14
(FRONT)
-
15
-
(REVERSE)
[reg. 6(1) (c)]
FORM 5.
FORY 5.
URBAN COUNCIL ELECTIONS (REGISTRATION OF ELECTORS)
REGULATIONS, 1955.
Notice of Change of Polling Station.
To the Registration Officer.
I the person whose name appears on the Provisional Register na
如下:
Surname and
fore-names
Polling Staliom :
搜類站
Surname and
fore-names
of elector
in Chinese
Letter and
Electoral
number
挑到
選轝⁂鑁発
of oloctor In English 選躍人性格 B热压
Address
(if any)
地址
中文盛出(如 有中文姓名者}
Qualideation,
.g. section 15.
paragraph
(a), (5), (0)
or (d).
hereby request that my name be transferred to the section of the register
將
which relates to
record my vote there.
A
姓
符
機
贊
polling station as I wish to 投無站採內,因本人能在
該段壊站投票故也。
(Signature)
(Date)
日期
|
SECOND FOLD HERE
ON HER MAJESTY'S SERVICE
OFFICIAL,
PAID
Registration Officer,
(Urban Council Elections)
HONG KONG
TKIND TUCK IN THIS FLAP
FIRST FOLD HERE
先在壯姬誰叠