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Election in the................................................................................constituency
[F1 or........................................[F2 district electoral area]],
F2SI 1985/454
Date of publication of notice of election................................................................................
The expenses incurred at the above election in support of............................................................, a candidate thereat, by................................................................................
(insert name of person or association or body of persons incurring the expenses) being expenses required by section forty-one of the Electoral Law Act (Northern Ireland), 1962, to be authorised by the election agent, amounted to £ ....................
The written authority of the election agent is annexed hereto.
Signature............................................................Date........................................
Election in the....................................................................................................constituency
[F3 or................................................................................[F4 district electoral area]],
F4SI 1985/454
Date of publication of notice of election........................................................................................................................
I hereby declare that—
1. I am the person [ or a director, general manager, secretary or other like officer of the association or body of persons] named as incurring expenses in the accompanying return, marked........................................, of expenses required by section forty-one of the Electoral Law Act (Northern Ireland), 1962, to be authorised by an election agent.
2. To the best of my knowledge and belief the said return is complete and correct.
3. The matters for which the expenses referred to in the said return were incurred were as follows................................................................................
Signature of declarant............................................................
Office held by declarant................................................................................
(in the case of an association or body of persons)
Date........................................
F5. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
F5Sch. 10 Form 4 omitted (16.12.2010) by virtue of Local Elections (Northern Ireland) Order 2010 (S.I. 2010/2977), arts. 1(2), 4, Sch. 1 para. 20(a) (with art. 1(3))
Election in the............................................................constituency.[F6 or district electoral area].
F6SI 1985/454
Date of publication of notice of election............................................................
Name of candidate ............................................................
I solemnly and sincerely declare as follows:—
1. I am the person named above as a candidate at this election [and was my own election agent] or I was at this election the election agent of the person named above as a candidate.
2. I have examined the return of election expenses [about to be]transmitted[F7 (or at a local election, delivered)] by my election agent [by me] to the returning officer, of which a copy is now shown to me and marked , and to the best of my knowledge and belief it is a complete and correct return as required by law.
F7SI 1987/168
3. To the best of my knowledge and belief, all expenses shown in the return as paid were paid by my election agent [by me], except as otherwise stated F8. . . .
F8Words in Sch. 10 Form 5 para. 3 omitted (16.12.2010) by virtue of Local Elections (Northern Ireland) Order 2010 (S.I. 2010/2977), arts. 1(2), 4, Sch. 1 para. 20(b)(i) (with art. 1(3))
F9. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
F9Sch. 10 Form 5 para. 4 omitted (16.12.2010) by virtue of Local Elections (Northern Ireland) Order 2010 (S.I. 2010/2977), arts. 1(2), 4, Sch. 1 para. 20(b)(ii) (with art. 1(3))
Signature of declarant............................................................
F10. . .
F10Words in Sch. 10 Form 5 omitted (16.12.2010) by virtue of Local Elections (Northern Ireland) Order 2010 (S.I. 2010/2977), arts. 1(2), 4, Sch. 1 para. 20(b)(iii) (with art. 1(3))
F10. . .
F10. . .
F10. . .
(NOTE.— Where there has been a change of election agent, suitable variations may be introduced into the declaration as to expenses.