1955-HKRS30-8-45_Part03 — Page 4

40

FORM 14.

[reg. 24(2).]

URBAN COUNCIL ELECTIONS (PROCEDURE) REGULATIONS, 1955.

Appointment of Polling Agent.

THE URBAN COUNCIL.

FORM 15.

41

[reg. 35(1)]

URBAN COUNCIL ELECTIONS (PROCEDURE) REGULATIONS, 1955.

Declaration to be made by the Companion of a Blind Voter.

THE URBAN COONCIL.

of

I. A.B., of

having

(none)

1

toecopesign

(address)

Покрышкирагамиант, и

(the election agent of) a candidate for election as an elected member of the Urban Council at the election to be held on the

day of 19 hereby appoint the persons samed in the recond column hereunder to act as polling agent on my behalf at the polling atations set opposite their respective names in the first column for the purpose of the said election.

Polling Station

Polling Agents

Name

Address

been requested to assist C.D. (who is numbered

on the register of electors for election of members of the Urban Council, to record this vote at the election now being held do hereby declare that (I am entitled to vote at the said election) (I am the *.

of the mid elector and have attained

the age of twenty-one years) and that I have not previously assisted any blind person (except E.F. of

to vote at the said election.

Dated the

(Signed)

day of

·

19

•

.........)

*State

relationship of comed

to Yober,

1.

2

3.

ત્ર

3

WYN KAYanaab ja annan kau bena z roaddu här NCAA KAIKEUDE

Penjual JKMAN MAALANE VENNA AMERIK

wwweneequent some women in mano addit. Les day we foun

4.

moja na maana ako at maddendam ko na ramen enterprrectverbete

5.

HNM

Dated this

day of

195

▸

• Delete words inapplicable

(Signature)

"Candidats/Blection Agent.

I, the undersigned, do hereby certify that I faithfully interpreted the above declaration to the above-named declarant.

(Signed)

G.E.

1, the undersigned, being

*

an muistant presiding ofcer

for the the presiding offiear polling station election of elected members of the Urban Council do hereby certify that the above declaration, having first been read to the above-named declarant, was signed by the declarant in diy presence.

(Signed)

J.K.

The

minutes past

day of o'clock in the

19

at Л

JOCK.

NOTE: If the person making the above declaration knowingly and wilfully makes therein a statement false in a material particular, he will be guilty of an offence,