Candidate Nomination Formspox_d002 NOMIN ATION OF A MEMBER OF THE HOUSE OF REPRESENTATIVES (Single...

CandidateNomination Forms

Australian Electoral Commissionpox_d002

NOMINATION OF AMEMBER OF THE

HOUSE OFREPRESENTATIVES

(Single nomination)

Information on this form is collected under provisions of the Commonwealth Electoral Act 1978.

This form will be publicly produced on nomination day and may be inspected by any member ofthe public and will be provided by the Australian Electoral Commission for media releases, inaccordance with the Commonwealth Electoral Act 1918.

No responsibility will be taken for faxed applications and no acknowledgement will be advised.

A person must not make a false or misleading statement or leave out details which would make astatement misleading on a nomination form.

PENALTY: Imprisonment for 6 monthsEF060( 1) 5/95

(front)

To the Divisional Returning Officer for the Division of 1

Complete l PART A if a candidate is nominated/endorsed by a Registered PartyOR l PART B if a candidate is nominated by 6 electors.

the ‘registered officer/deputy registered officer of the

I name of registered party

hereby nominate/endorse 1) as a Member of the House of Representatives for the above named Division.

name of candidate

I request that printed on the ballot paper adjacent to the name of the candidate appears the

registered abbreviation of the party name; 0OR

registered party name. clSignature of registeredofficer/deputy registered officer

I ‘Delete one

We, electors on the electoral roll for the above named Division and entitled to vote at the election of a Member of the House of Representatives for that Division, hereby

nominate )Ias a member of the House of Representatives for the above named Division.

name of candIdale

Details of electors

PLEASE NOTE:If a nominator or nominators have silent enrolment, then only include the address for correspondence s.166(7).

; /

/ // /

/ /

/ /

/ /

/ /EF060(1) 5/95

Payel

Surname or Family name

Christian or Given names

Form in which Christian or Givennames to appear on ballot paper

Do you have silent enrolment?

* Residential address

* If you are a sitting member who does not reside within the Division you represent, but you areenrolled for that Division, you may show your enrolled address rather than your place of residence.

Occupation

Contact Details

Contact name

Postal address

Contact numbers

(Name of registered party)

Business hours After hours Facsimile

Postcode

Postcode

Yes If yes, byNo

Date of birth Place of birth/ /

/ /

Details

Date granted citizenship

� I am at least 18 years of age

� I am an elector or qualified to be an elector

� I am capable of being chosen and sitting as aMember of the House of Representatives(because I am not disqualified by virtue ofSection 44 of the Constitution � see reverse side).

and I declare that:

� I am qualified under the Constitution and the laws of the Commonwealth to beelected as a Member of the House of Representatives;

� I am not, and do not intend to be, a candidate for any other election held on thesame day as the election to which this nomination relates;

� I consent to act as a Member of the House of Representatives for the aboveDivision if elected.

I wish my Christian or Given names to appear on the ballot paper as shown opposite.

Signature of candidate / /

Consecutive No. Received Date / / Time am/pm Receipt No. DRO�s signature

NoYes

NoYes

NoYes

EF060(1) 7/98()

PART C � Candidate to complete

Candidate's DeclarationI, the candidate named herein, state that:

� I am an Australian citizen

birth

naturalisation

other meansNo

I wish the word Independent to be printed on theballot paperORI am endorsed by

Female

Please tick the box if you approve for the Australian Electoral Commission to publicly release yourtelephone contact numbers. If the numbers are not to be available, you should provide these detailsseparately to the Divisional Returning Officer.

Please tick relevant boxesName of candidate as enrolled (If not enrolled the name under which you are entitled)

Ö

Yes

Male

These telephone numbers may be publicly released by the AEC.

Yes No

OFFICE USE

To the Divisional Returning Officer for the Division of

Complete � PART A if a candidate is nominated/endorsed by a Registered PartyOR � PART B if a candidate is nominated by 50 electors.

/ // // // // // // // /

Name as enrolledSurname or Family name Christian or Given names Residential address for which enrolled

Dateof birth Signature of elector

I, , the *registered officer/deputy registered officer of the

hereby nominate/endorse as a Member of the House of Representatives for the above named Division.


registered abbreviation of the party name;OR

registered party name.

*Delete one

name o f r eg i s t e r ed pa r t y

name of candidate

PLEASE NOTE:If a nominator or nominators have silent enrolment, they are not required to supply a residential address.

EF060(1) 7/98Page 1

/ /

PART A � Nomination/Endorsement by a Registered Party

PART B � Nomination by 50 electors

Signature of registeredofficer/deputy registered officer

Details of electors

Office UseElector ID

name of candidate

We, electors on the electoral roll for the above named Division and entitled to vote at the election of a Member of the House of Representatives for that Division,

hereby nominate as a member of the House of Representatives for the above named Division.

Details of electors (continued)

/ // // // // // /

Residential address for which enrolledDate

of birth Signature of elector

/ /

/ /

Name as enrolledSurname or Family name Christian or Given names


Dateof birth/ // // // // // /

/ /

/ // // // // // // /

/ /

/ /

PART B - Nomination by 50 electors


EF060(1) 7/98(page 2)

/ /

name of candidate

We, electors on the electoral roll for the above named Division and entitled to vote at the election of a Member of the House of Representatives for that

Division, hereby nominate as a member of the House of Representatives for the above namedDivision.


/ // // // // // /



/ /

/ /



Dateof birth/ // // // // // /

/ /

/ // // // // // // /

/ /

/ /



EF060(1) 7/98(page 3)

/ /

name of candidate

We, electors on the electoral roll for the above named Division and entitled to vote at the election of a Member of the House of Representatives for that

Division, hereby nominate as a member of the House of Representatives for the above namedDivision.

Have you included the following information on this form?

cl name of Division for which you are nominating

Part A (for candidates nominated/endorsed by a registered party)

CI name of registered officer/deputy registered officer

cl indicated whether registered officer or deputy registered officer

CI name of registered party

0 name of candidate

0 party name or party abbreviation request

LI signature of registered officer/deputy registered officer

Part B (for candidates nominated by 6 electors)

0 name of candidate

0 signatures and full details of at least 6 electors

Part C (candidate’s particulars)

0 ful l name

0 form of name to appear on ballot paper

cl residential address’, occupation and sex

cl contact details

cl independent/party name choice for ballot paper

0 candidate’s declaration - citizenship details- other questions answered- signature and date

0 candidate’s deposit enclosed ($250 in cash or bankers cheque)

Candidates who have any doubts on their eligibility, by virtue of Section 44 of the Constitution, are advised to obtain their ownlegal advice.

For further information refer to the Candidates Handbook.

Any person who -

(i) Is under any acknowledgement of allegiance, obedience, or adherence to a foreign power, or is asubject or a citizen or entitled to the rights or privileges of a subject or a citizen of a foreign power; or

(ii) Is attainted of treason, or has been convicted and is under sentence, or subject to be sentenced, for anyoffence punishable under the law of the Commonwealth or of a State by imprisonment for one year orlonger; or

(iii) Is an undischarged bankrupt or insolvent; or

(iv) Holds any office of profit under the Crown, or any pension payable during the pleasure of the Crown outof any of the revenues of the Commonwealth; or

(v) Has any direct or indirect pecuniary interest in any agreement with the Public Service of theCommonwealth otherwise than as a member and in common with the other members of an incorporatedcompany consisting of more than twenty-five persons;

shall be incapable of being chosen or of sitting as a senator or a member of the House of Representatives.

But sub-section iv. does not apply to the office of any of the Queen’s Ministers of State for the Commonwealth,or of any of the Queen’s Ministers for a State, or to the receipt of pay, half pay, or a pension, by any person as anofficer or member of the Queen’s navy or army, or to the receipt of pay as an officer or member of the naval or militaryforces of the Commonwealth by any person whose services are not wholly employed by the Commonwealth.

EF060(1) 3/97(back)

Have you included the following information on this form? Part C (candidate’s particulars)

0 name of State/Territory for which you are nominating


R name of registered officer/deputy registered officer

cl indicated whether registered officer or deputy registeredofficer

0 name of registered party

0 name of candidate


cl signature of registered officer/deputy registered officer


cl name of candidate

cl signatures and full details of at least 6 electors

cl

cl

full name

form of name to appear on ballot paper

residential address, occupation and sex

contact details

independent/party name choice for ballot paper

candidate’s declaration - citizenship details- other questions

answered- signature and date

indicated whether or not Voting Ticketwill be lodged (incumbent Senators only)

candidate’s deposit enclosed($500 in cash or bankers cheque)



Voting Tickets

If you are an incumbent Senator you may lodge up to 3 Voting Tickets. These will be displayed on a poster, in ballot paper order,at Polling places. If you lodge 2 or 3 Voting Tickets, they will be grouped together on the poster in an order specified by you.

The Voting Ticket(s) must be:

- lodged within 24 hours of the close of nominations;

- lodged with the Australian Electoral Officer for the State/Territory; and

- signed by the candidate.

Any person who -

(i)

(ii)

(iii)

(iv)

(v)

Is under any acknowledgement of allegiance, obedience, or adherence to a foreign power, or is a subjector a citizen or entitled to the rights or privileges of a subject or a citizen of a foreign power; or

Is attainted of treason, or has been convicted and is under sentence, or subject to be sentenced, for anyoffence punishable under the law of the Commonwealth or of a State by imprisonment for one year orlonger; or

Is an undischarged bankrupt or insolvent; or

Holds any office of profit under the Crown, or any pension payable during the pleasure of the Crown out ofany of the revenues of the Commonwealth; or

Has any direct or indirect pecuniary interest in any agreement with the Public Service of the Commonwealthotherwise than as a member and in common with the other members of an incorporated company consistingof more than twenty-five persons;


But sub-section iv. does not apply to the office of any of the Queen’s Ministers of State for the Commonwealth, orof any of the Queen’s Ministers for a State, or to the receipt of pay, half pay, or a pension, by any person as an officer ormember of the Queen’s navy or army, or to the receipt of pay as an officer or member of the naval or military forces of theCommonwealth by any person whose services are not wholly employed by the Commonwealth.

EF059(1) 5/95(back)

AECAustralian Electoral Commission

NOMINATION OF ASENATOR

NOTE: 1 Information on this form is collected under provisions of the Commonwealth Electoral Act 1918.


NOTE: 2 No responsibility will be taken for faxed applications and no acknowledgement will be advised.

NOTE: 3 A person must not make a false or misleading statement or leave out details which would make astatement misleading on a nomination form.

PENALTY: Imprisonment for 6 monthsEF059(1) 7/98

(front)

(Single nomination)

name of registered party

/ /

Complete � PART A if a candidate is nominated/endorsed by a Registered PartyOR � PART B if a candidate is nominated by 50 electors.

We, electors on the electoral roll for the above State/Territory and entitled to vote at the election of Senators for that State/Territory, hereby nominate

as a Senator for the above State/Territory to serve in the Senate of the Parliament of the Commonwealth.

Details of electors

/ // // // // // /



EF059(1) 7/98(page 1)

/ /

/ /


registered abbreviation of the party name;

ORregistered party name.

*Delete oneSignature of registeredofficer/deputy registered officer



To the Australian Electoral Officer for the State/Territory of



hereby nominate/endorse as a Senator for the above State/Territory to serve in theSenate of the Parliament of the Commonwealth.

name of candidate

Date / /name of candidate






/ // // // // // /



/ /

/ /




Dateof birth/ // // // // // /

/ /

/ /

/ // // // // // /

/ /

/ /


EF059(1) 7/98(page 2)

/ /





/ // // // // // /



/ /

/ /




Dateof birth/ // // // // // /

/ /

/ /

/ // // // // // /

/ /

/ /


EF059(1) 7/98(page 3)

/ /


EF059(1) 7/98(page 4)

Please tick relevant boxes

Name of candidate as enrolled (If not enrolled the name under which you are entitled)

PART C � Candidate to complete

Candidate's Declaration

I, the candidate named herein, state that:


birth

naturalisation

other means


Details


Signature of candidate

Yes If yes, byNo

/ /




* If you are an incumbent Senator who is enrolled for an address in the State other than yourplace of residence you may show your enrolled address rather than your place of residence.

Occupation

/ /

NoYes� I am at least 18 years of age


� I am capable of being chosen and sitting as aSenator (because I am not disqualified by virtue ofSection 44 of the Constitution � see reverse side)

� I am an incumbent Senator

� I intend lodging a Voting Ticket or Tickets(incumbent Senators only - see reverse)

and I declare that:

� I am qualified under the Constitution and the laws of the Commonwealth to beelected as a Senator;

� I am not, and do not intend to be, a candidate for any other election held onthe same day as the election to which this nomination relates;

� I consent to act as a Senator for the State/Territory if elected.

I wish my Christian or Given names to appear on the ballot paper as shownopposite.

Yes No

Postcode



Female


I wish the word Independent to be printed on theballot paperORI am endorsed by

Please tick the box if you approve for the Australian Electoral Commission to publicly releaseyour telephone contact numbers. If the numbers are not to be available, you should providethese details separately to the Returning Officer.


Contact Details

Contact name

Postal address

Contact numbers

Yes No


Postcode

OFFICE USE Consecutive No. Received Date / / Time am/pm Receipt No. AEO�s signature

NoYes

NoYes

NoYes

NoYes

Male

Ö

4AEC1 . . - ,r .

NOMINATION OFSENATORS

(Group nomination endorsed by more than one party)


This form will be publicly produced on nomination day and may be inspected by any member ofthe public and will be provided by the Australian Electoral Commission for media releases, inaccordance with the Commonwealth Electoral Ad 7918.



PENALTY: Imprisonment for 6 months EF059(3) 5/95(front)


Complete � PART A if a candidate is nominated/endorsed by more than one PartyOR � PART B if a candidate is nominated by 50 electors.

/ /

We, electors on the electoral roll for the above State/Territory and entitled to vote at the election of Senators for that State/Territory, hereby nominate the persons namedbelow (Part C) as Senators for the above State/Territory to serve in the Senate of the Parliament of the Commonwealth.

Date / /Details of electors

EF059(3) 7/98(page 1)

1stParty

2ndParty

PART A � Nomination/Endorsement by Registered Parties


hereby nominate/endorse the persons listed below (Part C), and indicated by the numbers as Senators for the above named

State/Territory to serve in the Senate of the Parliament of the Commonwealth.


I request that printed on the ballot paper adjacent to the name of each candidate appears the



*Delete one


/ /


hereby nominate/endorse the persons listed below (Part C), and indicated by the numbers as Senators for the above named

State/Territory to serve in the Senate of the Parliament of the Commonwealth.





*Delete one



/ // // // // // /


of birth Signature of electorName as enrolled

Surname or Family name Christian or Given namesOffice UseElector ID



/ // // // // // /



/ /

/ /



Date / /

Dateof birth/ // // // // // /

/ /

/ // // // // // // /

/ /

/ /


EF059(3) 7/98(page 2)

/ /




/ // // // // // /



/ /

/ /



Date / /

Dateof birth/ // // // // // /

/ /

/ // // // // // // /

/ /

/ /


EF059(3) 7/98(page 3)

/ /



Name of candidate Name of party endorsing Name of candidate Name of party endorsing

1

2

3

4

5

6

7

8

9

10

The name to be printed adjacent to the group ticket voting square on the ballot paper is

formed from the registered names or abbreviations of the parties endorsing the candidates in the group.

1st Party 2nd Party

/ // /Signature of registered officer/deputy registered officer

Signature of registered officer/deputy registered officer

Contact name

Contact numbers Business hours After hours Facsimile

Postal address Postcode

Please tick the box if you approve for the Australian Electoral Commission to publicly release your telephone contact numbers. If the numbers are not to be available, you should provide these detailsseparately to the Returning Officer.


Group Voting Tickets

Groups may lodge up to 3 Group Voting Tickets. These will be displayed on a poster, in ballot paper order, at polling places. If you lodge 2 or 3 Voting Tickets, they will begrouped together on the poster in an order specified by you.

The Group Voting Ticket(s) must be lodged with the Australian Electoral Officer for the State/Territory within 48 hours of the close of nominations by:

� the registered officers or deputy registered officers of all those parties that nominated candidates in the group; or

� a person authorised by all the members of the group, by written instrument given to the Australian Electoral Officer with the nomination, to lodge the ticket(s) onbehalf of the group.

Please give below the name of person(s) who will be lodging the Group Voting Ticket(s).Name Position Contact Numbers After hours Facsimile

Business hours

EF059(3) 7/98(page 4)

PART C � Order of candidates

PART D � Composite name for ballot paper

PART E � Contact Details for the Group






birth

naturalisation

other means


Details





and I declare that:




I request that my name be grouped with the names of other candidates in the orderspecified in Part C of the nomination form.



Yes If yes, byNo

/ /






Postcode

* If you are an incumbent Senator who is enrolled for an address in the State otherthan your place of residence you may show your enrolled address rather thanyour place of residence.

Occupation Male Female

I am endorsed by(Name of registered party)


EF059(3) 7/98(page 5)

/ /

PART F � Candidate to complete

NoYes

Yes

Yes

Yes

No

No

No

Ö



Part A (for candidates nominated/endorsed by registered parties)

Ll name of registered officers/deputy registered officers


0 names of registered parties

cl party names or party abbreviation request

0 signature of registered officers/deputy registered officers

Part B (fdr candidates nominated by 6 electors)

0 signatures and full details of at least 6 electors

Part C (order of candidates)

0 list of candidates in order

Part D (composite name)

0 composite name for ballot paper

Part E (contact details)

0 contact name and numbers for the group

Part F (candidate’s particulars)

cl full name

cl form of name to appear on ballot paper

cl residential address, occupation and sex

cl contact details

0 candidate’s declaration - citizenship details- other questions


0 candidate’s deposits enclosed($500 in cash or bankers chequefor each candidate)

Candidates who have any doubts on their elegibility, by virtue of Section 44 of the Constitution, are advised to obtain their ownlegal advice.


Any person who -

(i)

(ii)

(iii)

(iv)

(v)

Is under any acknowledgement of allegiance, obedience, or adherence to a foreign power, or is a subjector a citizen or entitled to the rights or privileges of a subject or a citizen of a foreign power; or

Is attainted of treason, or has been convicted and is under sentence, or subject to be sentenced, for anyoffence punishable under the law of the Commonwealth or of a State by imprisonment for one year orlonger; or

Is an undischarged bankrupt or insolvent; or

Holds any office of profit under the Crown, or any pension payable during the pleasure of the Crown out ofany of the revenues of the Commonwealth; or

Has any direct or indirect pecuniary interest in any agreement with the Public Service of the Commonwealthotherwise than as a member and in common with the other members of an incorporated company consistingof more than twenty-five persons;



EF059(3) 5 /95(back)

NOMINATION OFMEMBERS OF THE

HOUSE OFREPRESENTATIVES

(Bulk nomination)

NOTE: 1 If a registered officer or a deputy registered officer nominates a party’s endorsed candidates for theHouse of Representatives to the Australian Electoral Officer, no nomination of any other candidatesendorsed by that party should be made to a Divisional Returning Officer within that State or Territory.

If a nomination for another candidate endorsed by the same party is lodged with a Divisional ReturningOfficer all the party’s nominations made to the Australian Electoral Officer under section 167(3) of theCommonwealth Electoral Act 1918 wiII be rejected (section 172 CEA).





PENALTY: Imprisonment for 6 months

EFO60(2) 5/95(front)



OR

registered party name. Signature of registered officer/deputy registered officer

*Delete one



hereby nominate/endorse each candidate listed below as a Member of the House of Representatives for the Division indicated.

/ /


EF060(2) 7/98(Page 1)


Division Surname or Family name Christian or Given names

EF060(2) 7/98(page 2)

Division Surname or Family name Christian or Given names

I am endorsed by

Occupation

Contact Details

Contact name

Postal address

Contact numbers

Please tick the box if you approve for the Australian Electoral Commission to publicly release yourtelephone contact numbers. If the numbers are not to be available, you should provide thesedetails separately to the Divisional Returning Officer.







*If you are a sitting member who does not reside within the Division you represent, but you areenrolled for that Division, you may show your enrolled address rather than your place of residence.


Postcode


Postcode

Candidate's DeclarationI, the candidate named herein, state that:


birth

naturalisation

other means

Yes If yes, byNo

Yes


Details

Date granted citizenship / /

No

No

No

Signature of candidate / /

Consecutive No. Received Date / / Time am/pm Receipt No. DRO�s signature

Consecutive No. Received Date / / Time am/pm Receipt No. AEO�s signatureOFFICE USE



� I am capable of being chosen and sitting as aMember of the House of Representatives (because Iam not disqualified by virtue of Section 44 of theConstitution � see reverse side)

and I declare that:

� I am qualified under the Constitution and the laws of the Commonwealth to beelected as a Member of the House of Representatives;


� I consent to act as a Member of the House of Representatives for the aboveDivision if elected.

I wish my Christian or Given names to appear on the ballot paper as shown oppo-site.

EF060(2) 7/98(page 3)

PART B � Candidate to complete

Please tick relevant boxesTo the Divisional Returning Officer for


name of division

NoYes

Male Female

(as above)

Ö

Yes

Yes

Have you induded the following information on this form?

cl nomination includes ALL the party’s House of Representatives endorsed candidates

Part A (details of nomination by a registered party)

cl name of registered officer/deputy registered officer

0 indicated whether registered officer or deputy registered officer

cl name of registered party


0 signature of registered officer/deputy registered officer

0 list of candidates

Part B (candidate’s particulars)

0name of Division for which you are nominating

clfull name

0 form of name to appear on ballot paper

cl residential address, occupation and sex

cl contact details

cl name of party endorsing

cl candidate’s declaration -citizenship details- other questions answered- signature and date

cl candidate’s deposit enclosed ($250 in cash or bankers cheque for each candidate)



Any person who -

(i) Is under any acknowledgement of allegiance, obedience, or adherence to a foreign power, or is asubject or a citizen or entitled to the rights or privileges of a subject or a citizen of a foreign power; or

(ii) Is attainted of treason, or has been convicted and is under sentence, or subject to be sentenced, for anyoffence punishable under the law of the Commonwealth or of a State by imprisonment for one year or longer;or


(iv) Holds any office of profit under the Crown, or any pension payable during the pleasure of the Crown out of anyof the revenues of the Commonweatth or

(v) Has any direct or indirect pecuniary interest in any agreement with the Public Service of the Commonwealthotherwise than as a member and in common with the other members of an incorporated company consistingof more than twenty-five persons;


But sub-section iv. does not apply to the office of any of the Queen’s Ministers of State for the Commonwealth, or ofany of the Queen’s Ministers for a State, or to the receipt of pay, hall pay, or a pension, by any person as an officer or memberof the Queen’s navy or army, or to the receipt of pay as an officer or member of the naval or military forces of the Commonwealthby any person whose services are not wholly employed by the Commonwealth.

EFO60(2) 5/95(back)

NOMINATION OFSENATORS

(Group nomination)





PENALTY: Imprisonment for 6 months EF059(2) 5/95(front)



/ /


Complete � PART A if a candidate is endorsed and/or nominated by a Registered PartyOR � PART B if a candidate is nominated by 50 electors.

hereby nominate/endorse the persons listed below (Part C) as Senators for the above named State/Territory to serve in the Senate of the Parliament of the Commonwealth.


Date / /Details of electors

/ // // // // // /



EF059(2) 7/98(page 1)

/ /

/ /




*Delete one








/ // // // // // /



/ /

/ /



Date / /

Dateof birth/ // // // // // /

/ /

/ /

/ // // // // // /

/ /

/ /


EF059(2) 7/98(page 2)

/ /




/ // // // // // /



/ /

/ /



Date / /

Dateof birth/ // // // // // /

/ /

/ /

/ // // // // // /

/ /

/ /


EF059(2) 7/98(page 3)

/ /



Name of candidate Name of candidate

Contact name

Contact numbers Business hours After hours Facsimile

Postal address Postcode

Please tick the box if you approve for the Australian Electoral Commission to publicly release your telephone contact numbers. If the numbers are not to be available, you should provide these detailsseparately to the Returning Officer.


10

9

8

7

6

5

4

3

2

1

Group Voting Tickets

You may lodge up to 3 Group Voting Tickets. These will be displayed on a poster, in ballot paper order, at polling places. If you lodge 2 or 3 Voting Tickets, they will begrouped together on the poster in an order specified by you.

The Group Voting Ticket(s) must be lodged with the Australian Electoral Officer for the State/Territory within 48 hours of the close of nominations by:

� the registered officer or deputy registered officer of the party; or

� a person authorised by all the members of the group, by written instrument given to the Australian Electoral Officer with the nomination, to lodge the ticket(s) onbehalf of the group.

Please give below the name of person(s) who will be lodging the Group Voting Ticket(s).

Name Position Contact Numbers After hours FacsimileBusiness hours


EF059(2) 7/98(page 4)

PART C � Order of candidates

PART D � Contact Details for the Group

EF059(2) 7/98(page 5)



PART E � Candidate to complete




birth

naturalisation

other means


Details



Yes If yes, byNo

/ /






Postcode

* If you are an incumbent Senator who is enrolled for an address in the State otherthan your place of residence you may show your enrolled address rather thanyour place of residence.

Occupation Male Female

I am endorsed by

/ /


(if applicable)

NoYes

Ö

NoYes

NoYes

NoYes




and I declare that:


� I am not, and do not intend to be, a candidate for any other election held onthe same day as the election to which this nomination relates;


I request that my name be grouped with the names of other candidates in theorder specified in Part C of the nomination form.





0 name of registered officer/deputy registered officer


cl names of registered party


cl signature of registered officer/deputy registered officer


Ll signatures and full details of at least 6 electors

Part C (order of candidates)

cl list of candidates in order

Part D (contact details)

0 contact name and numbers for the group

Part E (candidate’s particulars)

clclcl0cl0

cl

full name

form of name to appear on ballot paper

residential address, occupation and sex

contact details

party name choice for ballot paper (if applicable)

candidate’s declaration

candidate’s deposits enclosed($500 in cash or bankers chequefor each candidate)

- citizenship details- other questions




Any person who -

(i) Is under any acknowledgement of allegiance, obedience, or adherence to a foreign power, or is a subjector a citizen or entitled to the rights or privileges of a subject or a citizen of a foreign power; or

(ii) Is attainted of treason, or has been convicted and is under sentence, or subject to be sentenced, for anyoffence punishable under the law of the Commonwealth or of a State by imprisonment for one year orlonger; or


(iv) Holds any office of profit under the Crown, or any pension payable during the pleasure of the Crown out ofany of the revenues of the Commonwealth; or

(v) Has any direct or indirect pecuniary interest in any agreement with the Public Service of the Commonwealthotherwise than as a member and in common with the other members of an incorporated company consistingof more than twenty-five persons;



EF059(2) 5/95(back)

Candidate Nomination Formspox_d002 NOMIN ATION OF A MEMBER OF THE HOUSE OF REPRESENTATIVES (Single...

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Transcript of Candidate Nomination Formspox_d002 NOMIN ATION OF A MEMBER OF THE HOUSE OF REPRESENTATIVES (Single...