1955-HKRS30-8-45_Part02 — Page 33

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