Application to vote by post
Elections Officer, Law and Democratic Services. Municipal Offices,
Town Hall Square, Grimsby.Telephone: (01472) 324160

Only one person per form please.  If more forms are needed, please reprint,
Please use BLOCK LETTERS.
FOR OFFICE USE ONLY
Polling District
Elector No.

1 About you

 
Surname   First names (in full)
 

 

   
 
Your address (where you are registered to vote)
 
 
  Postcode
         

2 How long do you want a postal vote?

 

I want to vote by post at all elections (tick one box)
until further notice    
  for the election(s) held on (date)  
for the period from (date) to (date)

3 Address for ballot paper

 

Please send my ballot paper to (tick one box)
  my address where I am registered to vote (see Part 1 above)
  the following address
 
 
  Postcode

 Ballot papers will be sent out between one to two weeks before election day.

4 Your signature

 

Each person has to sign their own form.  The form will be returned if it is not signed.
It is an offence to make a false statement on this form - maximum fine 5000.

Signed   Date
 

 

   

 Applications must be received no later than 5pm on the sixth working day prior to election day.
 In case we have a query, please give
Daytime telephone number   Email address