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Office Use Only LONDON BOROUGH OF RICHMOND UPON THAMES Electoral Services Office Room 223 Regal House London Road Twickenham TW1 3QB PD No. POSTAL VOTE APPLICATION FORM If you need help with this form please phone 020 8891 7775 Please use BLACK PEN 1. You can be fined for making a false statement on this form. 3. Your Postal Vote Your Date of Birth e.g. 02 05 1965 My application is for all election types until further notice D Only these particular election types or dates please state M Y Please SIGN within the box below using BLACK pen I understand that I now cannot vote in person at the Polling Station and my postal ballot papers cannot be sent to me earlier than 10 days before any election. Important - keep signature within the border. Address where you are registered to vote 4. Address to send postal ballot paper s My address where I am registered to vote in Part 1 or To the following address 2. About you First name s in full The reason for sending the ballot paper s to an alternative address Surname Title Mr Mrs Ms Miss Dr Other 5. Your Declaration Daytime or mobile telephone or email Optional As far as I know the details on this form are true and accurate. If you fail to do this this application may not be valid* RPF POSTAL - 2001 Date of signing F1 This form should be returned to The address at the top of this form or use envelope provided. Address where you are registered to vote 4. Address to send postal ballot paper s My address where I am registered to vote in Part 1 or To the following address 2. About you First name s in full The reason for sending the ballot paper s to an alternative address Surname Title Mr Mrs Ms Miss Dr Other 5. About you First name s in full The reason for sending the ballot paper s to an alternative address Surname Title Mr Mrs Ms Miss Dr Other 5. Your Declaration Daytime or mobile telephone or email Optional As far as I know the details on this form are true and accurate. Address where you are registered to vote 4. Address to send postal ballot paper s My address where I am registered to vote in Part 1 or To the following address 2. About you First name s in full The reason for sending the ballot paper s to an alternative address Surname Title Mr Mrs Ms Miss Dr Other 5. Your Declaration Daytime or mobile telephone or email Optional As far as I know the details on this form are true and accurate.

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