8/18/2019 UK Voter Registration Form (2015)

1/3Page 1

 Your date of birth (DD MM YYYY)

 

If you don’t know your date of birth, please tick if you are

 !nder 1" 1"#$% &'er $%

 Your name and address

orenae(s)

*urnae

 

Your address

  Postcode

Do you li'e at another address+

 o Yes

 If you also live at another address 

don’t gi'e us the address now, but we

ay ask you for ore inforation later-

Moved in the last 12 months?

 o Yes

If yes, please gi'e any pre'ious address where you ha'e li'ed duringthe last year-

  Postcode

If this address was o'erseas, were you registered in the !. as an

o'erseas 'oter+

 o Yes

Changed your name in the last 12 months?

 o YesIf yes, please gi'e us your pre'ious nae-

Please tell us the date you changed your nae (DD MM YYYY)-

 

or e/aple, you ay ha'e got

arried-

Go onlineYou can fill in this for at

www.gov.uk/registertovote

Indi'idual 0egistration or

!egister to vote&nly one person can register to 'ote using this for-

!se bla"k ink and write in 2PI324* or go online at

www.gov.uk/registertovote

#on$t know your e%a"t date of birth?

Please gi'e the date of birth you put on

other official docuents (for e/aple,

your passport or dri'ing licence) or tick

one of the bo/es-

I305657

8/18/2019 UK Voter Registration Form (2015)

2/3

Conta"t details

3elephone nuber(s)

7ail address (if you ha'e one) in 2PI324*

You don’t ha'e to gi'e us your

contact details, but if you do it will

help us if we need to contact you

about your registration-

 Your nationality

 

If you have more than one

nationality, please include the all-

You can only register to 'ote in the

!. if you ha'e lea'e to reain- 8e

ay check your iigration status

with the 9oe &ffice before we

include you on the electoral register-

#e"laration

3o the best of y knowledge, the inforation in this for is true-

I understand that the inforation I ha'e gi'en on this for will be used

on the electoral register-

I understand that if I do not ake an application for registration when

re:uired to do so I could face a fine of ;"%-

I understand that it is an offence to knowingly gi'e false inforation in

this for, and that I could face an unliited fine and

Can$t vote in )erson?

If you are unable to go to the polling station in person on polling day,

please choose how you would like to 'ote and we will send you a for-

 6y post

6y pro/y (soeone 'oting on your behalf)

You can also download an application

for at www.aboutmyvote."o.uk-

 Your 'ational Insuran"e number 

You ay find this on your payslip, or on official letters about ta/,

pensions or benefits-

If you "annot tell us your 'ational

Insuran"e number , we ay need to

ask you for proof of your identity-

8e will contact you about this, and

it ay take longer to deal with your

application-

#on$t know your date of birth* nationality or

'ational Insuran"e number?

Please tell us why-

 

I305657

8/18/2019 UK Voter Registration Form (2015)

3/3