(    )

Contact  phone:

Date of birth:

Day        Month         Year

Elections ACT

Postal Vote Form
ACT Aboriginal and Torres Strait Islander 
Elected Body election
Please read the instructions on the back of this form.

To the ACT Electoral Commissioner

Elector details

This is Approved Form AF2008-40  under section 34 of the Aboriginal and Torres Strait Islander Elected Body Act 2008

Address of  
 witness:

Name of  
 witness:

Signature of  
 witness:

•	I saw the elector sign this form.  OR
•	I saw another person sign this form on behalf of the elector, who is physically incapacitated and is unable to sign his or her name.
I am entitled to be a witness (see the back of this form).  
I am satisfied that all the statements made on this form are true.

Witness to complete

Today’s Date:

Day       Month        Year

 Signature or mark of elector

I declare that I am entitled to a postal vote for the ACT Aboriginal and Torres Strait Islander Elected Body election and that all the statements on this form are true.

Day        Month         Year

Date you moved:

If you no longer live at your enrolled address, please print your current address:

If you have changed your name since you last enrolled, please print your previous name here:

Elections ACT

Postal Vote Form
Instructions

Need more information?
Contact the ACT Electoral Commission  
phone (02) 6205 0033

The information sought on this form is required under the ACT Electoral Act 1992.  
Your name and address details and the fact that you have completed this form will be made publicly available after polling close day under the Electoral Act (except if your address is suppressed from the electoral roll, your address will not be made public).

Who can be a witness?
If you are in Australia, this form must be witnessed by an elector whose name appears on a Commonwealth of Australia electoral roll.  If you are overseas, any person 18 years old or older may be a witness.  A candidate for election may not be a witness.
What are the duties of a witness?
A witness must —
•	be satisfied as to the identity of the elector;
•	see the elector sign the form or see some one sign on the elector’s behalf;
•	be satisfied that the statements made in the form are true; and
•	sign the form and add his or her name and address.

Privacy statement

Am I entitled to a postal vote?
If you are on the ACT electoral roll and are Aboriginal or Torres Strait Islander, you are entitled to cast a postal vote if:
•	you expect to be unable to attend a polling place on polling day, or 
•	your address has been suppressed from the electoral roll.
Your personal details
Check your pre-printed name and enrolled address details.  
Please correct any errors.
If you have changed your name since you last enrolled, please print your previous name.  This will help us to find your name on the electoral roll so that your vote can be counted.
If you no longer live at your enrolled address, please print your current address in the box provided.
Please print your date of birth and a contact phone number.  Your date of birth is used to verify your identity.  Your phone number will be used if we need to check anything on your form.
Make sure you sign the form and date it.  You must also make sure a witness signs the form.  If you do not, your vote will not be counted.  If you cannot sign your name, you can make your mark.  If you are physically handicapped, another person can sign your form for you.
If you are unable to vote without help, you can ask some one to assist you.

Information about the witness

Information for the elector