Fillable Apply To Vote By Proxy At A-particular Election Or Referendum

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Apply To Vote By Proxy At A-particular Election Or Referendum

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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.
In England and Wales you must be 18 or over on polling day to vote.
In Scotland you must be 16 or over on polling day to vote in local elections and elections to the Scottish
Parliament. You must be 18 or over to vote in elections to the UK Parliament and European Parliament.
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 electoral registration office.
Return your form to your electoral registration office. You can find their details and more information
at yourvotematters.co.uk
Please do not return your form to the Electoral Commission. Your application form must arrive at
your electoral registration office by 5pm, 11 working days before the poll when changing or cancelling
an existing proxy, postal or postal proxy vote and by 5pm, 6 working days before the poll when
applying for a new proxy vote.
If you are not already registered to vote, your application to register must have reached your electoral
registration office by midnight, 12 working days before the poll.
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. They can apply to do this by 5pm, 11 working days before
the poll. They can contact the electoral registration office for more details and to request a further
application form. For contact details, go to yourvotematters.co.uk
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.
Application to vote by proxy at a
particular election or referendum
P1
P2
Privacy statement
The Electoral Registration Officer will only use the information you give them for electoral
purposes. They will look after personal information securely and will follow data protection
legislation. They will not give personal information about you or any personal information you may
provide on other people to anyone else or another organisation unless they 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 Representation of the People Act 1983 and associated
regulations.
The Electoral Registration Officer is the Data 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 yourvotematters.co.uk
Application to vote by proxy at a
particular election or referendum
Voting as a 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 (16 or over in
Scotland at local elections and elections to the Scottish Parliament) and they are (or will be) registered
for that election or referendum.
1 About you 4 Why do you want a proxy vote?
Surname
First name(s) (in full)
Your address (where you are registered to vote)
Postcode
Telephone no (optional)
Email (optional)
Providing an email and telephone 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
Email or telephone no (optional)
Please explain why you are not able to go to
your polling station on polling day:
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) held on:
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 BLOCK LETTERS. When you have completed every section and
signed the form yourself, send it to your electoral registration office. You can find their address at
yourvotematters.co.uk
P3
Application to vote by proxy at a
particular election or referendum
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.
D M Y YD M Y Y
Signature: Sign below using black ink,
keeping within the grey border.
6 Date of application
Today’s date
D M Y YD M Y Y
If you are unable to sign this form, please
contact your electoral registration office.
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Apply To Vote By Proxy At A-particular Election Or Referendum

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Completed 27 July 2020

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