Form No.
MUNICIPAL ELECTORS ORDINANCE, 1947
APPLICATION
FOR
REGISTRATION AS AN ELECTOR
NAME OF APPLICANT
SURNAME
(Block letters)
OTHER NAMES
(Block letters)
Place of residence at date of
application.
(House number and street name)
OCCUPATION
(Trade, business or profession)
Able to read and write.
(Insert "English" or "Chinese", or
both, as the case may be)
Date of birth.
(Day, month and year)
Place of birth.
(State country and town or county)
Nationality.
(If different from nationality on birth, state how and when acquired)
Race.
Length of residence in the Colony.
Date of commencement of residenos.
Periods of absence during the qualifying period.
FOR OFFICIAL USE ONLY
139
(Continued)