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Part 1 Preliminary

1 Name of Regulation

This Regulation is the Parliamentary Electorates and Elections Regulation 2001.

2 Commencement

This Regulation commences on 1 September 2001.
Note—
This Regulation replaces the Parliamentary Electorates and Elections Regulation 1996 which is repealed on 1 September 2001 under section 10 (2) of the Subordinate Legislation Act 1989.

3 Definitions

(1) In this Regulation:
the Act means the Parliamentary Electorates and Elections Act 1912.
the Commonwealth Act means the Commonwealth Electoral Act 1918.
(2) In this Regulation, a reference to a Form is a reference to a Form set out in Schedule 1.

4 Notes

The explanatory note, table of contents and notes in the text of this Regulation do not form part of this Regulation.

Part 2 Pre-poll matters

Division 1 Alteration of electoral districts

5 Notice of proposed alteration of electoral district

For the purposes of section 14 (1) of the Act, the prescribed notice of a proposed alteration of an electoral district:
(a) to be given in the Gazette—is a notice in Form 1, and
(b) to be given in some newspaper published or circulating in the district—is a notice in Form 2.

Division 2 Rolls

6 Adoption of Commonwealth forms for purposes of joint rolls

(1) For the purposes of sections 32 (2) (a) and 34 (1) of the Act, the prescribed form of claim for enrolment, transfer of enrolment or provisional enrolment is the form approved for the purposes of section 98 of the Commonwealth Act as at the prescribed date as defined in clause 6A.
(2) For the purposes of section 38A (1) and (2) of the Act, the prescribed form of request that a person’s residence not be entered on or be deleted from the roll is the relevant form approved for the purposes of section 104 of the Commonwealth Act.
(3) For the purposes of section 45 (2) of the Act, the prescribed form of notice of an objection to a name on the roll (to be given to the person objected to) is the form approved for the purposes of section 116 of the Commonwealth Act.
(4) For the purposes of section 47 (2) of the Act, the prescribed form of notice of determination of an objection is the form approved for the purposes of section 118 of the Commonwealth Act.
cl 6: Am 2007 (90), Sch 1 [1].

6A Enrolment

(1) Date of effect of this clause This clause has effect on and from the prescribed date.
(2) Enrolment to be provided A claim for enrolment, transfer of enrolment or provisional enrolment is required by this clause to be supported by evidence of the claimant’s identity for the purposes of section 32 (2) (c) (ii) of the Act.
(3) Nature of evidence The evidence is to be as required by subclause (4), (5) or (6), as applicable.
(4) Nature of evidence—first kind (driver’s licence number) Subject to subclauses (5) and (6), the claimant must provide details of:
(a)  his or her driver’s licence number, and
(b)  the Australian State or Territory in which the licence was issued.
(5) Nature of evidence—second kind (prescribed electors to sight prescribed documents) If the claimant does not hold a driver’s licence issued by an Australian State or Territory:
(a)  the claimant must show to a person in a class of electors set out in the Schedule of prescribed electors an original document, of a kind set out in the Schedule of prescribed documents, that identifies the claimant, and
(b)  the person must complete the declaration on the enrolment form, stating that the person:
(i)  is on the roll of electors, and
(ii)  has sighted the original of one of the documents in the Schedule of prescribed documents.
(6) Nature of evidence—third kind (other circumstances) If the claimant is unable to comply with subclause (4) or (5), the claimant must have his or her claim signed by 2 electors, who are able to:
(a)  confirm the claimant’s name, and
(b)  confirm that they have known the claimant for at least one month.
(7) Transitional provision This clause does not apply to a claim made before the prescribed date.
(8) Definitions In this clause:
Commonwealth identification regulations means provisions of regulations under the Commonwealth Act imposing requirements in relation to identification for enrolment pursuant to claims for enrolment, transfer of enrolment or age 17 enrolment under that Act.
prescribed date means:
(a)  the date on which the Commonwealth identification regulations first come into operation, unless paragraph (b) applies, or
(b)  16 April 2007, if those regulations came into operation before 16 April 2007.
Schedule of prescribed documents means the schedule of documents set out in the Commonwealth identification regulations as in force on the prescribed date.
Schedule of prescribed electors means the schedule of electors set out in the Commonwealth identification regulations as in force on the prescribed date.
cl 6A: Ins 2007 (90), Sch 1 [2].

7 Enrolment notice

Every registrar must, as soon as practicable after the end of each period of 28 days, notify the Electoral Commissioner of particulars of claimants enrolled (otherwise than by way of transfer) during that period.

Division 3 Order of candidates on ballot papers

8 Council election: claim to be included in a group

(1) For the purposes of section 81C (1) of the Act, the prescribed form of claim for the grouping of candidates nominated for a periodic Council election (including any request under section 81C (1A) for a group voting square for the group) is Form 3.
(2) For the purposes of section 81C (3) of the Act, the prescribed form for the withdrawal of a claim is Form 4.
(3) The Electoral Commissioner must, on receipt of a claim under section 81C (1) of the Act or a withdrawal of a claim under section 81C (3) of the Act, make a notation on the claim or withdrawal of the time and date of receipt.

9 Ballot to determine order of candidates on ballot paper: Assembly election

A ballot referred to in section 82A (1) of the Act is to be conducted in the following manner:
(a)  the returning officer must, at the place appointed for the receipt of nominations and before all persons present, make out in respect of each candidate a slip bearing the surname and given names of the candidate,
(b)  the returning officer must then enclose the slips in separate identical containers, securely seal each container and deposit all the containers in a locked ballot box,
(c)  the returning officer must then shake and rotate the ballot box and, on request, permit any other person present to do the same,
(d)  the returning officer must then unlock the ballot box and take out and open each container one by one,
(e)  the returning officer must then record in duplicate the surname and given names of the candidate whose name appears on the slip enclosed in the container first taken from the ballot box and, in consecutive order, the surname and given names of the candidate whose name appears on the slip enclosed in the container next taken from the ballot box, and so on until the placing of all the names has been determined,
(f)  the record made of the names of the candidates as extracted in strict consecutive order must be signed by the returning officer and may also be signed by any of the persons present,
(g)  the original of the record made of the names of the candidates as extracted must be promptly delivered to the Electoral Commissioner by the returning officer or a person authorised by the returning officer or be forwarded to the Electoral Commissioner.

10 Ballot to determine order of groups of candidates on ballot paper: Council election

A ballot referred to in section 83B (1) (a) of the Act is to be conducted in the following manner:
(a)  the Electoral Commissioner must, at the place appointed for the receipt of nominations and before all persons present, make out in respect of each group of candidates a slip bearing the surname of each candidate in the group and, if the Electoral Commissioner considers it necessary to do so, the given names or the initial letter or letters of the given names of each candidate in the group,
(b)  the Electoral Commissioner must then enclose the slips in separate identical containers, securely seal each container and deposit all the containers in a locked ballot box,
(c)  the Electoral Commissioner must then shake and rotate the ballot box and, on request, permit any other person present to do the same,
(d)  the Electoral Commissioner must then unlock the ballot box and take out and open each container one by one,
(e)  the Electoral Commissioner must then write the word “Group” followed by the letter “A” on the slip enclosed in the container first taken from the ballot box and write the word “Group” followed by the letter “B” on the slip enclosed in the container next taken from the ballot box, and so on until the word “Group” and a successive letter of the alphabet (or, if there are more than 26 groups, a distinctive symbol determined by the Electoral Commissioner) have been written on each slip,
(f)  the Electoral Commissioner must then cause a record to be made of the names of the candidates in each group and include in that record, before the names of the candidates in each group, the word “Group” followed by the identifying letter or symbol determined in respect of that group in accordance with paragraph (e),
(g)  the record must be signed by the Electoral Commissioner and may also be signed by any of the persons present.

11 Ballot to determine order on ballot paper of candidates not in a group: Council election

A ballot referred to in section 83B (1) (b) of the Act is to be conducted in the following manner:
(a)  the Electoral Commissioner must, at the place appointed for the receipt of nominations and before all persons present, make out in respect of each candidate a slip bearing the surname and the given names of the candidate,
(b)  the Electoral Commissioner must then enclose the slips in separate identical containers, securely seal each container and deposit all the containers in a locked ballot box,
(c)  the Electoral Commissioner must then shake and rotate the ballot box and, on request, permit any other person present to do the same,
(d)  the Electoral Commissioner must then unlock the ballot box and take out and open each container one by one,
(e)  the Electoral Commissioner must then record the surname and given names of the candidate whose name appears on the slip enclosed in the container first taken from the ballot box and, in consecutive order, the surname and given names of the candidate whose name appears on the slip enclosed in the container next taken from the ballot box, and so on until a record has been made of the name of each candidate,
(f)  the record must be signed by the Electoral Commissioner and may also be signed by any of the persons present.

12 Form of ballot paper for Council elections with more than 33 groups

Pursuant to section 176 (3) of the Act, the form of the ballot papers to be used for a periodic Council election for which there are more than 33 groups is declared to be altered so that they are in Form 5 instead of the relevant form prescribed by Schedule 4A or 15A to the Act.

Division 4 Miscellaneous

13 Declaration by person of Jewish persuasion

For the purposes of section 109 of the Act:
(a) the prescribed time for making a declaration referred to in that section is immediately after a ballot paper is given to the person, and
(b) the prescribed form of such a declaration (which may be made orally or in writing) is Form 6.

14 Pre-poll voting

(1)   (Repealed)
(2) For the purposes of sections 114Q (1) and 114ZR (3) of the Act, the prescribed form of declaration is Form 8.
(3) For the purposes of section 114ZR (6A) of the Act, it is an additional requirement that not more than one item of electoral material relating to a candidate may be made available for perusal by electors engaging in pre-poll voting at declared institutions.
(4) In the case of an Assembly general election or by-election, if more than one item of electoral material has been registered in relation to a particular candidate, the one item available for perusal, for the purposes of subclause (3), is to be the item nominated to the Electoral Commissioner by:
(a)  if a registered party has endorsed the candidate for election—the registered officer of the registered party or another person representing that officer, or
(b)  in any other case—the candidate.
(5) In the case of a periodic Council election, if more than one item of electoral material has been registered in relation to a particular candidate, the one item available for perusal, for the purposes of subclause (3), is to be the item nominated to the Electoral Commissioner by:
(a)  if a registered party has endorsed the candidate for election—the registered officer of the registered party or another person representing that officer, or
(b)  if the candidate is included in a group—a person representing that group, or
(c)  in any other case—the candidate.
cl 14: Am 2006 (635), Sch 1 [1] [2].

15 Voting outside district: declaration

For the purposes of section 115 (1) (c) of the Act, the prescribed form of declaration to be made to be allowed to vote as an absent voter is Form 9.

16 (Repealed)

cl 16: Rep 2006 (635), Sch 2 [1].

17 Registration of electoral material

An application under section 151G of the Act for registration of electoral material must be made in the appropriate form approved by the Electoral Commissioner.
cl 17: Am 2006 (635), Sch 1 [3].

17A Child-related conduct declaration

For the purposes of section 81L (3) of the Act, the prescribed form for a child-related conduct declaration is Form 9A.
cl 17A: Ins 2007 (39), Sch 1 [1].

Part 3 Polls

Division 1 General

18 Official mark on ballot papers

For the purposes of section 122A (3) of the Act, a mark depicting the arms of the State enclosed within a fastened oval belt which bears the words “Electoral Commission” and across the lower half of which is superimposed a banner bearing the words “New South Wales” (whether or not the mark depicts any other decorative matter) is prescribed as an official mark.
cl 18: Am 2006 (635), Sch 1 [4].

19 Declaration of residence: person whose residence is not shown on roll

For the purposes of section 99A of the Act, the prescribed form of declaration to be made by an elector whose residence does not appear on the roll is Form 10.

20 Marking of roll

Immediately on delivering a ballot paper to a voter, an election official must, in the manner approved by the Electoral Commissioner, place a mark against the voter’s name on a copy of the roll.
cl 20: Am 2006 (635), Sch 1 [5] [6].

21 Person claiming to vote: declaration if name noted under section 114G

For the purposes of section 114GA (1) of the Act, the prescribed form of declaration for a person who claims not to have received, or to have lost, a postal vote certificate or postal ballot paper is Form 11.

22 Declaration for section 106: disputed votes

(1) For the purposes of section 106 (1) and (1A) of the Act, the prescribed form of declaration to be made by a person claiming to vote pursuant to either of those subsections is Form 11.
(2) For the purposes of section 106 (1) and (1A) of the Act, the prescribed questions are those set out in section 100 (1) of the Act.
(3) For the purposes of section 106 (2) of the Act, the prescribed form of declaration to be made by a person claiming to vote pursuant to that subsection is Form 12.

23 (Repealed)

cl 23: Rep 2006 (635), Sch 1 [7].

Division 2 Postal voting

24 Form of application for postal vote

For the purposes of section 114A (2) (a) of the Act, the prescribed form of application for a postal vote certificate and postal ballot paper is:
(a) in the case of an elector referred to in section 114A (1) (a), (b), (c), (d), (d1), (e), (g) or (h) of the Act—Form 14, and
(b) in the case of an elector referred to in section 114A (1) (f) of the Act—Form 15.
cl 24: Am 2006 (635), Sch 1 [8].

25 Form of postal vote certificate

For the purposes of section 114D (1) (b) (ii) of the Act, the prescribed form of postal vote certificate is Form 16.

26 Application for postal vote by persons outside NSW

For the purposes of section 114ZA (2) (a) of the Act, the prescribed form of application to a postal voting officer for a postal vote certificate and a postal ballot paper is Form 17.

27 Postal vote certificate issued to persons outside NSW

For the purposes of section 114ZB (1) (b) (ii) of the Act, the prescribed form of postal vote certificate is Form 18.

28 General postal voters registration: absence from NSW

(1) An elector who will not be within the State during any period that exceeds 3 months is a prescribed elector for the purposes of section 114AA of the Act.
(2) All the functions of a registrar under section 114AA of the Act in relation to the registration of an elector referred to in subclause (1) are to be exercised by the Electoral Commissioner instead of by the registrar.
(3) A reference in section 114AA to a registrar is to be read, in relation to the registration of an elector referred to in subclause (1), as a reference to the Electoral Commissioner.

29 Application for registration as a general postal voter

(1) For the purposes of section 114AA (5) of the Act, the prescribed form of application to be registered as a general postal voter is Form 19.
(2) The register for a subdivision referred to in section 114AA (11) of the Act is to be kept in 2 parts as follows:
(a) one part is to be kept in relation to the electors referred to in clause 28 (1) who are registered as general postal voters,
(b) the other part is to be kept in relation to all other electors who are registered as general postal voters for that subdivision.
(3) The Electoral Commissioner is to provide the returning officer for each district with the relevant particulars of such electors referred to in clause 28 (1) as are registered in relation to the returning officer’s district.

30 Cancellation of registration of elector as general postal voter

(1) For the purposes of section 114AA (13) of the Act:
(a)  the prescribed circumstances in which a registrar may cancel the registration of an elector (other than an elector referred to in clause 28 (1)) as a general postal voter are circumstances in which the registrar is satisfied that the elector has ceased to be a prescribed elector within the meaning of section 114AA of the Act, and
(b)  the prescribed circumstances in which the Electoral Commissioner may cancel the registration of an elector referred to in clause 28 (1) as a general postal voter are circumstances in which the Electoral Commissioner is satisfied that the elector has returned to the State during the period of registration.
(2) If a registrar cancels the registration of an elector (other than an elector referred to in clause 28 (1)) as a general postal voter, the registrar must give, personally or by post, notice in writing to the elector of the cancellation.
(3) A notice of cancellation given to a person must include a statement setting out the person’s right to request the Electoral Commissioner to refer the cancellation to the registrar for review.
(4) If a registrar receives a request referred to in subclause (3), the registrar must forthwith forward to the Electoral Commissioner a copy of the request and a statement in writing setting out the reasons for the cancellation of the registration of the person as a general postal voter.
(5) The Electoral Commissioner must, as soon as practicable after receipt of a request referred to in subclause (3) or a copy of any such request under subclause (4), decide whether to direct the registrar to conduct a review of the register in relation to the cancellation.
(6) When the Electoral Commissioner makes a decision under subclause (5), the Electoral Commissioner must cause a copy of the decision to be given to:
(a)  the person who made the request, and
(b)  the registrar in relation to whose decision the request was made.

31 Postal votes received by returning officer in respect of another district

For the purposes of section 114H (2) of the Act, the prescribed manner in which a returning officer is to deal with an envelope posted or delivered to the returning officer in accordance with that subsection is as follows:
(a)  the returning officer must endorse on the envelope the words “Received by me” and add the date of receipt, his or her signature, the words “Returning Officer” and the name of the returning officer’s district,
(b)  the returning officer must then make a record of the name of the voter and the name of the district appearing in the postal vote certificate,
(c)  the returning officer must then enclose the envelope in an outer cover, fasten and seal the outer cover and address it to the returning officer for the district in respect of which the voter named in the postal vote certificate claims to be enrolled and transmit it to that returning officer in a manner authorised by the Electoral Commissioner,
(d)  the returning officer must retain the record made under paragraph (b).

32 Postal votes received by polling place manager

(1) For the purposes of section 114H (2) of the Act, the prescribed manner in which a polling place manager is to deal with an envelope delivered to the polling place manager in accordance with that subsection is as follows:
(a)  the polling place manager must endorse on the envelope the words “Received by me at .............................. polling place” and add his or her signature, the words “Polling Place Manager” and the date,
(b)  the polling place manager must then make a record of the name of the voter and the name of the district appearing in the postal vote certificate,
(c)  the polling place manager must then deposit the envelope in the ballot box used for the purpose of postal polling at the polling place,
(d)  at the close of the poll, the polling place manager must forward all the envelopes bearing postal vote certificates to the returning officer for whom the polling place manager is acting,
(e)  the polling place manager must forward to the returning officer for whom the polling place manager is acting the record made under paragraph (b).
(2) A returning officer who receives envelopes under subclause (1) (d) is to deal with them in the manner prescribed by clause 31 (c).
cl 32: Am 2006 (635), Sch 1 [9].

33 (Repealed)

cl 33: Rep 2006 (635), Sch 1 [10].

Part 4 Registration of parties

34 Party membership declaration forms

For the purposes of section 66D (2) (g1) of the Act, the prescribed form of declaration of membership of a party to be completed and signed by a member of the party on whom the party relies for the purposes of qualifying as an eligible party is Form 20.

35 Registered party annual return

For the purposes of section 66HA (1) of the Act, the prescribed form of return as to continued eligibility for registration of a party is Form 21.

36 Procedure where same member relied on by 2 or more parties

(1) This clause applies, for the purposes of section 66A (2) of the Act, where a person is relied on by 2 or more parties as a member of the party for the purpose of qualifying or continuing to qualify as an eligible party.
(2) In any such case, the Electoral Commissioner must:
(a) request the person in writing to nominate, within 30 days of receiving the request, the party entitled to rely on the member, and
(b) advise the parties in writing that the Electoral Commissioner has made that request.
(3) If, as a result of a nomination made by the person or a failure by the person to make a nomination, a party ceases to qualify as an eligible party, the Electoral Commissioner must advise the party in writing of that fact and give the party at least 60 days in which to provide the requisite particulars and declarations of party membership of the necessary number of additional members of the party that it requires to qualify as an eligible party.

Part 5 Miscellaneous

37 Prescribed officer: inspection of documents

For the purposes of section 161 (1) (iii) of the Act, the prescribed officer is, in respect of the inspection of:
(a) any documents used at or in connection with an election, or
(b) any claim made under section 81C (1) of the Act,
the Electoral Commissioner or a public servant authorised in writing by the Electoral Commissioner.
cl 37: Subst 2006 (635), Sch 1 [11].

37A Declarations made by appointed officials

For the purposes of section 21AO of the Act, the following persons are prescribed persons:
(a)  a returning officer,
(b)  a polling place manager,
(c)  a New South Wales public servant or a person appointed or engaged under the Public Service Act 1999 of the Commonwealth,
(d)  a member of the clergy of any church or religious denomination,
(e)  a person in charge of a post office,
(f)  an Australian legal practitioner.
cl 37A: Ins 2006 (635), Sch 1 [12].

38 Penalty notices

(1) For the purposes of section 120C (2) of the Act, the prescribed form of penalty notice for the offence of failing to vote is Form 22.
(2) For the purposes of section 120C (2) of the Act, the prescribed time for giving the Electoral Commissioner a sufficient reason for a failure to vote or for paying a penalty specified in a penalty notice is the period of 28 days immediately following the date of service of the penalty notice.

39 Savings

Any act, matter or thing that had effect under the Parliamentary Electorates and Elections Regulation 1996 immediately before the repeal of that Regulation by the Subordinate Legislation Act 1989 is taken to have effect under this Regulation.

Schedule 1 Forms

(Clause 3 (2))

Form 1 Notice of proposed alterations of electoral districts

(Clause 5 (1))

(Parliamentary Electorates and Elections Act 1912 (section 14))

THE Electoral Districts Commissioners give notice that it is proposed to alter the (or certain of the) electoral districts of New South Wales by constituting, instead of those electoral districts, new electoral districts, with the names and boundaries described in the first column of the Appendix.

Suggestions or objections in relation to any of the proposed alterations will be received by the Commissioners at their Sydney office. All suggestions or objections must be in writing, and must be received at the office of the Commissioners within 30 days after the date of the publication in the Gazette of this notice.

A written statement of the Commissioners’ reasons for making the proposed alterations will be available for inspection at no cost during office hours at the office of the New South Wales Electoral Commission for the period of 30 days after publication in the Gazette of this notice.

Appendix

Names and Boundaries of proposed new Electoral Districts

Electoral Districts the whole or parts of which the proposed new Electoral Districts comprise

(signed)
Electoral Districts Commissioners

Form 2 Notice of proposed alterations of electoral districts

(Clause 5 (2))

(Parliamentary Electorates and Elections Act 1912 (section 14))

THE Electoral Districts Commissioners give notice that it is proposed to alter the (or certain of the) electoral districts of New South Wales by constituting, among others, a certain new electoral district (or certain new electoral districts), with the names and boundaries described in the Gazette of (date), and marked on maps that may be inspected at the office of the New South Wales Electoral Commission, at the offices of the local councils of the local government areas within current or proposed boundaries, and on the Commission’s internet website [details may be inserted here].

(signed)
Electoral Districts Commissioners

Form 3 Claim to be included in a group (including request for group voting square)

(Clause 8 (1))

(Parliamentary Electorates and Elections Act 1912 (section 81C))

To the Electoral Commissioner:

Pursuant to section 81C (1) of the Parliamentary Electorates and Elections Act 1912, we, the undersigned candidates nominated for the periodic Legislative Council election to be held on (date), claim to have our names included in a group in the ballot papers to be used in that election and to have our names included in that group in the order specified hereunder.

Pursuant to section 81C (1A) of that Act, we also request a group voting square for the group on the ballot papers to be used in that election¹.

Pursuant to section 81C (6) of that Act, we nominate the following group of candidates for the purposes of section 129EB of that Act:²

Surname

Given Names

Signature of Candidate³

Date:

Notes.

Strike out if inapplicable. A request for a group voting square may only be made if there are at least 15 candidates in the group.

Strike out if inapplicable. The nomination is to be made for a group that has also requested a group voting square. A second preference vote is taken to be recorded for the nominated group on all ballot papers on which only a first preference vote is recorded for the group to which this claim relates if that group ceases to have 15 candidates because of the operation of section 81C (5) of that Act. Alternatively, the nomination may be made to the Electoral Commissioner within 24 hours after the close of nominations by the candidates in the group (or, on their behalf, by the first candidate in the group or the registered officer of the registered party that has endorsed all or any of the candidates).

The signature of the candidate must appear opposite the candidate’s name to signify consent to the inclusion of the name in the group and to the order in which the candidates’ names are included in the group, and to any request or nomination in this form.

[lhrule]
(For Office use only)


Time and date of receipt of claim	Signature of Electoral Commissioner

Time and date of withdrawal of claim	Signature of Electoral Commissioner

Other group nominated under section 81C (6)	Signature of Electoral Commissioner

Form 4 Withdrawal of claim to be included in a group

(Clause 8 (2))

(Parliamentary Electorates and Elections Act 1912 (Section 81C))

To the Electoral Commissioner:

Pursuant to section 81C (3) of the Parliamentary Electorates and Elections Act 1912, we, the undersigned candidates nominated for the periodic Legislative Council election to be held on (date), withdraw the claim made by us pursuant to section 81C (1) of that Act to have our names included in a group in the order specified hereunder.

Surname

Given Names

Signature of Candidate¹

Note.

The signature of the candidate must appear opposite the candidate’s name to signify consent to the withdrawal of the claim.

Date:

(For Office use only)

Time and date of receipt of withdrawal of claim

Signature of Electoral Commissioner

Form 5 Form of ballot paper for Council elections with more than 33 groups

(Clause 12)

Form 6 Declaration of person of the Jewish persuasion claiming to vote on Saturday or day of a Jewish fast or festival

(Clause 13 (b))

(Parliamentary Electorates and Elections Act 1912 (Section 109))

I, (full name), am of the Jewish persuasion, and object on religious grounds to voting in the manner provided by the Parliamentary Electorates and Elections Act 1912.

Note.

This declaration may be made orally or in writing to an election official.

Form 7

(Repealed)

Form 8 Pre-poll voter’s form of declaration

(Clause 14 (2))

(Parliamentary Electorates and Elections Act 1912 (Sections 114Q and 114ZR))

I declare that I am the person enrolled as:

Surname:

Given name or names:

Residence as enrolled:

Current address:

Date of birth:

on the State Electoral Roll for the Electoral District of (place) that I am entitled to vote in accordance with the Parliamentary Electorates and Elections Act 1912, and that if I am permitted to vote at this place I will not vote elsewhere at this election.

(signed)
(Signature of Elector)

Declared before me at: (date)

(signed)
Pre-poll voting officer

Note.

A person making any untrue statement in this declaration is liable to a maximum penalty of 10 penalty units or imprisonment for 6 months, or both.

Form 9 Absent voter’s form of declaration

(Clause 15)

(Parliamentary Electorates and Elections Act 1912 (Section 115))

I declare that I am the person enrolled as:

Surname:

Given name or names:

Residence as enrolled:

Current address:

Date of birth:

on the electoral roll for the State Electoral District of (place) and that I am still qualified to vote for that district, that I have not voted at either this or any other polling place, and that if I am permitted to vote at this polling place I will not vote elsewhere at this election.

Signature of elector:

Declared before me this: (date)
at (place) polling place in the Electoral District of (place)

Signature of election official:

Penalty: If a person makes a declaration knowing it is untrue in any material particular he or she is liable to a maximum penalty of 10 penalty units or imprisonment for 6 months, or both.

Form 9A Child-related conduct declaration

(Clause 17A)

Parliamentary Electorates and Elections Act 1912 (Section 81L (3))

Notice to candidates

As part of the nomination process, all candidates for the Legislative Assembly and the Legislative Council are required by the Parliamentary Electorates and Elections Act 1912 to make a child-related conduct declaration.

You are required to:

□ read the Notice to candidates and the Attachment,

□ sign the Notice to candidates acknowledging that you have read the Notice and the Attachment,

□ complete and sign Part A,

□ if required to because of an answer given in Part A—complete and sign Part B,

□ return the declaration to the New South Wales Electoral Commission with your nomination form and deposit.

If you do not complete, sign and return these forms, your nomination will not be valid.

Not legal advice

The Parliamentary Electorates and Elections Act 1912 specifies what must be declared in this declaration. The information contained in this form about what must be declared is intended as general guidance for candidates only. You should seek independent legal advice if you have any specific legal queries about whether any conviction, proceeding or order must be declared in your declaration.

Guidance on which offences must be included in declaration

Your declaration must set out and describe any of the following convictions, proceedings or court orders:

• any conviction against you for a child sexual offence, which includes (but is not limited to) offences against children involving sexual activity or acts of indecency punishable by 12 months or more imprisonment, child pornography offences if punishable by 12 months or more imprisonment and similar offences committed outside New South Wales (see the definition set out in the Attachment),

• any conviction against you for child murder,

• any criminal proceedings ever commenced against you for child murder or child sexual offences. This includes criminal charges laid against you that were subsequently withdrawn for any reason or which did not lead to a conviction. This also includes proceedings where you were found not guilty or where your conviction was subsequently quashed on appeal, and

• any relevant apprehended violence order which has ever been made by a court against you, being an order made on the application of a police officer or other public official, for the protection of a child from sexual activity or acts of indecency.

A child is a person under 18 years of age.

You must include any convictions, proceedings or court orders against you in your current name or any former name.

Offence for false statement and disqualification

It is a serious offence for you to make a false statement on this form, punishable by up to five (5) years imprisonment. If you are elected as a member of either House of Parliament, and are convicted of such an offence, your seat will become vacant because of that conviction.

Declaration will be public

Your declaration will be made public by the New South Wales Electoral Commissioner, and if you are elected, it will be audited by the Commission for Children and Young People and a report will be prepared on the results of that audit and provided to the Presiding Officer of the House of Parliament to which you have been elected. That report will then be made public.

Criminal records check

A criminal records check will be carried out on the National CrimTrac Database for all candidates who are successful at the election. This check will identify offences or proceedings required to be disclosed as part of this form. This criminal records check is carried out at the request of the Commission for Children and Young People in accordance with the Parliamentary Electorates and Elections Act 1912 and is carried out for the purpose of verifying that the information disclosed by you in this form is correct and accurate.

If a criminal records check is required to be carried out, you will be required to provide proof of identity in the form required by the Commission for Children and Young People.

A report will be prepared for the Presiding Officer of the House of Parliament to which you have been elected using the information obtained from the criminal records check. That report will identify whether your declaration is accurate, and if not, details of any discrepancies. The report will only deal with those offences or proceedings that are required to be disclosed as part of this form. The report will be made public. In addition, if there are any discrepancies, information may also be provided to the NSW Police Force or the Director of Public Prosecutions for prosecution action.

This criminal records check is required to be carried out in accordance with the provisions of the Parliamentary Electorates and Elections Act 1912. A failure to sign the consent below will mean that your nomination to be a candidate for the election will not be valid.

Which parts of the Declaration to complete

You must complete Part A of the declaration. If in Part A you declare that you have ever been subject to any of the relevant convictions, proceedings or orders, you must then provide sufficient details in Part B of the declaration to identify those offences, proceedings or orders.

How to complete the declaration

Other than your signature, you should print in BLOCK letters in black pen.

Acknowledgement and consent

Please sign below to indicate that you:

1 have read and understood the information above and in the Attachment, and

2 consent to the criminal records check using the National CrimTrac Database being carried out.

Surname

Given names

Signature of candidate

Date:

ATTACHMENT

For the purposes of Division 5A of Part 5 of the Parliamentary Electorates and Elections Act 1912, child sexual offence means:

(a) an offence involving sexual activity or acts of indecency that was committed in New South Wales and that was punishable by penal servitude or imprisonment for 12 months or more, and that was committed against, with or in the presence of a child (including a child pornography offence that is so punishable), or

(b) an offence involving sexual activity or acts of indecency, that was committed elsewhere and that would have been an offence punishable by penal servitude or imprisonment for 12 months or more if committed in New South Wales, and that was committed against, with or in the presence of a child (including a child pornography offence that is so punishable), or

(c) an offence under section 80D or 80E of the Crimes Act 1900, where the person against whom the offence is committed is a child, or

(d) an offence under sections 91D–91G of the Crimes Act 1900 (other than if committed by a child prostitute) or a similar offence under a law other than a law of New South Wales, or

(e) an offence under section 91H, 578B or 578C (2A) of the Crimes Act 1900 or a similar offence under a law other than a law of New South Wales, or

(f) an offence an element of which is an intention to commit an offence referred to in the preceding paragraphs, or

(g) an offence of attempting, or of conspiracy or incitement, to commit an offence referred to in the preceding paragraphs.

An offence that was a child sexual offence at the time of its commission is not a child sexual offence for the purposes of that Division if the conduct constituting the offence has ceased to be an offence in New South Wales.

An offence involving sexual activity or an act of indecency is not a child sexual offence for the purposes of that Division if the conduct constituting the offence:

(a) occurred in a public place, and

(b) would not have constituted an offence in New South Wales if the place were not a public place.

For the purposes of that Division, section 579 of the Crimes Act 1900 (which relates to older convictions dealt with by way of recognizance) does not apply to or in respect of a child sexual offence.

Candidate declaration

Part A

(Answer questions 1–4 by ticking the relevant box in black pen)

1	Have you ever been convicted of a child sexual offence*? □ No □ Yes
2	Have you ever been convicted of the murder of a child? □ No □ Yes
3	Have any criminal proceedings* ever been commenced against you for the murder of a child, or for a child sexual offence*, other than proceedings relating to a conviction disclosed under questions 1 or 2? □ No □ Yes
4	Have you ever had a relevant apprehended violence order* made against you? □ No □ Yes

In completing this declaration, you should have regard to the Parliamentary Electorates and Elections Act 1912, and the Notice to candidates and the Attachment to the notice that are part of this declaration.

*See the Notice to candidates for the meaning of these terms. In particular, a relevant apprehended violence order is an apprehended violence order that has been made by a court, on the application of a police officer or other public official, for the protection of a child from sexual activity or acts of indecency.

I DECLARE THAT the answers I have made in this Part to questions 1–4 state the matters required to be stated under section 81L (1) of the Parliamentary Electorates and Elections Act 1912.

Surname

Given names

Signature of candidate

Date:

Part B

(Print using BLOCK letters in black pen)

I DECLARE THAT the following list identifies all convictions, proceedings or orders in my current name and any former name that I am required to identify under section 81L (2) of the Parliamentary Electorates and Elections Act 1912:

1 Convictions for child murder and/or child sexual offences, including findings of guilt where no conviction was recorded, and name under which those convictions were recorded:
............................................................
............................................................
............................................................
............................................................
............................................................
............................................................

2  Criminal proceedings for child murder and/or child sexual offences, and name under which those charges were laid:
(a)  Charges laid against me that are currently before the courts:
............................................................
............................................................
............................................................
............................................................
(b)  Charges laid against me but withdrawn before or during trial:
............................................................
............................................................
............................................................
............................................................
(c)  Charges for which I was tried but found not guilty at trial:
............................................................
............................................................
............................................................
............................................................
(d)  Charges for which I was tried and convicted but found to be not guilty on appeal:
............................................................
............................................................
............................................................
............................................................
(e)  Charges for which I was found guilty but for which I was subsequently pardoned:
............................................................
............................................................
............................................................
............................................................
(f)  Any other charges or indictments not declared in the above categories:
............................................................
............................................................
............................................................
............................................................

3 Relevant apprehended violence orders, and name under which those orders were made:
............................................................
............................................................
............................................................
............................................................
............................................................
............................................................
(Please attach a further sheet if additional space is required.)

Surname

Given names

Signature of candidate

Date:

Form 10 Declaration by an elector whose residence is not on the Roll

(Clause 19)

(Parliamentary Electorates and Elections Act 1912 (Section 99A))

Note.

Elector to complete—please print

Surname or family name:

Given name or names:

Address for which you claim to be enrolled:

Note.

If you have changed your name since you enrolled for the above address, please print your previous name here:

I am entitled to vote. I have not already voted in this election.

I declare that the information shown above is true.

Signature of elector:

Signature of election official:

Polling place:

Electoral District:

Penalty: If a person makes a declaration knowing it is untrue in any material particular he or she is liable to a maximum penalty of 10 penalty units or imprisonment for 6 months, or both.

Form 11 Declaration where name marked off Roll

(Clauses 21 and 22 (1))

(Parliamentary Electorates and Elections Act 1912 (Sections 106 and 114GA))

The Returning Officer

State Electoral District of:

Form of declaration, to be made by a person when:

(a) a second vote is tendered for one name at the same polling booth, or

(b) a postal vote certificate or postal ballot paper, or a pre-poll vote, has not been received or has been lost.

Polling place at which elector claims to vote:

Electoral District of:

I,	(a) (Name in full (as appearing on Roll) print in BLOCK letters) (b) (Address in full (as appearing on Roll)) (c) (Date of birth), declare that:
1	My name appears on the certified copy of the Roll used at the abovenamed polling place, opposite the number (number) on the Roll.
2²	I claim to vote under the provisions of section 106 (1) of the Act. I have not voted in connection with the State election being held this day, even though a mark has been placed against my name on the Roll to indicate that a ballot paper has been issued to me at the polling place. or
2²	I claim to vote under the provisions of section 106 (1A) of the Act. I have not applied for a postal vote certificate and postal ballot paper in connection with the State election being held this day, even though my name has been noted on the Roll as that of an elector to whom a postal vote certificate and postal ballot paper have been issued, or I have not applied for and been issued with a pre-poll vote, even though my name has been noted on the Roll as that of an elector to whom a pre-poll vote has been issued. or
2²	I claim to vote under the provisions of section 114GA of the Act. I have not received, or have lost, a postal vote certificate or postal ballot paper in connection with the State election being held this day, even though a mark has been placed against my name on the Roll to indicate that a postal vote certificate and postal ballot paper have been issued to me.

Signature of voter:

Declared before me (date) at the abovenamed polling place.

(signed)
Election official

Notes.

A person making any untrue statement in this declaration is liable to a maximum penalty of 10 penalty units or imprisonment for 6 months, or both.

Two of these paragraphs as the case requires should be struck out.

Form 12 Declaration where name omitted/struck from Roll

(Clause 22 (3))

(Parliamentary Electorates and Elections Act 1912 (Section 106))

The Returning Officer
State Electoral District of:

Form of declaration to be made by a person claiming to vote, who claims that his or her name has been omitted from or struck out of the certified copy of the Roll for the polling place at which he or she claims to be entitled to vote (owing to an error of an officer or a mistake of fact) or by a person whose name cannot be found.

I,	(a) (Name in full, print in BLOCK letters) (b) (Address in full) (c) (Date of birth),

declare that:
I am entitled to be enrolled on the Electoral Roll for the Electoral District of:

After becoming qualified for enrolment for the district, I sent or delivered to the Registrar for the subdivision of the district in which I reside a fully completed claim for enrolment (or transfer of enrolment) and my claim was received by the Registrar before 6 pm on the date that electoral rolls closed, ie on: (date of issue of writ)

From the time of sending or delivering my claim to the Registrar and up to the issue of the writ, I continuously retained my right to be enrolled for the district and did not become qualified for enrolment for any other district. To the best of my knowledge and belief my name has been omitted from or struck out of the certified copy of the Roll for this polling place owing to an error of an officer or a mistake of fact, and not as a result of an objection on the ground of non-residence or other disqualification, or because of a transfer or duplication of enrolment.

Signature of voter:

Declared before me: (date) at (place) polling place.

(signed)
Election official

Note.

A person making any untrue statement in this declaration is liable to a maximum penalty of 10 penalty units or imprisonment for 6 months, or both.

Form 13

(Repealed)

Form 14 Application for a postal vote certificate and postal ballot paper

(Clause 24)

(Parliamentary Electorates and Elections Act 1912 (Section 114A))

To the Electoral Commissioner or the Returning Officer for the Electoral District of (Insert name of Electoral District to which the application is to be sent)

I, (Print full name in BLOCK letters), (Insert date of birth) of (Insert place of living as appearing on Roll) apply for a postal vote certificate and a postal ballot paper to enable me to vote by post at the forthcoming election/referendum.

I declare:

That I am an elector enrolled on the electoral roll for the State Electoral District of (place)

That my answers to the following questions are true in every particular:

Question	Applicant’s Answer
(A) Is your real place of living within the electorate in which you claim to vote?
Note. If answer to Question (A) is “Yes” the applicant is not required to answer Question (B).
(B) Was your real place of living within the 3 months immediately preceding the date fixed for the polling at the election, within the electorate in respect of which you claim to vote?
Note. The words “real place of living” in Questions (A) and (B) include the place of living to which a person, temporarily living elsewhere, has a fixed intention of returning for the purpose of continuing to live.

That the ground on which I apply to vote by post is:

Note.

The elector MUST indicate which of the following grounds apply to his or her particular circumstances.

(a) that I will not, throughout the hours of polling on polling day, be within New South Wales,

(b) that I will not, throughout the hours of polling on polling day, be within 8 kilometres by the nearest practicable route of any polling booth open for the purposes of an election,

(c) that I will throughout the hours of polling on polling day be travelling under conditions which will preclude me from voting at any polling booth,

(d) that I am seriously ill or infirm or approaching maternity and by reason of such illness or infirmity or approaching maternity will be precluded from attending at any polling booth to vote,

(e) that I will be, at a place other than a hospital, caring for a person who is seriously ill or infirm or approaching maternity and because of caring for the person will be precluded from attending at any polling booth to vote,

(f)  that, because of my membership of a religious order or my religious beliefs:
(i)  I am precluded from attending at a polling booth, or
(ii)  I am precluded from voting throughout the hours of polling on polling day or throughout the greater part of those hours,

(g) that I will, because of being engaged for fee, gain or reward in any work throughout the hours of polling on polling day, be precluded from attending at any polling booth to vote,

(h) that I am a silent elector.

That my place of living at the time when the postal vote certificate and the postal ballot paper would be delivered in the ordinary course of post will be as follows: (Here insert full place of living address to which it is required postal voting papers be posted.)

An elector must not make, and a person must not induce an elector to make, any false statement in an application for a postal vote certificate and a postal ballot paper, or in the declaration contained in the application.

Maximum penalty: 10 penalty units or imprisonment for 6 months, or both.

Signed by the elector: (Signature or mark of elector)

Signed by the elector in my presence:

Signature of authorised witness:

Address:

Date:

Form 15 Application for a postal vote certificate and postal ballot paper

(Clause 24)

(Parliamentary Electorates and Elections Act 1912 (Section 114A))

To the Electoral Commissioner or the Returning Officer for the Electoral District of (Here insert name of Electoral District to which the application is to be sent)

I, (Print full name in BLOCK letters)
of (Insert place of living as appearing on Roll)

Date of birth:

apply for a postal vote certificate and a postal ballot paper to enable me to vote by post at the forthcoming election/referendum.

I declare:

That I am an elector enrolled on the electoral roll for the State Electoral District of (place)

That the ground on which I apply to vote by post is that, by reason of my being kept in a correctional centre within the meaning of the Crimes (Administration of Sentences) Act 1999, I will be precluded from attending at any polling booth to vote.

That my address at the time when the postal vote certificate and the postal ballot paper would be delivered in the ordinary course of post will be as follows: (Here insert name and address of correctional centre to which it is required postal voting papers be posted.)

Signature of Applicant: (Personal signature or mark of elector)

Signed by the elector in my presence:

Signature of authorised witness:

Address:

Date:

Form 16 Postal vote certificate

(Clause 25)

(Parliamentary Electorates and Elections Act 1912 (Section 114D))

Application No:

Electoral District of (place) Roll No:

Subject to the Parliamentary Electorates and Elections Act 1912, (name) is entitled to vote by post at the election to be held on (date)

Date of issue: (date)

Signature of Electoral Commissioner or issuing Returning Officer:

State Electoral District of:

Certificate of voter

I certify that the “signature of voter” hereunder is written by me with my own hand in the presence of the authorised witness. I declare I am entitled in accordance with the above Act to vote at this election as a postal voter.

Signature of voter: (Signature or mark of elector)

Certificate of authorised witness

I certify that the “Certificate of voter” was signed by the voter in my presence at (place) on the (date), and I act as an authorised witness:

(Strike out whichever clauses do not apply)

(1) as an elector on the electoral roll for the State of New South Wales, or

(2) as an elector on the Commonwealth electoral roll for the State or Territory of (place), or (if outside Australia)

(3) under the following title:

Signature of authorised witness:

Name of authorised witness: (Print in capital letters)

Address of authorised witness:

Note.

The “Instructions for Postal Voters” should be carefully read by the witness before completing this declaration.

Form 17 Application by a person outside New South Wales for a postal vote certificate and postal ballot paper

(Clause 26)

(Parliamentary Electorates and Elections Act 1912 (Section 114ZA))

To the Postal Voting Officer at:

I, (Print full name in BLOCK letters)
of (Insert place of living as appearing on Roll)

Date of birth:

Passport details(To be completed if out of Australasia.)

Passport No:

Place of issue of Passport:

Date of issue of Passport:

apply for a postal vote certificate and a postal ballot paper to enable me to vote by post at the forthcoming election.

I declare:

That I am an elector enrolled on the electoral roll for the State Electoral District of (place)

That my answers to the following questions are true in every particular:

Question	Applicant’s Answer
(A) Is your real place of living within the electorate in which you claim to vote?
Note. If answer to Question (A) is “Yes” the applicant is not required to answer Question (B).
(B) Was your real place of living, at any time within the 3 months immediately preceding the date fixed for the polling at the election, within the electorate in respect of which you claim to vote?
Note. The words “real place of living” in Questions (A) and (B) include the real place of living to which a person, temporarily living elsewhere, has a fixed intention of returning for the purpose of continuing to live.

That I apply to vote by post on the ground that I will not throughout the hours of polling on polling day be within the State.

That my real place of living at the time when the postal vote certificate and the postal ballot paper would be delivered in the ordinary course of post will be as follows: (Here insert full address to which it is required postal voting papers be posted.)

Signed by the elector in my presence:

Signature of applicant: (Signature or mark of elector)

Signature of authorised witness:

Address:

Date:

Form 18 Postal vote certificate

(Clause 27)

(Parliamentary Electorates and Elections Act 1912 (Section 114ZB))

Application No:

Electoral District of:

Subject to the Parliamentary Electorates and Elections Act 1912, (name) has been issued with a ballot paper to vote by post at the election to be held on (date).

Date of issue:

Signature of issuing Postal Voting Officer:

Place of issue:

Certificate of voter

I certify that the “signature of voter” hereunder is my signature or mark, written by me with my own hand in the presence of the authorised witness. I declare I am entitled in accordance with the above Act to vote at this election in respect of my enrolment at (residence as enrolled)

Date of birth:

Signature of voter: (Signature or mark of elector)

Certificate of authorised witness

I certify that the “Certificate of voter” was signed by the voter in my presence at (place) on the (date), and I act as an authorised witness:

(Strike out whichever clauses do not apply)

(1) as an elector on the electoral roll for the State of New South Wales, or

(2) as an elector on the Commonwealth electoral roll for the State or Territory of (place), or

(3) under the following title: (if outside Australia)

Signature of authorised witness:

Name of authorised witness:

Address of authorised witness:

Note.

The “Instructions for Postal Voters” should be carefully read by the witness before completing this declaration.

Form 19 Application for registration as general postal voter

(Clause 29)

(Parliamentary Electorates and Elections Act 1912 (Section 114AA))

I, (Print full name in BLOCK letters)
of (Insert place of living as appearing on Roll)

Date of birth:

apply for registration as a general postal voter.

I seek registration because I am:
(Please tick the box next to the ground which applies.)

□	(a) an elector whose real place of living is not within 20 kilometres, by the nearest practicable route, of a polling place,
□	(b) an elector who: (i) is a patient in a hospital (not being a hospital that is a polling place or a declared institution under section 114ZN of the Act), and (ii) because of being seriously ill or infirm, is unable to travel from that hospital: • the name of that hospital is: • the address of that hospital is:
□	(c) an elector who: (i) is not a patient in a hospital, and (ii) because of being seriously ill or infirm, is unable to travel from the place where I reside,
□	(d) an elector who, because I will be at a place (other than a hospital) caring for a person who is seriously ill or infirm, is unable to travel from that place to a polling place,
□	(e) an elector who is being kept in a correctional centre (within the meaning of the Crimes (Administration of Sentences) Act 1999) • the name and address of the place where I am detained is:
□	(f) an elector who is enrolled pursuant to a claim made under section 32 (3) of the Act,
□	(g) an elector whom a registered medical practitioner has certified, in writing, to be so physically incapacitated that I cannot sign my name,
□	(h) an elector who will be absent from the State for a period exceeding 3 months. I will be absent from the State from: (date of departure from the State) to (date of return to the State). The address(es) to which any postal voting papers are to be sent during my absence from the State is (are) as follows:
□	(i) an elector who is a silent elector,
□	(j) an elector who, because of my religious beliefs or membership of a religious order: (i) is precluded from attending a polling booth, or (ii) for the greater part of the hours of polling on polling day, is precluded from attending a polling booth.

Signature or mark of elector or person making application on behalf of elector:

Date:

Form 20 Registration of party—declaration of party membership

(Clause 34)

(Parliamentary Electorates and Elections Act 1912 (Section 66D (2) (g1))

To the Electoral Commissioner:

I, (Print full name in BLOCK letters, as enrolled) of (Insert place of living as appearing on Electoral roll) born (Insert date of birth) declare that I am a member of the following political party: (Insert full name of the party as registered or to be registered) and I consent to that party relying on my membership for the purposes of the party qualifying for registration under the Parliamentary Electorates and Elections Act 1912.

Signature of party member:

Date:

Notes.

Each declaration of membership must be completed by (or at the direction of) the party member concerned and then signed by the member. Particulars to be completed are to be written by hand at the same time the form is signed. Each declaration of membership is to be made on a separate sheet of paper.

The Electoral Commissioner may, in order to verify the requirements for registration of a party, request a person who signs a declaration of membership to confirm that the person is a member of the party and that the person completed and signed the form.

Form 21 Registration of party—annual return

(Clause 35)

Parliamentary Electorates and Elections Act 1912 (Section 66HA (1))

To the Electoral Commissioner:

Annual return for ..... (year)

of: .................... (name of party as appearing on Register of Parties)

1. All the members of the party on whom the party relies to continue to be eligible for registration under Part 4A of the Parliamentary Electorates and Elections Act 1912 are still members of the party.

2. Annexure “A”, pages 1 to .., shows members of the party who are members on whom it relies to continue to be eligible for registration (in place of former members of the party shown in the annexure). The remainder of the members on whom the party relies are still members of the party.

3. Annexure “B”, pages 1 to .., shows the changes that have occurred in the names or addresses of members of the party on whom it relies to continue to be eligible for registration.

Cross out whichever clause or clauses above do not apply.

I, ............................................................
(print full name in BLOCK letters)
the registered officer of the above party, do solemnly and sincerely declare that I have made all reasonable inquiries to verify the above information and that the information is, to the best of my knowledge and belief, correct, and I make this solemn declaration conscientiously believing the same to be true, and by virtue of the provisions of the Oaths Act 1900.

Date: ..........	Signed: .........................
	(Signature of registered officer of party)

Sworn by the deponent on .................... (date)

before me, ....................J.P.	.........................
(Name)	(Signature)

(For Office use only)

Date of receipt of annual return:

Signature of Electoral Commissioner:

Date: ...............

Page ..... of .....

Annexure “A”

The following list specifies in Column A those former members of the party on whom it previously relied for continued registration. Column B specifies the list of members instead of those former members on whom the party now wishes to rely for continued registration. The remainder of the members on whom the party relies are still members of the party.

Column A	Column B
Names and addresses (as enrolled) of former members on whom the party relied	Names and addresses (as enrolled) of replacement members on whom the party relies
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.

Note—

A Declaration of Party Membership (Form 20) completed by each replacement member specified in Column B on whom the party relies is to be attached.

Date: ...............

Page ..... of .....

Annexure “B”

The following list specifies the former names and/or addresses of members of the party on whom it relies to continue to be eligible for registration. Where a member on whom the party relies for continued registration has changed their name, their address, or both, detail these changes below.

Column A	Column B
Previous names and addresses (as enrolled) of members on whom the party relies	Current names and addresses (as enrolled) of members
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.

Form 22 Penalty notice for failure to vote

(Clause 38)

(Parliamentary Electorates and Elections Act 1912 (Section 120C))

Electoral District: (place) No on Roll:

If penalty is not paid or reason is not given within 28 days, court proceedings may be taken against you.

Name and address of elector:

You are notified that electoral records show that you appear to have failed to vote at the election held on:

Under section 120F of the Parliamentary Electorates and Elections Act 1912 the maximum penalty for failing to vote is 0.5 penalty units.

If you consider you have a sufficient reason for your failure to vote you should return this notice with any explanation you may wish to offer.

Alternatively, you may dispose of the matter by:

1 Paying a penalty of $25 to the Electoral Commissioner within 28 days of the date of this notice, or

2 Having the matter dealt with by a Court, where the maximum penalty is 0.5 penalty units plus court costs.

Procedure for payment of penalty or offer of explanation

Deliver or post the penalty or the explanation to the Electoral Commissioner.

[Here insert the methods by which payment may be made.]

Part payment of this penalty cannot be accepted

Penalty for any person giving a false reason for failure to vote is 0.5 penalty units.

This form must be forwarded with your payment or explanation.

Indicate if receipt is required.

Electoral Commissioner:

Date:

sch 1: Am 2006 (635), Schs 1 [13]–[41], 2 [2]–[4]; 2007 (39), Sch 1 [2]; 2007 No 27, Sch 4.21.

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Parliamentary Electorates and Elections Regulation 2001