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    Elector Details: Surname Given Names Residential Address

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    Saroj Khanal
    This document is an application for a postal vote. It contains details about the applicant such as their name, address, date of birth, and contact information. It asks the applicant to declare whether they have already voted in the election and which reason applies for their eligibility to vote by post, such as illness, distance from a polling place, or caring for others. The back of the form provides descriptions of the eligibility reasons. It must be signed by the applicant or an authorized witness and submitted to the Electoral Commission of South Australia by a specified deadline in order to receive ballot papers.

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    © All Rights Reserved
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    Elector Details: Surname Given Names Residential Address

    Uploaded by

    Saroj Khanal
    29 views2 pages
    This document is an application for a postal vote. It contains details about the applicant such as their name, address, date of birth, and contact information. It asks the applicant to declare whether they have already voted in the election and which reason applies for their eligibility to vote by post, such as illness, distance from a polling place, or caring for others. The back of the form provides descriptions of the eligibility reasons. It must be signed by the applicant or an authorized witness and submitted to the Electoral Commission of South Australia by a specified deadline in order to receive ballot papers.

    Original Title

    Postal Vote Application

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    This document is an application for a postal vote. It contains details about the applicant such as their name, address, date of birth, and contact information. It asks the applicant to declare whether they have already voted in the election and which reason applies for their eligibility to vote by post, such as illness, distance from a polling place, or caring for others. The back of the form provides descriptions of the eligibility reasons. It must be signed by the applicant or an authorized witness and submitted to the Electoral Commission of South Australia by a specified deadline in order to receive ballot papers.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    29 views2 pages

    Elector Details: Surname Given Names Residential Address

    Uploaded by

    Saroj Khanal
    This document is an application for a postal vote. It contains details about the applicant such as their name, address, date of birth, and contact information. It asks the applicant to declare whether they have already voted in the election and which reason applies for their eligibility to vote by post, such as illness, distance from a polling place, or caring for others. The back of the form provides descriptions of the eligibility reasons. It must be signed by the applicant or an authorized witness and submitted to the Electoral Commission of South Australia by a specified deadline in order to receive ballot papers.

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    OFFICE USE ONLY

    Application for a Postal Vote PP 22

    1. Elector details
    Surname

    Given names
    Residential address
    for which you claim
    to be enrolled
    PO Box, RMD & RSD
    numbers are not
    acceptable
    Day Month Year
    Date of birth

    Email address
    Home Mobile
    Contact number

    2. Address to send ballot papers


    Same as residential address above

    Please send ballot


    papers for this
    election/referendum
    to me at this address

    3. Elector declaration
    I declare that I:
    ▪ have not previously voted in this election/referendum; and
    ▪ am eligible for a postal vote for one of the following reasons (tick the box that applies):
    See back of this application for detailed description of reasons
    Illness, infirmity or
    Distance Travelling
    disability

    Advanced
    Caring for others Religion
    pregnancy

    Resident of an Under COVID-19


    Working
    institution direction

    Date
    Signature
    or mark / /
    of elector

    Date
    Signature
    of authorised
    person or / /
    witness
    only if elector is unable to sign (see reverse)
    Qualification to apply for a postal vote
    Distance During the hours of polling I am unlikely to be within 8 km
    from any polling booth.
    Travelling During the hours of polling I will be travelling under
    conditions that preclude my attendance at a polling booth.
    Illness, infirmity I suffer illness, infirmity or disability that will preclude my
    or disability attendance at a polling booth.
    Advanced By polling day my pregnancy will be advanced which will
    pregnancy preclude my attendance at a polling booth.
    Caring for I am caring for a person who is seriously ill, infirm or disabled
    others which will preclude my attendance at a polling booth.
    Religion Membership of religious order or having religious beliefs that
    will preclude my attendance at a polling booth.
    Working I am working during the hours of polling and will not be able
    to leave my place of work to attend a polling booth.
    Resident of an I am a resident of an institution or declared institution being
    institution a hospital, convalescent home, nursing home, home for the
    aged, hostel for the aged or infirm, prison or other place of
    confinement.
    Under COVID-19 I am subject to a direction under the Emergency
    direction Management Act requiring me to quarantine or isolate during
    the hours of polling.

    Obligations of authorised person or witness


    An authorised person or witness may sign the declaration in the space
    provided that the person:
    ▪ is any person (other than a candidate in the election) who is at least 18
    years of age, and
    ▪ in the case that the applicant is able to make a distinguishing mark, the
    authorised person or witness saw the applicant make that mark in the
    space provided for the applicant’s signature, or
    ▪ in the case that the applicant is incapable of making their mark, a
    certificate from a medical practitioner to that effect has been included
    with this application

    Availability of ballot papers


    Ballot papers cannot be printed until after nominations close.

    Application by post
    Completed applications must be received at:
    Electoral Commission SA
    Reply Paid 666, Adelaide SA 5001
    Level 6, 60 Light Square, Adelaide SA 5000
    or an appointed overseas office.
    Should you need details on how to complete your application or the
    deadline for when applications must be received, go to the Electoral
    Commission SA website at www.ecsa.sa.gov.au
    If you have any queries please contact the Electoral Commission SA
    enquiry line: 1300 655 232
    2022

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