N.I.DECLARATION BY VOTER
F1. . .
F1Sch. 5 Appendix of Forms: words in the Declaration of identity Front of form repealed (1.7.2008) by Electoral Administration Act 2006 (c. 22), ss. 47, 74(2), 77(2), Sch. 1 para. 61(4), Sch. 2; S.I. 2008/1316, arts. 2(3), 5(f)(iii)(g)(i)
I hereby declare that I am the person to whom the ballot paper numbered above was sent.
[F2Except where the voter is a proxy:
F2SI 2002/2835
My date of birth is................................................................................
F2SI 2002/2835
Voter's signature ................................................................................]
[F2Voter's signature ................................................................................]