Fillable Form 1: Application to vote by emergency proxy (East Staffordshire Borough Council)

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Form 1: Application to vote by emergency proxy (East Staffordshire Borough Council)

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Application to vote by emergency proxy based on
occupation, service or employment
How do I apply to vote by proxy?
1
2
3
4
You must ask someone if they are willing and able to be your proxy and vote on your behalf.
Please note that a person can only be the proxy for close relatives and up to two other people
at the same election or referendum*.
Unless you are registered to vote as a service voter, you must get an appropriate person to sign
your application. See notes below for information on who can support your application
Make sure you complete all sections of the form and supply your date of birth and signature.
Return your form to your local electoral registration office. You can find their details at
www.aboutmyvote.co.uk.
Only electors who are (or will be) registered individually are entitled to vote by proxy. In addition,
the person you wish to appoint as your proxy can only act as proxy if they are (or will be) registered
individually. Contact your electoral registration office for further information.
Please do not return your form to the Electoral Commission. Please note: this form can only be used
after 5pm on the sixth working day before an election and must arrive at your electoral registration
office before 5pm on the day of the election.
* By referendum we mean: Neighbourhood Planning Referendums, Council Tax Referendums, Mayoral & Governance Arrangements
Referendums, and Local Authority Advisory polls. If you wish to apply to vote by post for a different type of referendum, please contact
your Electoral Registration Officer.
Application to vote by emergency proxy based on
occupation, service or employment
Voting by proxy
If you are not able to attend the polling station in
person for reasons relating to your occupation,
service or employment, and you only become aware
of this after 5pm on the sixth working day before an
election, you can apply to vote by emergency proxy
(someone else voting on your behalf). You can apply
up until 5pm on election day.
This form should not be used if you have been
detained in a hospital under Section 145 of the
Mental Health Act 1983 in England and Wales
or Section 329 of the Mental Health (Care and
Treatment) (Scotland) Act 2003 in Scotland.
Who can support my application?
n “I’m self-employed, who can support my
application?”
A person aged 18 years or over who knows you
and is not your spouse, civil partner, parent,
grandparent, brother, sister, child or grandchild.
n “I’m employed, who can support my
application?”
Your employer or another authorised person at
your workplace.
n “I am registered as a service voter, who can
support my application?”
If you are a member of the Armed Forces, a
Crown servant, a British Council employee or the
spouse or civil partner of one of the above and
you are registered as a service voter, you do not
need support for your application.
If you are registered as an ordinary elector, you
will need support from your employer or another
authorised person at your workplace.
What happens after I’ve returned
this form?
n Your proxy must go to your polling station
to vote on your behalf.
n You should tell your proxy how you want them
to vote on your behalf, for example, which
candidate, party, or outcome.
n Your local election office will tell your proxy
when and where to vote on your behalf.
n You will 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 Officer.
Voting as 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 and they are
(or will be) registered individually.
More information
If you have any questions about voting by proxy,
go to www.aboutmyvote.co.uk or contact your
electoral registration office.
In England and Wales, the electoral registration
office is based at your local council. In Scotland,
it may be a separate office. For contact details, go
to www.aboutmyvote.co.uk.
This form does not apply in Northern Ireland.
Visit www.eoni.org.uk for more information.
Electoral Registration Officers will only use the
information you provide for electoral purposes.
They will look after personal information securely
and will follow the Data Protection Act 1998.
Electoral Registration Officers will not give personal
information about you to anyone else or another
organisation unless they have to by law.
Application to vote by emergency proxy based on
occupation, service or employment
Only one person can apply to vote by emergency proxy using this form. Write in black ink and use
BLOCK LETTERS. When you have filled in every section and signed the form yourself, send it to your
local electoral registration office. You can get the address at www.aboutmyvote.co.uk
4
Your employment details and reason you can’t
vote in person
About you
1
Surname
Please fill in Section A if you are self-employed,
Section B if you are employed, or Section C if you are
First names (in full)
a service voter.
A – Self-Employed
Your current full address
I am self-employed as (give job title):
I am not able to go to the polling station on election day
for the following reason related to my occupation:
Postcode or BFPO
Your correspondence address (if different)
B – Employed
I am employed by (give employer’s name and address):
Daytime telephone or mobile number (optional)
As (give job title):
E-mail address (optional)
Full name
I am not able to go to the polling station on election day
for the following reason related to my employment:
About your proxy
2
Relationship to you (if any)
Full address
Postcode
3
At which election do you want a proxy
I want to vote by proxy at the election(s) held on:
D D M M Y Y Y Y
C – Service voter
Tick the type of service voter that applies:
I am a member of the Armed Forces
I am a Crown servant
I am a British Council employee
I am the spouse or civil partner of one
of the above
I am not able to go to the polling station on election day
for the following reason related to my service (or that of
my spouse or civil partner):
Application to vote by emergency proxy based on
occupation, service or employment
Only one person can apply to vote by emergency proxy using this form. Write in black ink and use
BLOCK LETTERS. When you have filled in every section and signed the form yourself, send it to your
local electoral registration office. You can get the address at www.aboutmyvote.co.uk
5
When did you become aware of the reason?
Time
Date
D D M M Y Y Y Y
6
Your date of birth and declaration
Declaration: I have asked the person I have named as
my proxy and confirm that he/she is willing and able 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 2 years and/or a fine.
Date of birth: Please write your date of birth ‘DD MM YYYY’
in the black boxes below, using black ink.
Signature: Sign below, keeping within the grey border.
Note: if you are registered to vote as a service
voter, you do not need support for your
application.
8
Supporter’s declaration (if self-employed)
Read the notes to see who can support this
application. Please ask the person who is
supporting your application to give their name
and address.
Supporter’s full name
Supporter’s address
Postcode
Declaration:
• 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 in Parts 4
and 5 are true
Signature
Date
D D M M Y Y Y Y
If you are unable to sign this form, please contact
your Electoral Registration Officer.
7
Date of application
Today’s date
D D M M Y Y Y Y
Application to vote by emergency proxy based on
occupation, service or employment
Only one person can apply to vote by emergency proxy using this form. Write in black ink and use
BLOCK LETTERS. When you have filled in every section and signed the form yourself, send it to your
local electoral registration office. You can get the address at www.aboutmyvote.co.uk
9
Employer’s declaration (if employed)
Read the notes to see who can support this
application. Please ask the person who is authorised
to support your application to give their name,
address and position.
Supporter’s full name
Supporter’s address
Postcode
Supporter’s position with the employer
Declaration:
• I am the applicant’s employer or an employee
with authority to act for the employer
• I confirm that to the best of my knowledge and
belief, the applicant’s statements in Parts 4 and 5
are true
Signature
Date
D D M M Y Y Y Y
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Form 1: Application to vote by emergency proxy (East Staffordshire Borough Council)

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Completed 1 August 2020

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