Fillable Enrol to vote or update your details (Department of the Environment and Energy)

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Enrol to vote or update your details (Department of the Environment and Energy)

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Country of origin: AUSTRALIA
File type: PDF

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Who has access to your enrolment information?
The Commonwealth of Australia
The Australian Electoral Commission (AEC) is authorised under the
Commonwealth Electoral Act 1918 (CEA) to collect and verify the
information you have been asked to complete on this form. The
information provided will assist the AEC to maintain electoral rolls.
The AEC may disclose electoral information to persons or
organisations in accordance with the CEA. This may include:
■
access to the publicly available electoral roll (containing
names and addresses) which may be inspected at
electoralofces
■
state and territory electoral authorities
■
Members of Parliament, Senators, registered political
parties, and candidates for the House of Representatives
■
approved medical research and public health
screening programs
■
any agencies, persons or organisations prescribed in the
Electoral and Referendum Regulation 2016.
For more information on privacy, visit www.privacy.gov.au
The State of Queensland
Electoral Commission Queensland provides electoral information
to organisations authorised under the Queensland Electoral
Act 1992.
Help in other languages
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If you are deaf, or have a hearing or
speech impairment
Contact the AEC through the National Relay Service (NRS):
■
TTY – 133 677 then ask for 13 23 26
■
Speak and Listen – 1300 555 727 then ask for 13 23 26
■
Internet relay – connect to the NRS then ask for 13 23 26
You can use this form to:
■
enrol to vote
■
change your residential or postal address, and/or
■
change your name
on the electoral roll for federal, state and local
government elections in Queensland.
Who can enrol and vote?
It is compulsory for all eligible Australian citizens over 18 years
to enrol to vote. You are eligible to enrol and vote if you:
■
are an Australian citizen, or a British subject who was
enrolled on 25 January 1984*
■
are 18 years or older, and
■
have lived at your address for at least one month.
*For Queensland electors only, if you were eligible to be on the
state electoral roll on 31 December 1991.
You can enrol at 16 but cannot vote until you are 18.
Within three weeks of receiving your enrolment form the AEC will
conrmyourenrolment.Wemayseekfurtherinformationfrom
youandconrmyourenrolmentusinganyofthecontactdetails
you provide.
Special enrolment
Special category enrolment forms are available if you:
■
are temporarily overseas
■
cannot attend a polling place on election day
■
believe that having your address shown on a publicly
available roll may endanger your safety or that of
your family
■
havenoxedaddress
■
are in prison
■
are physically incapable of signing your name
■
are working in Antarctica.
For more information
Australian Electoral Commission
www.aec.gov.au or 13 23 26
Electoral Commission Queensland
www.ecq.qld.gov.au or 1300 881 665
Returning your form
Post Australian Electoral Commission
Reply paid 9867
BRISBANE QLD 4001
(No stamp is needed if posted in Australia)
Fax 02 6293 7607
Upload Upload your scanned signed form at
www.aec.gov.au/return
In person
 ToanyAECofce
Enrol to vote or update your details
You can complete this form online today at www.aec.gov.au
ER016w_QLD_1217
© Commonwealth of Australia 2017
Office use only –
Date received
NINNotation CATS
Your current name
1
Mr
Mrs
Miss Ms
Other
Family name
Given name(s)
If notifying a
change of name
If notifying a change of
address
Previous given name(s)
Previous residential address
Previous family name
Date of birth (dd/mm/yyyy)
2
Gender
• •
3
Current residential address
4
Current postal address
Leave blank if the same as
your residential address
Clearly identify your residential
address. A locality name or mail
service number is not enough
Email address
Daytime
Mobile
5
Citizenship status
To enrol you must be an
Australian citizen, or a British
subject who was on the
Commonwealth electoral roll
on 25 January 1984
*For Queensland electors only,
if you were eligible to be on
the state electoral roll on
31 December 1991
6
7
Evidence of your identity
Complete ONE option only
Australian driver’s licence
Australian passport
OR
OR
Number
Number
Name on citizenship
certificate
Australian citizen by birth
I have become an Australian citizen
OR
OR
Town
of birth
Country of birth
State or territory
State or territory
Citizenship certificate number
ER016w_QLD_1217
Enrol to vote or update your details
for federal, state and local government elections in Queensland
You can complete this form online today at www.aec.gov.au
Phone numbers
( )
If completing by hand use a 8
where appropriate.
Use black or blue pen and
BLOCK LETTERS
Occupation
Returning your form – see overleaf for instructions
I2
Postcode
State
Postcode
State
Postcode
State
• I am eligible to enrol at my current residential address as listed at Question 3 and
claim enrolment for federal, state and local government elections in Queensland
• The information I have given on this form is true and complete, and
• I understand that giving false or misleading information is a serious offence.
Your declaration
NOTE: A person who is on the Commonwealth electoral roll
must confirm the elector’s identity at Question 6 if the elector
has made a mark because they are unable to sign their name.
A person who is on the Commonwealth electoral roll will confirm my identity
Declaration by person confirming your identity
• I am on the Commonwealth electoral roll, and
• I confirm the identity of the applicant.
/ /
-
Your
signature
or mark
/ /
-
Signature
Name on
25 January 1984
British subject who
was enrolled on
25 January 1984
Country of birth
Person’s name
and address
(BLOCK LETTERS)
• •
Date of birth
(dd/mm/yyyy)
I2
Instructions
Please print and sign your form before
returning it to an address shown on page 1
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Completed 18 October 2020

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