Isle of Wight Council

Household Voter Registration Form

	Use this form if you have moved house, will soon be 18 years old or just absent from the electoral register.
	PLEASE CLICK HERE TO READ THE NOTES ON HOW TO COMPLETE THIS FORM. If you need help filling in this form, please phone 01983 823200 or email [email protected]

Current Address

*	Building/house name/number
*	Street address
*	Town Name
	County
*	Postcode
	Telephone Number (include area code)
	Email address

	You do not have to give your telephone number or email address but it may help us resolve any queries quickly.
	Previous Address

	Building/house name/number
	Street address
	Town Name
	County
	Postcode
	Date of move
	Please give name and address (if known) of your previous Council

	Names to be added to the current Register
	1. Add the names of the eligible persons resident at this address. 2. EACH PERSON LISTED MUST SIGN OPPOSITE HIS OR HER NAME IN THE SIGNATURE FIELD. (Without their signature, they cannot be added to the Register.) Please PRINT this form when complete in order to sign.

Person 1

	Title
*	Forename
	Middle name/Initials
*	Surname
	Nationality
	16 & 17 Year Olds Enter date of birth of anyone aged 16 or 17 years
	Age If you are not yet 18 years of age please supply your date of birth
	Jury Service If you are 70 years of older please indicate	Yes No
	Edited Register If you do not want your name to appear on the Edited Register please tick. Please see Notes.
	Postal Vote Would you like a Postal Vote application form sent to you?	Yes No
	Signature As far as I know, the details on this form are true and accurate. I am a British, other Commonwealth, Irish or other European citizen. EACH PERSON MUST SIGN THIS FORM Please print	Signed ............................................................................... Name................................................................................. Date...................................................................................

PLEASE CLICK HERE IF THERE ARE NO MORE NAMES OF ELIGLE PERSONS RESIDENT AT THIS ADDRESS. Please click NEXT below if you have more names to add.

Person 2

	Title
*	Forename
	Middle name/Initials
*	Surname
	Nationality
	16 & 17 Year Olds Enter date of birth of anyone aged 16 or 17 years
	Age If you are not yet 18 years of age please supply your date of birth
	Jury Service If you are 70 years of older please indicate	Yes No
	Edited Register If you do not want your name to appear on the Edited Register please please tick. Please see Notes.
	Postal Vote Would you like a Postal Vote application form sent to you?	Yes No
	Signature As far as I know, the details on this form are true and accurate. I am a British, other Commonwealth, Irish or other European citizen. EACH PERSON MUST SIGN THIS FORM	Signed ............................................................................... Name................................................................................. Date...................................................................................

PLEASE CLICK HERE IF THERE ARE NO MORE NAMES OF ELIGLE PERSONS RESIDENT AT THIS ADDRESS. Please click NEXT below if you have more names to add.

Person 3

	Title
*	Forename
	Middle name/Initials
*	Surname
	Nationality
	16 & 17 Year Olds Enter date of birth of anyone aged 16 or 17 years
	Age If you are not yet 18 years of age please supply your date of birth
	Jury Service If you are 70 years of older please indicate	Yes No
	Edited Register If you do not want your name to appear on the Edited Register please please tick. Please see Notes.
	Postal Vote Would you like a Postal Vote application form sent to you?	Yes No
	Signature As far as I know, the details on this form are true and accurate. I am a British, other Commonwealth, Irish or other European citizen. EACH PERSON MUST SIGN THIS FORM	Signed ............................................................................... Name................................................................................. Date...................................................................................

PLEASE CLICK HERE IF THERE ARE NO MORE NAMES OF ELIGLE PERSONS RESIDENT AT THIS ADDRESS. Please click NEXT below if you have more names to add.

Person 4

	Title
*	Forename
	Middle name/Initials
*	Surname
	Nationality
	16 & 17 Year Olds Enter date of birth of anyone aged 16 or 17 years
	Age If you are not yet 18 years of age please supply your date of birth
	Jury Service If you are 70 years of older please indicate	Yes No
	Edited Register If you do not want your name to appear on the Edited Register please please tick. Please see Notes.
	Postal Vote Would you like a Postal Vote application form sent to you?	Yes No
	Signature As far as I know, the details on this form are true and accurate. I am a British, other Commonwealth, Irish or other European citizen. EACH PERSON MUST SIGN THIS FORM	Signed ............................................................................... Name................................................................................. Date...................................................................................

PLEASE CLICK HERE IF THERE ARE NO MORE NAMES OF ELIGLE PERSONS RESIDENT AT THIS ADDRESS. Please click NEXT below if you have more names to add.

Person 5

	Title
*	Forename
	Middle name/Initials
*	Surname
	Nationality
	16 & 17 Year Olds Enter date of birth of anyone aged 16 or 17 years
	Age If you are not yet 18 years of age please supply your date of birth
	Jury Service If you are 70 years of older please indicate	Yes No
	Edited Register If you do not want your name to appear on the Edited Register please please tick. Please see Notes.
	Postal Vote Would you like a Postal Vote application form sent to you?	Yes No
	Signature As far as I know, the details on this form are true and accurate. I am a British, other Commonwealth, Irish or other European citizen. EACH PERSON MUST SIGN THIS FORM	Signed ............................................................................... Name................................................................................. Date...................................................................................

	Reason for remaining on a previous register
	Date of Application
	Please return to	Electoral Services Isle of Wight Council County Hall, Newport Isle of Wight PO30 1UD.

For Office Use Only

	Data Protection Act 1998
	This application may be monitored by the Isle of Wight Council for regulatory, quality control or crime detection purposes. Information from this application will be processed in accordance with the Data Protection Act 1998 for the purpose of processing your particular enquiry/request. The Isle of Wight Council ("the Council") is the data controller. By completing this form you consent to the Council contacting you by email or nominated contact method in relation to your enquiry/request. The information contained in this application may, in exceptional circumstances, be subject to disclosure to third parties under either the Data Protection Act 1998 or the Freedom of Information Act 2000 to the extent the law allows and in accordance with the Isle of Wight Council's Access to Information Policy . Disclosure will only be made where in all the circumstances it would be fair to do so and in the public interest. Please note that the Council may process your information in the absence of consent for the purpose of crime prevention or detection so far as is in accordance with the law. Sometimes we may use your information to keep you informed about services, goods or relevant issues that we believe may be of interest to you. If you wish to receive this information for these purposes please tick this box To improve the quality of other services that we provide to you the Council wishes to hold your non-sensitive personal information on a secure central database. This will enable all Council services to use this information when they are providing a service to/for you. If you wish your non-sensitive personal information to be held by the Council please tick this box

Date printed: 07/03/2013