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I ( name in full) ................................................................................
of ( home address in full ....................................................................................................
hereby consent to my nomination as a candidate for election as councillor for the........................................ district electoral area in the district of ........................................
I declare that I have attained the age of [F118] years and that I am a [F2qualifying] Commonwealth citizen or[F3, citizen of the Republic of Ireland or a citizen of another Member State of the European [F4Union]] and—
F1Word in Sch. 5 Appendix of Forms substituted (16.12.2010) by The Local Elections (Northern Ireland) Order 2010 (S.I. 2010/2977), art. 1(2), Sch. 1 para. 82(2)(a) (with art. 1(3))
F2Word in Sch. 5 Appendix of Forms inserted (16.12.2010) by The Local Elections (Northern Ireland) Order 2010 (S.I. 2010/2977), art. 1(2), Sch. 1 para. 82(2)(b) (with art. 1(3))
F3SI 1995/1948
F4Word in Sch. 5 Appendix of Forms substituted (16.12.2010) by The Local Elections (Northern Ireland) Order 2010 (S.I. 2010/2977), art. 1(2), Sch. 1 para. 82(2)(c) (with art. 1(3))
*Delete whichever is inappropriate | * (a) I am a local elector for the district of the council; or | |
* (b) during the whole of the period of twelve months preceding the day of the poll:— | ||
....................* (i) I have occupied as owner or tenant land in that district, or | ||
....................* (ii) resided in that district; or | ||
* (c) my principal or only place of work during that twelve months has been in that district. |
[F5My date of birth is [DD/MM/YEAR]]
F5Words in Sch. 5 Appendix of Forms inserted (16.12.2010) by The Local Elections (Northern Ireland) Order 2010 (S.I. 2010/2977), art. 1(2), Sch. 1 para. 82(3) (with art. 1(3))
I further declare that to the best of my knowledge and belief I am not disqualified for being elected by reason of any disqualification contained in section 4 of the Local Government Act (Northern Ireland) 1972, a copy of which is printed overleaf.
[F6I declare that I am not a candidate at an election in the same local government electoral area the poll for which is to be held on the same day as the election to which this consent relates.]
F6Words in Sch. 5 Appendix of Forms inserted (16.12.2010) by The Local Elections (Northern Ireland) Order 2010 (S.I. 2010/2977), art. 1(2), Sch. 1 para. 82(4) (with art. 1(3))
[F7I declare that, if elected, I will not by word or deed express support for or approval of—
(a)any organisation that is for the time being a proscribed organisation specified in Schedule 2 to the Northern Ireland (Emergency Provisions) Act 1978; or
(b)acts of terrorism (that is to say, violence for political ends) connected with the affairs of Northern Ireland.]
Signed ........................................
Date ........................................
Signed in my presence
Signature of witness ................................................................................
Name and address................................................................................
of witness (in................................................................................
CAPITAL LETTERS)................................................................................
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