Schedule 4
FORM OF BALLOT-PAPER FOR A REFERENDUM
ELECTORAL DISTRICT OF
REFERENDUM ON PROPOSED BILL
Directions to Voter
If you approve of the proposed Bill, write "YES" in the space provided opposite the question set out below.
If you disapprove of the proposed Bill, write "NO" in the space provided opposite the question set out below.
[HERE INSERT THE SHORT TITLE OF THE BILL]
DO YOU APPROVE OF THIS BILL?
Fold the ballot-paper and put it in the ballot-box or declaration envelope, as appropriate.
Í Í Í Í Í Í Í Í Í Í Í Í Í Í Í