1955-HKRS30-8-45_Part02 — Page 31

A

10

(FRONT) Foam 2.

[reg. 3 & 6(1)1

URBAN COUNCIL ELECTIONS (REGISTRATION OF ELECTORS)

REGULATIONS, 1955.

Application for Registration as an Elector.

ŒZA TE DO • ## #

TO

The Registration Officer E***:

For Oficial do unly

TELETHEA STICH

11

(REVERSE)

Form 2.

FIRST FOLD HERE

先在此聯攞盛

Name of Applicant (PSHAREZ

SURNAME IN ENGLISH (BLOCK CAPITALS)

(as on identity card, if any)

# » HÆLAH(BREK)

(如有身份証,組與該單上所填者相间)

FORE-NAMES IN ENGLISH (BLOCK CAPITALS)

(as on identity card, if any)

AECOM (WDER )

(如有身惟証,須與該認上所填者相同力

FULL NAME IN CHINESE CHARACTERS (IF ANY)

(as on identity card, if any)

中文姓名(如有中文姓名者,

CONTAINE » URUNAMAZIA)

IDENTITY CARD NUMBER (IF ANY)

身份証蛋制(如有身份证者,

ADDRESS OF RESIDENCE AT DATE OF

APPLICATION 申請時所G地址

OCCUPATION #

QUALIFICATION & #:

*.g. (1) Juror

(2) qualified as juror

but exempt or omitted.

例如 1.陪箍

(3) teacher (as defined).

(4) qualified Government

sorvent (giving department).

(5) member of Defence

Force or Auxiliary

Bervice (giving unit).

(6) Tax-payer (aa

defined).

2.具陪年資,但以離

免服役,或在編製培流山 名昭時還襴姓名者

*. *MCEREMON)|

4. #RMAZEHAIGE C

註明所屬機

ZUGUNUSAU

(註明所感染,

5.

6. MBA (JBEYRAMA

A)

LISTED POLLING STATION WHERE APPLICANT

WOULD PREFER TO VOTE

列明申請人往搜骢之投票站

I CERTIFY THAT THE ABOVE PARTICULARS ARE CORRECT.

“不人藪特冠明上列篩范,全屬調確~

SECOND POLD HERE AIA 15 IN 2

ON HER MAJESTY'S SERVICE

OFFICIAL

PAID

Registration Officer,

(Urban Council Elections).

ED FON

THIRD TUCK IN THIS FLAP

最後,將此場宛人概糟内の

Signature. *