms/
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 will only use the information you give us for electoral purposes. We will look after personal
information securely and we will follow data protection legislation. We will not give personal information
about you or any personal information you may provide on other people to anyone else or another
organisation unless we have to by law.
The lawful basis to collect the information in this form is that it is necessary for the performance of a
task carried out in the public interest and exercise of official authority as vested in the Electoral
Registration Officer as set out in the Representation of the People Act 1983 and associated
regulations.
The Data Controller is Ian H Milton, Grampian Electoral Registration Officer, Woodhill House,
Westburn Road, Aberdeen, AB16 5GE, Tel 01224 068400.
For further information relating to the processing of personal data you should refer to the privacy notice
at www.grampian-vjb.gov.uk/privacy-notice Version 20200930
Page 2 of 5
D M Y YD M Y Y
D M Y YD M Y Y
D M Y YD M Y Y
D M Y YD M Y Y
D M Y YD M Y Y
D M Y YD M Y Y
Application to vote by proxy due to
attendance on an educational course
Only one person can apply to vote by proxy using this form
Please write in black ink and use BLOCK LETTERS. When all sections are complete and you have
signed the form yourself, send it to: Grampian Electoral Registration Officer, Woodhill House,
Westburn Road, Aberdeen, AB16 5GE or email a scanned copy to ero@grampian-ero.gov.uk
Page 3 of 5
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)
3 How long do you want a proxy vote for?
I want to vote by proxy (tick one box only):
until further notice
for the period
from
to
4 Why do you want a proxy vote?
Please complete either 4A or 4B.
4A – I am attending an educational course at
(give name of educational establishment)
Course title
from
to
4B – I am the spouse/civil partner of
(enter
their name)
My spouse/civil partner is attending an
educational course at (give name of
educational establishment)
Course title
from
to
D M Y YD M Y Y
Application to vote by proxy due to
attendance on an educational course
5 The reason you can’t vote in person
Please give the reason relevant to the
educational course.
6 Your date of birth and declaration
D M Y YD M Y Y
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.
Please contact us if you are unable to sign
this form.
Page 4 of 5
7 Date of application
Today’s date
8 Support for this application
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
Phone no (optional)
Email (optional)
Supporter’s position
Your supporter should now complete the
relevant declaration.
D M Y YD M Y Y
D M Y YD M Y Y
Application to vote by proxy due to
attendance on an educational course
9A
Supporter’s declaration if
the applicant is attending an
educational course
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 aged 18 years or over
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
Today’s 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 aged 18 years or over
I know the person named at 4B who is the
spouse/civil partner of the applicant, but I
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
Today’s date
Declaration by a 16 or 17 year old supporter in Scotland.
(Only valid for local elections and elections to the Scottish Parliament.)
9C
Declaration by 16 or 17 year
old supporter if the
applicant is attending an
educational course
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 16 or 17 years old
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
Today’s date
D M Y YD M Y Y
9D
Declaration by 16 or 17 year old
supporter 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 16 or 17 years old
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 statements at 4B is true.
Signature
Today’s date
D M Y YD M Y Y
Page 5 of 5
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Application to vote by proxy due to attendance (Grampian Valuation Joint Board)

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Completed 30 January 2021

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