Service Voter Declaration
Isle of Wight Council
Service Voter Declaration
Application to register for the election as a service voter.
If you need help filling in this form, please phone 01983 821000.
Please return form to: Electoral Services, County Hall, Newport, Isle of Wight, PO30 1UD.
1. About You
*
Applicant's Forename
Applicant's Middle name
*
Applicant's Surname
If you are the spouse of a Member of the Forces enter the Service Person's details below and tick appropriate box
Yes
No
Service Person's Details
Forename
(if different)
Middle name
(if different)
Surname
(if different)
*
Rank
*
Service Number
*
Category (Army,RAF,Navy)
Regiment / Corps (if Army)
Registered address (address on electoral register)
*
Building/house name/number
*
Street address
*
Town Name
County
*
Postcode
Is the above address
where you are living
where you have lived
where you would be living
Service address (address for correspondence):
*
Building/house name/number
*
Street address
*
Town Name
County
*
Postcode
Age
If you are not yet 18 years of age please supply date of birth.
If you are 70 years or older please indicate
Yes
No
2. Two versions of the Register
If you do not want your name to appear on the edit register please tick here.
Please see
notes
.
3. Declaration
Please print off this form and fill this section in by hand before returning your form.
As far as I know, the details on this form are true and accurate.
Signature
Signed ...............................................................................
Name.................................................................................
Date...................................................................................
If you would like to be able to vote by post or by proxy please click NEXT below to continue.
If you do not want to vote by post or proxy click here to go to the end of the form.
4. Postal / Proxy Voting Application for Service Voters
You may complete this section to enable you to vote by post or by proxy.
Post
(Complete this part only if you wish to vote by post)
Building/house name/number
Street address
Town Name
County
Postcode
Proxy
(Please give Proxy's details only if you wish to vote by proxy)
Title
Forename
Middle name
Surname
Building/house name/number
Street address
Town Name
County
Postcode
Relationship of proxy to you
( if any)
Please tick which statement applies to you
I, the person named above, confirm that I am willing and allowed to vote on behalf of the applicant. (Proxy sign at Proxys signature)
I have consulted the person named above and I confirm that he/she is willing and is allowed to vote on my behalf. (You sign at Your signature)
Signature
Signed ...............................................................................
Name.................................................................................
Date...................................................................................
Application of Proxy to vote by Post
If your proxy is unable to vote on your behalf at your polling station then your proxy may wish to complete this section
Address for Ballot Paper (only complete if proxy wishes to vote by post)
Building/house name/number
Street address
Town Name
County
Postcode
Proxy's Signature
Signed ...............................................................................
Name.................................................................................
Date...................................................................................
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