New South Wales Consolidated Regulations New South Wales Consolidated Regulations(Clause 17 (2))
(Clauses 18 and 46)
( Agricultural Industry Services Regulation 2015 )
I certify that this roll contains the full names (consecutively numbered and listed in alphabetical order) and addresses of those primary producers and nominees who, in my opinion, are entitled to vote in the poll*/election* in relation to which this roll has been prepared.
The first and last entries in the roll are as follows:
First entry: No:
Name:
Address:
Last entry: No:
Name:
Address:
Dated:
Signed:
* Delete whichever is inapplicable.
(Clauses 25 and 53)
( Agricultural Industry Services Regulation 2015 )
Surname:
Given names:
Postal Address:
Postcode:
Telephone No:
Address of property on which the primary product the subject of the poll*/election* is actually grown, raised, produced, packed, processed or marketed for sale:
Local government area in which the property is situated:
I apply to be enrolled in the final roll for the following poll*/election* and in any subsequent poll or election: [specify the poll*/election* to which the application relates [#93]
I am applying for enrolment:
(a)* as the sole producer of the primary product,
(b)* as the nominee of a corporation on behalf of which the primary product is actually grown, raised, produced, packed, processed or marketed for sale,
(c)* as the nominee of a partnership on behalf of which the primary product is actually grown, raised, produced, packed, processed or marketed for sale,
(d)* as the nominee of the trustee or legal personal representative of a person or estate on behalf of whom or which the primary product is actually grown, raised, produced, packed, processed or marketed for sale.
Particulars of corporation*/partnership*/trustee*/legal personal representative* in respect of whom or which the applicant is the nominee (see paragraphs (b), (c) and (d) above)*:
Name:
Postal address:
Postcode:
I declare that I am qualified to vote in the poll*/election* (as determined in accordance with the Agricultural Industry Services Regulation 2015 ).
I further declare that, to the best of my knowledge, the information contained in this application is true.
Dated:
Signed:
* Delete whichever is inapplicable.
(Clauses 26 and 54)
( Agricultural Industry Services Regulation 2015 )
I object to the inclusion in the final roll for the following poll*/election*:
[specify the poll*/election* to which the objection relates [#93]
of the name of [name in full [#93] of [postal address [#93]
This objection is based on the following grounds: [specify the grounds of the objection [#93]
Name of objector:
Postal address:
Postcode:
Telephone No:
Dated:
Signed:
* Delete whichever is inapplicable.
(Clauses 26 and 54)
( Agricultural Industry Services Regulation 2015 )
I object to the voting entitlement included in the final roll for the
following poll*/election*: [specify the poll*/election* to which the objection
relates [#93]
for [name in full [#93] of [postal address [#93]
The voting entitlement is stated to be:
This objection is based on the following grounds: [specify the grounds of the objection [#93]
Name of objector:
Postal address:
Postcode:
Telephone No:
Dated:
Signed:
* Delete whichever is inapplicable.
(Clause 42)
( Agricultural Industry Services Regulation 2015 )
We nominate [name in full [#93] of [postal address [#93] as a candidate for the following election: [specify the election to which the nomination relates and the area or electoral district in which the election is to be held [#93]
We declare that we are each entitled to vote in the election.
Name in full:
Address:
Signature:
Note : This nomination must be completed by not less than 6 persons (other than the candidate), each of whom is qualified to vote (as determined in accordance with the Agricultural Industry Services Regulation 2015 ) in respect of the election.
I [name [#93] consent to being a candidate at the election to which this nomination relates.
Postal address:
Postcode:
Telephone No:
Date of birth:
Dated:
Signed:
(Clause 45)
( Agricultural Industry Services Regulation 2015 )
I, [name [#93] of [address [#93] do solemnly and sincerely declare that:
1 My full name is:
2 My residential address and postcode is:
3 My date of birth is:
4 I am self-employed*/employed by [employer name [#93]* as [specify nature of employment [#93]
5 I hold the following qualifications (academic/trade/professional):
6 I am a member of the following organisations:
7 I hold the following offices (other than employment):
8 [See Note [#93]
And I make this solemn declaration conscientiously believing the same to be true, and by virtue of the provisions of the Oaths Act 1900 .
Declared at: [place [#93]
Date:
Before me:
[signature [#93]
Justice of the Peace
Note : A candidate may include further information relating to the candidacy. Such information should not exceed 4 lines of typescript.
* Delete whichever is inapplicable.
Certificate under section 34 (1) (c) of Oaths Act 1900
* Please cross out any text that does not apply
I [insert name of witness [#93], a Justice of the Peace, certify the following matters concerning the making of this statutory declaration by the person who made it:
1 *I saw the face of the person or *I did not see the face of the person because the person was wearing a face covering, but I am satisfied that the person had a special justification for not removing the covering.
2 *I have known the person for at least 12 months or *I have confirmed the person's identity using an identification document and the document I relied on was [describe identification document relied on [#93].
[insert signature of witness [#93]
Date: