Declaration of Appointment of Election Agent/Declaration of ...

LE39A
LOCAL ELECTIONS 5 MAY 2011
COUNCIL AREA:
DISTRICT ELECTORAL AREA:
I declare that I have appointed
Full Name
(CAPITAL LETTERS)
Full Address
(CAPITAL LETTERS)
Declaration of Appointment of Election Agent
to be my election agent . The address of his / her office and other contact details are as
follows :
Office Address
(CAPITAL LETTERS)
Postcode
Tel No.
Email
Mobile No.
Signed
(Candidate)
Date
I accept the above appointment:
Declaration of Acceptance
Signed
(Election Agent)
Date
Please see notes on reverse
2011/002571 Page 1 of 2

LE39A
Notes
1. This declaration must reach the relevant Deputy Returning Officer at his/her
principal office no later than 1.00pm on Thursday 7 April 2011. If it is received
after that time it may be ineffective.
2. Items shown in bold are required in all cases. If they are not completed the
appointment will be invalid.
3. The mandatory information must be legible. If it cannot be read the declaration
may be held invalid. Apart from the signatures and dates please complete in
CAPITALS.
4. Names must be given in full - it is not sufficient to use initials.
5. The office address of your agent must, by law, be in the local council area.
6. If you do not provide the additional contact details for your agent you may not
receive important information about the election as quickly as other candidates.
2011/002571 Page 2 of 2