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

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

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Application to vote by proxy
due to employment
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 your employment or your spouse or civil partner’s
employment 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.
You must get someone to support your application. See notes below for information on who can support
your 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 to reach us 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 r
egister 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:
an employer or another authorised person at the place of work (if employed)
a person who knows you and is not related to you (if self-employed)
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.
Your supporter must give their details in section 7 and complete the relevant declaration in section 8.
Page 1 of 7
Application to vote by proxy
due to employment
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 7
D M Y YD M Y Y
D M Y YD M Y Y
Page 3 of 7
Application to vote by proxy
due to employment
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
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 (permanent proxy vote)
for the period
from
to
Page 4 of 7
Application to vote by proxy
due to employment
4
4 Why do you want a proxy vote?
Complete only one of the relevant sections
4A, 4B, 4C or 4D.
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
polling day for the following reason relevant to
my employment:
4B Self- employed
i) I am self-employed as (give job title):
ii) I am not able to go to the polling station on
polling day for the following reason relevant to
my occupation:
4C
Spouse/civil partner of an
employed person
i) I am the spouse/civil partner of (please
enter your spouse/civil partner’s 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
polling 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 (please
enter your spouse /civil partner’s name):
ii) My spouse/civil partner is self-employed as
(give their job title):
iii) I am not able to go to the polling station on
polling day for the following reason relevant to
their occupation:
D M Y YD M Y Y
D M Y YD M Y Y
Application to vote by proxy
due to employment
Page 5 of 7
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.
Please contact us if you are unable to sign
this form.
6 Date of application
Today’s date
7 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
Supporter’s position
Phone number (optional)
Email (optional)
Your supporter should now complete the
relevant declaration.
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 employment
Page 6 of 7
8A
Supporter’s declaration (if the
applicant is employed)
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
8B
Supporter’s declaration (if the
applicant is self-employed)
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
8C
Supporter’s declaration (if the
applicant is the spouse or civil
partner of an employed person)
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
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 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
Page 7 of 7
Application to vote by proxy
due to employment
Declaration by a 16 or 17 year old supporter in Scotland.
(Only valid for local elections and elections to the Scottish
Parliament.)
8E
Declaration by 16 or 17 year old
supporter if the applicant
is employed
I am the applicant’s employer or an
employee with authority to act for the
employer
I am 16 or 17 years old
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
8F
Declaration by 16 or 17 year old
supporter if the applicant is
self-employed
I am 16 or 17 years old
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
8G
Declaration by 16 or 17 year old
supporter if the applicant is the spouse
or civil partner of an employed person
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 16 or 17 years old
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
8H
Declaration by 16 or 17 year old
supporter if the applicant is the spouse
or civil partner of a self-employed person
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
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Application to vote by proxy due to employment (Grampian Valuation Joint Board)

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Completed 30 January 2021

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