CO129-609-3 Future policy- draft Municipal Council Ordinance 1-1-1947 - 31-12-1947 — Page 130

FORM G

1

3rd Sched. (Part IV)

130

Form of declaration to be made by the companion of a blind elector.

Part III (Paragraph 21(2))

State

relationship

I, A.B., of

requested to assist C.D., who is numbered

on the register of electors for the (

, having been

Ward of the)

Municipality of Hong Kong, to record his vote at the election now

being held for the said (Ward) (Mmicipality) do hereby declare that (I am entitled to vote at the said election) (I am the

of companion of the said elector and have attained the age of twenty-one years) to elector.

and that I have not previously assisted any blind person (except E.F.

af

Dated the

) to vote at the said election.

Signed ................ A.B.

day of

19

I, the undersigned, do hereby certify that I faithfully interpreted

the above declaration to the above-named declarant.

Signed

G.H.

I, the undersigned, being the presiding officer for the

polling station for the (

Ward of the) Municipality of

Hong Kong, do hereby certify that the above declaration, having first

been read to the above named declarant, was signed by the declarant in

my presenos,

Signed

J.K.

The

da

af

19

at

minutes past

o'clock in the

noon.

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.

(7)

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