Commonwealth Numbered Regulations

1983 No. 183 NORTHERN TERRITORY ELECTORAL REGULATIONS (AMENDMENT) - REG 2

2. The First Schedule to the Northern Territory Electoral Regulations is
amended by omitting Form 2 and substituting the following form:
FORM 2
Regulation 23
THE NORTHERN TERRITORY
ELECTORAL CLAIM Fill in this form if-

   (a)  you are claiming enrolment on an electoral roll; or

   (b)  you need to change your name, address or other details on an electoral
        roll. Please post it in the prepaid envelope, or deliver it, to the
        Australian Electoral Office. Your claim will be acknowledged.
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Australian Capital Territory
To the Electoral Registrar,
PERSONAL PARTICULARS                               Division

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-- Please use BLOCK LETTERS     My name is            Surname
only. Please use blue or black ink only. -----------------------------
Please include all names by                        Christian or given names
which you are generally known. -----------------------------
Residential address - you    I live at             Flat/Street    Street/Road

can only be enrolled for                           number
your residential address. If you live in a rural area
----------------------------
show sufficient detail to                          Suburb/Town/Locality
identify your place of living. ----------------------------

Postal address - if the      My postal address is  Postal address
Postcode same as residential address put 'As above'.
-----------------------------
Your postal address will     My occupation is      Occupation       (delete

one) not appear on the roll.                                             and I
am Male/Female
----------------------------- The remaining details are    I was born on
day month year Town Country necessary for identification
but will not appear on the                         .../.../... in
roll. -----------------------------
Complete former address      My former address     No. Street Suburb/ State/

only if you have moved since was                              Town
Territory your last enrolment.
----------------------------- Complete former name only    My former name was
Former name if you have changed your name (for example by
----------------------------- marriage) since your last enrolment
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-- DECLARATION                                        I am entitled to
enrolment ------------------------------------------------- because-
Upon enrolment you will be entitled to vote at     (a) I am not under 18
years
elections for the House of Representatives and         of age;

the Senate.                                        (b) I have lived
continuously
in Australia for at least
6 months;

   (c)  I am an Australian
citizen or other British
subject;

   (d)  I have lived at my
present address (or
elsewhere within the
the Division) for the
period of 1 month
immediately before the
date of this claim, and
I claim enrolment for the
Division.
You must sign this declaration in the presence of   I declare that the a

person who is enrolled, or entitled to be         statements made in this

enrolled, on an electoral roll kept for the         claim, including my

purposes of a House of Representatives election.    personal particulars set

out above, are true to the
best of my knowledge and
belief. A person who is unable to sign his name in writing may make his mark
as his
personal signature.                                          ..............
../../..
                                                    Personal Signature   Date

of Claimant
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-- WITNESS                                             I saw this claim signed
by -------------------------------------------------- the claimant and am As
the person to witness                            satisfied that the this claim

you must be                              statements contained in the satisfied

from personal                             claim are true. knowledge or enquiry

of the claimant or                                  I am enrolled, or entitled

otherwise that the                                  to be enrolled, on an

information declared                                electoral roll kept for

the is true.                                            purposes of a House
of
Representatives election. ----------------------------
                             Name of witness in     Surname    Christian or

                             BLOCK LETTERS                     given names

---------------------------- You may not witness this     Full address of

Address claim unless you are able    witness to sign your name in writing
----------------------------
................. ../../..
Signature of Date
witness
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