Form of declaration to be made by the companion of a [F1voter with disabilities]U.K.
Textual Amendments
F1Sch. 1 Appendix of Forms: words in Form of declaration to be made by the companion of a blind voter substituted (16.2.2001) by 2000 c. 2, s. 13(1)(4)(a); S.I. 2001/116, art. 2(1)
F2...U.K.
I, A. B., of , having been requested to assist C. D., (in the case of a [F3voter with disabilities] voting as proxy add voting as proxy for M. N.) whose number on the register is to record his vote at the election now being held in this constituency, hereby declare that [F4I am aged 18 or over] and that I have not previously assisted any [F5voter with disabilities] [except E. F., of ] to vote at the said election.
(Signed) A. B.,
day of 19 .
I, the undersigned, being the presiding officer for the polling station for the Consitiuency, hereby certify that the above declaration, having been first read to the above-named declarant, was signed by the declarant in my presence.
(Signed) G. H.,
day of 19 .
minutes past o’clock [a.m.] [p.m.]
[F6NOTE 1.]If the person making the above declaration knowingly and wilfully makes therein a statement false in a material particular, he will be guilty of an offence.
[F7 2. A voter with disabilities is a voter who has made a declaration under the parliamentary elections rules that he is so incapacitated by his blindness or other incapacity, or by his inability to read, as to be unable to vote without assistance.]
Textual Amendments
F2Words in Sch. 1 Appendix of forms omitted (29.12.2022) by virtue of Elections Act 2022 (c. 37), ss. 9(4)(b), 67(1); S.I. 2022/1270, reg. 2(a) (with reg. 3)
F3Appendix of forms: words in “form of declaration to be made by the companion of a blind person” substituted (16.2.2001) by 2000 c. 2, s. 13(1)(4)(a); S.I. 2001/116, art. 2(1)
F4Words in Sch. 1 Appendix of forms substituted (29.12.2022) by Elections Act 2022 (c. 37), ss. 9(4)(a), 67(1); S.I. 2022/1270, reg. 2(a) (with reg. 3)
F5Appendix of forms: words in “form of declaration to be made by the companion of a blind person” substituted (16.2.2001) by 2000 c. 2, s. 13(1)(4)(a); S.I. 2001/116, art. 2(1)
F6Sch. 1 Appendix of Forms, Form of declaration to be made by the companion of a blind voter: Note renumbered as Note 1(16.2.2001) by 2000 c. 2, s. 13(5)(b); S.I. 2001/116, art. 2(1)
F7Sch. 1 Appendix of Forms, Form of declaration to be made by the companion of a blind voter: Note 2 inserted (16.2.2001) by 2000 c. 2, s. 13(5)(b); S.I. 2001/116, art. 2(1)