Second Schedule — GENERAL ELECTIONS ACT

Amended by

L.N. 426 of 2012.

(Article 21)

Substituted by

L.N.350 of 2017.

FORM NO. 1

Form of Application for Registration as a Voter

To the Electoral Commission, Valletta, Malta.

Surname ______________________________________ I.D. Card No. _____________________________

Name __________________________________________________________________________________

Place of Birth __________________________________ Date of Birth ______________________________

Name of town / village ____________________________________________________________________

Street and number / name of premises ________________________________________________________

Parent’s Name, Surname and Surname at birth __________________________________________________

Place of Birth _______________________________________ Nationality* __________________________

* (if applicant’s parent shown above is dead, state nationality at the time of death)

Parent’s name, Surname and Surname at birth __________________________________________________

Place of Birth _______________________________________ Nationality ** ________________________

** (if applicant’s parent shown above is dead, state nationality at the time of death)

I hereby apply to be registered as a voter for the election of Members of the House of Representatives for the

___________________________ (1) electoral division in accordance with the 1991 General Elections Act.

Date ___________________________________

Signature or mark of applicant

(1) Insert number of electoral division

FOR OFFICIAL USE ONLY

Remarks

Vtd. ______________________________

Chkd. ______________________________

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