Nomination of a Candidate
Aboriginal and Torres Strait Islander Elected Body - ACT 		
	Nomination by Four Electors		
	To: The Electoral Commissioner		
	We, persons listed on the following pages and entitled to vote at the election of members of the Aboriginal and Torres Strait Islander Elected Body - ACT, hereby nominate the person named on this form as a candidate for election. 		
					
	Candidate		
	I, THE CANDIDATE NAMED BELOW, DECLARE THAT:
•	I am an Aboriginal person or Torres Strait Islander; and
•	I am at least 18 years old; and
•	I am enrolled, or entitled to be enrolled, on the ACT electoral roll (see next page); and
•	I am not under sentence of imprisonment for 1 year or longer for a conviction for an indictable offence;
AND I STATE THAT:
•	I consent to this nomination for election and to be a member of the Aboriginal and Torres Strait Islander Elected Body, if elected.		
						
	Surname:			Residential address *:		
						
	Given names in full:					
						
	Given name(s) to be printed on the ballot paper:			Occupation:		
						
	Signature:	Date:					
	/      /       					
	* Note all details on this form will be publicly available.  Where a candidate’s address is suppressed from the electoral roll, this form should not show that address, but in that case the candidate must notify the Commissioner in writing of a correspondence address for the candidate.		
	Contact details for candidate		
	The person named as contact officer should be someone who can readily relay information to the candidate		
	Name of Contact Officer:			
					
	Phone (H):		Phone (W):		Phone (Mob):			
					
	Fax:		Email:			
	Note all details on this form will be publicly available.  If the contact officer does not want to make any of the above details publicly available, please advise the Commissioner in writing of these details on a separate sheet.	
	Office use only		
					
	Date received:	/        /	Time:	am/pm				
					
	Received by:		Signed:				
	05/08	ACT Electoral Commission		

	Nominator 1			Nominator 2		
	I, THE NOMINATOR NAMED BELOW, DECLARE THAT, at the time of making this declaration:
•	I am an Aboriginal person or Torres Strait Islander; and
•	I am at least 18 years old; and
•	I am enrolled, or entitled to be enrolled, on the ACT electoral roll; and
•	I am not under sentence of imprisonment for 1 year or longer for a conviction for an indictable offence.			I, THE NOMINATOR NAMED BELOW, DECLARE THAT, at the time of making this declaration:
•	I am an Aboriginal person or Torres Strait Islander; and
•	I am at least 18 years old; and
•	I am enrolled, or entitled to be enrolled, on the ACT electoral roll; and
•	I am not under sentence of imprisonment for 1 year or longer for a conviction for an indictable offence.		
	Surname:			Surname:		
						
	Given names:			Given names:		
						
	Residential address for which enrolled:			Residential address for which enrolled:		

	Date of Birth:			Date of Birth:		
	/        /			/        /		
	Signature:	Date:			Signature:	Date:		
	/      /       			/      /       		
					
	Nominator 3			Nominator 4		
	I, THE NOMINATOR NAMED BELOW, DECLARE THAT, at the time of making this declaration:
•	I am an Aboriginal person or Torres Strait Islander; and
•	I am at least 18 years old; and
•	I am enrolled, or entitled to be enrolled, on the ACT electoral roll; and
•	I am not under sentence of imprisonment for 1 year or longer for a conviction for an indictable offence.			I, THE NOMINATOR NAMED BELOW, DECLARE THAT, at the time of making this declaration:
•	I am an Aboriginal person or Torres Strait Islander; and
•	I am at least 18 years old; and
•	I am enrolled, or entitled to be enrolled, on the ACT electoral roll; and
•	I am not under sentence of imprisonment for 1 year or longer for a conviction for an indictable offence.		
	Surname:			Surname:		
						
	Given names:			Given names:		
						
	Residential address for which enrolled:			Residential address for which enrolled:		

	Date of Birth:			Date of Birth:		
	/        /			/        /		
	Signature:	Date:			Signature:	Date:		
	/      /       			/      /       		

Entitlement to be on the ACT Electoral Roll:

You are eligible to enrol and vote if you:
•	Are an Australian citizen; and
•	Are 18 years or older; and
•	Have lived at your ACT address for at least one month.

Optional extra nominators:

	Nominator (Extra)			Nominator (Extra)		
	I, THE NOMINATOR NAMED BELOW, DECLARE THAT, at the time of making this declaration:
•	I am an Aboriginal person or Torres Strait Islander; and
•	I am at least 18 years old; and
•	I am enrolled, or entitled to be enrolled, on the ACT electoral roll; and
•	I am not under sentence of imprisonment for 1 year or longer for a conviction for an indictable offence.			I, THE NOMINATOR NAMED BELOW, DECLARE THAT, at the time of making this declaration:
•	I am an Aboriginal person or Torres Strait Islander; and
•	I am at least 18 years old; and
•	I am enrolled, or entitled to be enrolled, on the ACT electoral roll; and
•	I am not under sentence of imprisonment for 1 year or longer for a conviction for an indictable offence.		
	Surname:			Surname:		
						
	Given names:			Given names:		
						
	Residential address for which enrolled:			Residential address for which enrolled:		

	Date of Birth:			Date of Birth:		
	/        /			/        /		
	Signature:	Date:			Signature:	Date:		
	/      /       			/      /       		
					
	Nominator (Extra)			Nominator (Extra)		
	I, THE NOMINATOR NAMED BELOW, DECLARE THAT, at the time of making this declaration:
•	I am an Aboriginal person or Torres Strait Islander; and
•	I am at least 18 years old; and
•	I am enrolled, or entitled to be enrolled, on the ACT electoral roll; and
•	I am not under sentence of imprisonment for 1 year or longer for a conviction for an indictable offence.			I, THE NOMINATOR NAMED BELOW, DECLARE THAT, at the time of making this declaration:
•	I am an Aboriginal person or Torres Strait Islander; and
•	I am at least 18 years old; and
•	I am enrolled, or entitled to be enrolled, on the ACT electoral roll; and
•	I am not under sentence of imprisonment for 1 year or longer for a conviction for an indictable offence.		
	Surname:			Surname:		
						
	Given names:			Given names:		
						
	Residential address for which enrolled:			Residential address for which enrolled:		

	Date of Birth:			Date of Birth:		
	/        /			/        /		
	Signature:	Date:			Signature:	Date:		
	/      /       			/      /