Electoral Regulations 1996

Western Australia

Electoral Act 1907

Part 1 — Preliminary

1. Citation

These regulations may be cited as the Electoral Regulations 1996 1.

2. Interpretation

In these regulations, unless the contrary intention appears —

“authorised person” means a presiding officer or a person performing the duties of, or exercising the powers of, a presiding officer under section 105 of the Act;

“ballot paper envelope” means an envelope referred to in section 90(4)(c)(ii) of the Act or in regulation 14(1)(c), 14(3)(b) or 15(b);

“issuing officer” means a person referred to in section 90(1a) of the Act;

“record” means any thing or process —

(a)upon or by which information is recorded or stored; or

(b)by means of which a meaning can be conveyed by any means in a visible or recoverable form,

whether or not the use or assistance of some electronic, electrical, mechanical, chemical or other device or process is required to recover or convey the information or meaning.

[Regulation 2 amended in Gazette 10 November 2000 p.6164.]

3. Application of declaration to a region

In any form of declaration or statement made, or to be made, by an officer, clerk, elector or voter, in relation to an election or referendum, a reference in the declaration or statement to a district is, unless the contrary intention appears, to be read and construed, as well, as a reference to the corresponding region.

4. Application to more than one election

The provisions of these regulations, and the forms prescribed in these regulations apply, as nearly as is practicable and with such modifications as are, in the opinion of the Electoral Commissioner, necessary or expedient, as well to more than one election, including one or more referendums, held for a district or region on the same day as to any other election.

Part 2 — Charges and forms

[5.Repealed in Gazette 20 October 2000 p.5927.]

6. Declarations and appointments — Schedule 2

(1)The declaration by an officer prescribed for the purposes of section 15A of the Act is the declaration in Form 1 in Schedule 2.

[(2)repealed]

(3)A person is not permitted to enter a polling place for the purpose of acting as a scrutineer unless that person has made a declaration in the form of Form 3 in Schedule 2.

(4)The form prescribed for the purposes of section 104(1) of the Act for the appointment of a presiding officer, assistant presiding officer, poll clerk or doorkeeper is Form 4 in Schedule 2.

[Regulation 6 amended in Gazette 8 November 1996 p.6267.]

7. Forms — Schedule 3

(1)The forms in Schedule 3 are prescribed in relation to the matters specified in the forms.

(2)If a form in a schedule is to be completed by the insertion of particulars required in the form, those particulars are prescribed as the particulars required under the provision of the Act or of these regulations for the purposes of which the form is prescribed.

(3)If a form in a schedule contains directions for its completion the form is to be completed in accordance with those directions.

Part 3 — Rolls

8. Rolls

(1)In addition to the matters prescribed in section 22 of the Act a roll is to set out the sex and occupation of each elector on the roll.

(2)Despite subregulation (1), the sex and occupation of electors may be omitted when rolls are printed under section 24 of the Act, made available under section 25 of the Act, provided under section 25A of the Act or supplied under section 112 of the Act or when information on or derived from rolls is made available under section 25 or provided under section 25A.

(3)A person’s name may be omitted when the Electoral Commissioner makes rolls or information on rolls available under section 25 of the Act if —

(a)by virtue of section 51B of the Act, the person’s address is not shown on a roll; and

(b)at or after the time of making a request under section 51B, the person requested the Electoral Commissioner to omit the person’s name when making rolls or information on rolls available under section 25.

[Regulation 8 amended in Gazette 8 November 1996 p.6267; 20 October 2000 p.5928.]

[9.Repealed in Gazette 10 November 2000 p.6164.]

10. Roll to be marked where objection subject to appeal (s.47(3)(g))

(1)If an enrolment officer objects to any claim for enrolment, and is required under section 47(3)(g) of the Act to enrol the claimant, the enrolment officer is to enter the notation “47(3)(g)” against the claimant’s name on the roll.

(2)The notation referred to in subregulation (1) may be entered by electronic means if that is appropriate in the circumstances.

[Regulation 10 amended in Gazette 10 November 2000 p.6164.]

10A.Recording the issue of a ballot paper

The record that section 126(1) of the Act requires to be made in respect of a person’s name on a copy of a roll is to be made —

(a)by making a mark next to the person’s name; or

(b)by electronic means,

whichever is appropriate in the circumstances.

[Regulation 10A inserted in Gazette 20 October 2000 pp.5928‑9.]

Part 4 — Early, absent and provisional voting

[Heading amended in Gazette 10 November 2000 p.6164.]

11. Issue of early ballot papers

(1)An oral application for an early ballot paper is to include a statement of the surname and given name of the applicant and the address for which the applicant is enrolled.

(2)When an oral or written application for an early vote is made to an issuing officer, the issuing officer is to make a record of the name of the applicant and the address for which the applicant is enrolled as specified in the application.

(3)The issuing officer is to —

(a)assign an identifying number to each oral or written application for an early ballot paper at the time it is received; and

(b)record the number on the application in the case of a written application and on the record made under subregulation (2) in the case of an oral application.

(4)Each issuing officer is to forward the records of applications compiled by the issuing officer under subregulation (2) to the Electoral Commissioner at intervals directed by the Electoral Commissioner.

(5)Immediately after 6.00 p.m. on the day preceding the day fixed for polling, each issuing officer is to forward to the Electoral Commissioner —

(a)every record not yet forwarded under subregulation (4); and

(b)a consolidated record of all applications received and early ballot papers issued by the issuing officer.

[Regulation 11 amended in Gazette 10 November 2000 p.6165.]

[12.Repealed in Gazette 18 April 2000 p.1976.]

13. Taking of early ballot papers

Where an envelope containing an early ballot paper is posted or delivered under section 92(4a) of the Act the returning officer or presiding officer, as the case may be, is to deposit the envelope in a sealed ballot box.

[Regulation 13 amended in Gazette 10 November 2000 p.6165.]

14. Taking of absent votes.

(1)Subject to subregulations (2) and (3), the following provisions apply to the taking of absent votes —

(a)an absent vote is not to be cast by an elector at any polling place that is appointed under section 100 of the Act for the district for which the elector is enrolled;

(b)before a person is issued with a ballot paper for the purposes of casting an absent vote —

(i)the person in the presence of an authorised person is to sign a declaration in the form of Form 30 in Schedule 3 declaring that the person is enrolled on the electoral roll for the district claimed and entitled to vote for that district; and

(ii)the authorised person is to attest the signature of that person to the declaration;

(c)the declaration referred to in paragraph (b) is to be attached to the envelope to be used for the purpose of forwarding the ballot paper to the Electoral Commissioner;

(d)the ballot paper issued to an elector for the purposes of absent voting is to contain the particulars relevant to a ballot paper in relation to the district or region in relation to which the vote is proposed to be cast in accordance with the Act, and if necessary these particulars are to be endorsed on the ballot paper by the appropriate officer;

(e)the elector is to indicate his or her vote on the ballot paper in the manner prescribed by section 128 of the Act, fold the ballot paper, put it in the envelope attached to the declaration made by the elector under paragraph (b), and deposit the fastened envelope in a sealed ballot box in use at the polling place at which the vote was cast.

(2)If an elector wishes to vote as an absent voter at a polling place at which there is a copy of the roll for the district for which the elector is enrolled, an issuing officer may dispense with the requirements of subregulation (1)(b) to (e).

(3)If the issuing officer issues a ballot paper to the elector after dispensing with the requirements of subregulation (1)(b) to (e) —

(a)the issuing officer is to make a record in respect of the elector’s name on a copy of the roll referred to in subregulation (2);

(b)the issuing officer is to give the elector an envelope bearing the name of the region or district in respect of which the ballot paper is issued; and

(c)the elector is to indicate his or her vote on the ballot paper in the manner prescribed by section 128 of the Act, fold the ballot paper, put it in the envelope and deposit the fastened envelope in a sealed ballot box in use at the polling place at which the vote was cast.

(4)The record referred to in subregulation (3)(a) may be made by electronic means if that is appropriate in the circumstances.

[Regulation 14 amended in Gazette 10 November 2000 pp.6165‑6.]

15. Taking of provisional votes

The following provisions apply to the taking of provisional votes under sections 119(4a), 122(2) or 122A(1) of the Act —

(a)the declaration required to be made by a person under section 119(4), 122(1) or 122A(1) of the Act is to be in the form of Form 31 in Schedule 3 and is to be signed in the presence of an authorised person who is to attest the signature of the person to the declaration;

(b)the declaration referred to in paragraph (a) is to be attached to the envelope to be used for the purpose of forwarding the ballot paper to the Electoral Commissioner;

(c)the ballot paper issued for the purposes of provisional voting is to contain the particulars relevant to the district or region for which the vote is to be cast, and if necessary those particulars may be endorsed on the ballot paper by the appropriate officer;

(d)the person claiming the provisional vote is to indicate his or her vote on the ballot paper in the manner prescribed by section 128 of the Act, fold the ballot paper, put it in the envelope attached to the declaration made by the person under paragraph (a), and deposit the fastened envelope in a sealed ballot box in use at the polling place where the vote was cast.

[Regulation 15 amended in Gazette 10 November 2000 pp.6166‑7.]

16. Records of early, absent and provisional votes to be made

(1)A presiding officer is to maintain records, in a form approved by the Electoral Commissioner, of —

(a)all early ballot papers received at the polling;

(b)the particulars of every person issued with a ballot paper for absent voting at the polling; and

(c)the particulars of every person issued with a ballot paper for provisional voting at the polling.

(2)At the close of the poll the presiding officer is to forward the records made under subregulation (1) —

(a)to the Returning Officer for the district or region as the case requires; or

(b)if so directed by the Electoral Commissioner or the Returning Officer for the district or region as the case requires, to the Electoral Commissioner,

by any means approved by the Electoral Commissioner.

[Regulation 16 amended in Gazette 10 November 2000 p.6167.]

17. Early, absent and provisional votes to be sorted

(1)At the close of the poll the Assistant Returning Officer or Returning Officer who opens the ballot box is to —

(a)cause the envelopes with early ballot papers, absent votes or provisional votes to be separated from the other ballot papers contained in the ballot boxes; and

(b)cause the envelopes to be sorted into their respective districts or regions.

(2)If the ballot box is opened by an Assistant Returning Officer, the Assistant Returning Officer is to forward the envelopes —

(a)to the Returning Officer for the district or region as the case requires; or

(b)if so directed by the Electoral Commissioner or the Returning Officer for the district or region as the case requires, to the Electoral Commissioner,

by any means approved by the Electoral Commissioner.

[Regulation 17 amended in Gazette 10 November 2000 p.6167.]

18. Returning Officer to forward early, absent and provisional votes and records to Electoral Commissioner

The Returning Officer is to —

(a)compile a consolidated record in a form approved by the Electoral Commissioner of the records made under regulation 16; and

(b)forward the consolidated record to the Electoral Commissioner, together with the envelopes with early ballot papers, absent votes and provisional votes and the records, by any means approved by the Electoral Commissioner.

[Regulation 18 amended in Gazette 10 November 2000 p.6167.]

19. Scrutiny of declarations relating to early ballot papers and counting of votes

(1)The officer concerned with the scrutiny of declarations relating to early ballot papers is to —

(a)open the envelope addressed to the Electoral Commissioner and examine the declaration to ensure that the early ballot paper should not be rejected under section 92(9) of the Act;

(b)if satisfied that the early ballot paper should not be rejected —

(i)make a record of the elector having voted; and

(ii)detach the declaration from the ballot paper envelope, open the ballot paper envelope, remove the ballot paper contained in it and place the ballot paper, without inspection, in a sealed ballot box for the relevant district or region to await counting in accordance with the relevant provisions of this Act;

and

(c)if satisfied that the early ballot paper should be rejected, set the envelope aside for retention by the Electoral Commissioner.

(2)In addition to the duties referred to in subregulation (1), if the early ballot paper was obtained by written application the officer concerned with the scrutiny of declarations relating to early ballot papers is to check the declaration against the application made by the person applying for that early ballot paper.

(3)If a declaration cannot be checked against a written application but the Assistant Returning Officer is satisfied from the record of applications for early ballot papers that the early ballot paper was obtained by written application, the Assistant Returning Officer is to allow the declaration to be dealt with under subregulation (1).

(4)If any declarations are scrutinised before the close of the poll, the officer concerned with the scrutiny is to give written notice of the time and place of the scrutiny to —

(a)each registered political party; and

(b)any candidate who is not a recognised candidate of a registered political party.

[Regulation 19 amended in Gazette 10 November 2000 pp.6167‑8.]

20. Scrutiny of declarations relating to absent votes and provisional votes and counting of votes

(1)The officer concerned with the scrutiny of declarations made under section 119(4), 122(1) or 122A(1) of the Act, or regulation 14(1)(b), in relation to absent or provisional votes is to —

(a)examine the declaration to ensure it is signed by the person claiming to vote and witnessed by the authorised person;

(b)examine the roll to ensure that the name of the person claiming to vote is enrolled;

(c)if the name is on the roll —

(i)make a record of the elector having voted; and

(ii)detach the declaration from the ballot paper envelope, remove the ballot paper contained in it and place the ballot paper, without inspection, in a sealed ballot box for the relevant district or region to await counting in accordance with the relevant provisions of this Act;

and

(d)if the name is not on the roll, set the envelope aside for retention by the Electoral Commissioner.

(2)Where a declaration relating to an absent or provisional vote is not signed by the authorised person, the officer conducting the scrutiny of the declarations is not to reject the ballot paper for that reason alone.

(3)An Assistant Returning Officer who is counting absent voters’ ballot papers in accordance with the relevant provisions of this Act is to open any ballot paper envelope referred to in regulation 14(3)(b), remove the ballot paper contained in it and count the ballot paper.

[Regulation 20 amended in Gazette 10 November 2000 pp.6168‑9.]

21. Rejection of early, absent and provisional votes

[(1)repealed]

(2)Where a ballot paper in a ballot paper envelope is not the ballot paper for the district or region in relation to which the ballot paper was cast the ballot paper is to be rejected.

[Regulation 21 amended in Gazette 10 November 2000 p.6169.]

Part 5 — Miscellaneous

22. Enrolment procedure

(1)A person entitled to enrolment as an elector is to fill in, sign and send to the Electoral Commissioner a claim in the form of Form 2 in Schedule 3.

(2)Where it appears to the Electoral Commissioner that the name of a person who is qualified to be enrolled as an elector on a roll under this Act is not so enrolled the Electoral Commissioner is to —

(a)notify that person in writing that —

(i)that person is required to fill in, sign and send to the Electoral Commissioner, within the period specified in the notice, a claim for enrolment in accordance with section 45 of the Act;

(ii)no claim or notice in writing for enrolment in respect of that person’s present address has been received by the Electoral Commissioner or on the Electoral Commissioner’s behalf subsequently to the last known date of the breach of section 45(1) or (2) of the Act;

(iii)a penalty (not exceeding $20) has been imposed by the Electoral Commissioner for the apparent breach and advising that upon payment of the penalty and lodgement of a claim or notice in writing by that person within a specified time no further action in respect of the breach will be taken; and

(iv)should the penalty not be paid and a claim or notice in writing for enrolment not be lodged with or on behalf of the Electoral Commissioner within the specified time, the Electoral Commissioner may institute proceeding before a court of summary jurisdiction for a breach of section 45(1) or (2) of the Act;

and

(b)provide a copy of Form 4 in Schedule 3 to the person and inform the person of his or her rights under subregulation (3).

(3)If a person against whom action has been taken under subregulation (2) believes that he or she is not in breach of section 45(1) or (2) of the Act that person may complete and sign a declaration in accordance with Form 4 within the period specified in the notice under subregulation (2) and return it to the Electoral Commissioner who may then decide to discontinue the action under subregulation (2) or to confirm that action and advise that person accordingly.

(4)No action taken under subregulation (2) against a person prevents any further like action should a breach of section 45(1) or (2) of the Act appear to the Electoral Commissioner to continue on the part of that person.

[Regulation 22 amended in Gazette 10 November 2000 p.6169.]

23. Compulsory voting

A notice sent under section 156(4) of the Act to an elector is to be sent within 3 months after the return of the writ for the election at which the elector appears to have failed to vote.

24. Appointment of scrutineer

The appointment of a scrutineer under section 137 or section 146C of the Act is to be signed by the candidate, or, if the scrutineer is appointed by a group, by any of the candidates in the group, by whom the scrutineer is appointed.

25. Verification of nomination

A nomination by message sent by electronic means under section 156C of the Act is verified —

(a)where the nominating candidate has signed the message, if the Electoral Commissioner is satisfied that the signature by the nominating candidate on the message is the same signature as that of that person on the form on which that person nominated as a candidate in the most recent election in the region; or

(b)where the nominating candidate has not signed the message, if the Electoral Commissioner has been orally advised by the nominating candidate that that person was the person who sent the electronic message.

26. Declaration on a re-count

When on a re-count under section 156D(8) of the Act a consenting candidate is elected the Electoral Commissioner shall, before all persons then present, declare that consenting candidate to be elected as a member of the Council to fill the vacancy.

27. Prescribed officer under section 162(1)(ca)

Any officer employed in the department referred to in section 4A of the Act is a prescribed officer for the purpose of section 162(1)(ca) of the Act.

28. Public employees standing for election

(1)In this regulation, unless the contrary intention appears —

“election” means a Legislative Council election or Legislative Assembly election;

“election period”, in relation to a candidate in an election, means the period commencing when the nomination of that candidate is lodged and ending when —

(a)that nomination is withdrawn;

(b)that candidate or another candidate is declared elected to the Legislative Council or Legislative Assembly, as the case may be; or

(c)the Electoral Commissioner, during the counting of the votes, certifies under subregulation (2) that the candidate has no prospect of being elected,

whichever occurs first;

“member” in relation to a prescribed body means —

(a)any member of the body whether known as a member, commissioner, councillor, trustee, director or by any other title;

(b)any deputy, alternate or acting member of the body,

and includes a person holding the office of chairman or president or any other office of the body;

“prescribed body” means a commission, council, board, committee or other body mentioned in Part 3 of Schedule V to the Constitution Acts Amendment Act 1899;

“public employee” means a person who holds any office or place mentioned in Part 2 of Schedule V to the Constitution Acts Amendment Act 1899.

(2)The Electoral Commissioner may during the counting of the votes certify that a candidate has no prospect of being elected.

(3)A public employee who nominates as a candidate in an election is to take leave of absence from employment as a public employee, such leave to commence not later than the working day next following the day on which the election period commences and to end not earlier than the day on which the election period ends or, if that day is not a working day, the working day next preceding that day.

(4)Notwithstanding anything contained in the Act under which a public employee is appointed or employed —

(a)the employee is by this regulation authorised to apply for and take; and

(b)the employer of the employee is by this regulation authorised to grant,

leave of absence that is required to be taken under subregulation (3).

(5)Leave of absence taken by a public employee under subregulation (3) is to be taken without pay except to the extent that the employee has an accrued entitlement to, and applies for, leave with pay.

(6)A member of a prescribed body who nominates as a candidate in an election is not at any time during the election period to attend any meeting of the body, or perform any function or duty as a member of the body, or receive any salary, fees, allowances, expenses or other remuneration as a member of the body.

(7)The inability of a member of a prescribed body to —

(a)attend a meeting of the body; or

(b)perform a function or duty as a member of the body,

without contravening subregulation (6) is sufficient cause for a duly appointed or elected deputy as alternate of that member to attend the meeting or perform the duty or function, as the case may require.

(8)Where a member of a prescribed body —

(a)is absent from a meeting of the body; or

(b)fails to perform a function or duty as a member of the body,

in compliance with subregulation (6), that absence or failure is to be disregarded for the purposes of any enactment under which the member may vacate or be removed from office as a member by reason of absence from meetings or neglect of duty.

[Regulation 28 amended in Gazette 8 November 1996 p.6267; 20 October 2000 p.5929.]

29. Transmission and destruction of records

(1)When transmitting documents to the Clerk of the Council or the Clerk of the Assembly under section 151 of the Act, the Returning Officer is to transmit a copy, in a written form, of any electronic record made for the purposes of these regulations that would have been required to be so transmitted if it had been made in a written form.

(2)Section 155 of the Act applies to a record made under these regulations as if the record were a document for the purposes of that section.

29A.Articles that can be used for electoral advertising

The following classes of articles are prescribed for the purposes of section 187(2)(d) of the Act —

(a)articles of apparel;

(b)articles in the nature of dress or personal accessories.

[Regulation 29A inserted in Gazette 10 November 2000 p.6170.]

[30.Omitted under the Reprints Act 1984 s.7(4)(f).]

[Schedule 1 repealed in Gazette 20 October 2000 p.5929.]

Schedule 2

Form 1

[Regulation 6(1)]

Western Australia

Electoral Act 1907 (s.15A)

DECLARATION BY OFFICER

I, ............................................................................................................................,

of ............................................................................................................................

declare that —

1. I accept the office of ...................................................................................;

2. I will faithfully and impartially perform the duties of my office to the best of my understanding and ability; and

3. I have no active or official connection with —

(a)any political party;

(b)any election or campaign committee; or

(c)any person who has nominated as a candidate for an election in a district or region in, or respect of which, I will be carrying out my duties,

and I will immediately notify the Electoral Commissioner if such a connection arises.

.......................................................................

Signature of officer

Declared before me on ...............................................

Date

.....................................................................................

Signature of witness

.....................................................................................

Name of witness

[A declaration by the Electoral Commissioner, the Deputy Electoral Commissioner, an Acting Electoral Commissioner or a Returning Officer must be witnessed by a Justice of the Peace.

A declaration by any other officer must be witnessed by a person who is, or is qualified to be, an elector at Commonwealth or State elections.]

[Form 2 deleted]

Form 3

[Regulation 6(3)]

Western Australia

Electoral Act 1907 (s.114(3))

DECLARATION BY SCRUTINEER

I, ............................................................ of ............................................................

a scrutineer appointed by ......................................................................................,

a candidate for the ................................................................ District (or Region), at the ......................................................................... Polling Place declare that I will faithfully observe all the provisions of the Electoral Act 1907 which relate to the office of scrutineer.

....................................................................

Signature of scrutineer

Declared before me on ....................................................

Date

.........................................................................................

Returning Officer or presiding officer

Form 4

[Regulation 6(4)]

Western Australia

Electoral Act 1907 (s.104(1))

APPOINTMENT OF PRESIDING OFFICER, ASSISTANT PRESIDING OFFICER, POLL CLERK OR DOORKEEPER

I appoint .................................................................................................................

(full name of appointee)

of ......................................................... to be .........................................................

(position)

at the ............................................................................................... polling place for the election to be held on ..................................................................................

........................................................................................................................

DateReturning Officer

[Schedule 2 amended in Gazette 8 November 1996 p.6268.]

Schedule 3

Form 1

Western Australia

Electoral Act 1907 (s.22)

FORM OF ELECTORAL ROLL

Roll of electors for the .............................................................................. District and that part of the ..................................................................................... Region in that District.

SurnameChristian orResidenceOccupation*Sex*

given names

[* This column may be omitted when rolls are printed under section 24 of the Act, made available under section 25 of the Act, provided under section 25A of the Act or supplied under section 112 of the Act or when information on or derived from rolls is made available under section 25 or provided under section 25A.]

Form 2

Western Australia

Electoral Act 1907 (s.42)

CLAIM FOR ENROLMENT

1	Surname or family name
All Christian or given names

2	Address
		Postcode
		Shire

3	Daytime phone number (if convenient)


4	Postal address
		Postcode

5	Occupation					6	Male o Female o

7	Date of birth	Day Month Year		8	Town of birth

9	Place of birth

10	I am an Australian citizen	NO o YES o ►	If you are an Australian citizen by naturalisation please supply the following details: Date of Citizenship naturalisation Certificate No.
			Day Month Year


11	Former surname or family name
Former Christian or given names

12	Former address
		Postcode

DECLARATION I am eligible to enrol for Western Australian elections. I declare that all the information I have given on this form is true and complete.
Signature or mark of applicant		Date	Day Month Year

WITNESS	I saw the applicant sign this form.

Signature of witness
Name BLOCK LETTERS
Address

Form 3

Western Australia

Electoral Act 1907 (s.44A(3)(a))

NOTICE OF REJECTION OF CLAIM

To ........................................................................................... :

I wish to advise that your claim dated .................................... to have your name placed on the roll for the State Electoral District of .................................. and the related part of the .......................................................... Region does not comply with section 44 of the Electoral Act 1907 for the following reasons:

.................................................................................................................................

Therefore, your claim is rejected.

......................................................................

ENROLMENT OFFICER

......................................................................

Date

Form 4

Western Australia

Electoral Act 1907 (reg.22)

DECLARATION BY A PERSON ALLEGED TO HAVE FAILED TO COMPLY WITH THE COMPULSORY ENROLMENT PROVISIONS OF SECTION 45 OF THE ELECTORAL ACT

I, ............................................................ of ............................................................

....................................................................... declare that* ...................................

.................................................................................................................................

Signed: ..................................................

Date: ..................................................

Declared before me:

............................................................................

An elector or a person qualified to be an

elector for the Commonwealth or the State

............................................................................

Address of witness

* Set out any facts which you believe should be taken into account in dealing with the alleged offence.

Form 5

Western Australia

Electoral Act 1907 (s.47(3)(a))

ENROLMENT OFFICER’S OBJECTION TO CLAIM

To ........................................................................................... :

I refer to your claim dated ....................................... to be enrolled as an elector for the State Electoral District of ................................................. and advise that I believe that you are not entitled to be so enrolled for the following reasons:

.................................................................................................................................

Unless the attached notice of appeal (Form 6) is completed and signed by you and returned to me within .................................. days from the date of this notice, your claim will be rejected.

.........................................................................

ENROLMENT OFFICER

.........................................................................

Date

Form 6

Western Australia

Electoral Act 1907 (s.47(3)(a))

APPEAL AGAINST OBJECTION TO CLAIM

To the Enrolment Officer:

District
Surname
Given names
Residential Address	Street No.		Street Name
	Suburb				Postcode
Phone numbers	(Home)			(Work)
Fax number		E‑mail
I wish to appeal against your objection to my claim for enrolment as an elector for the State Electoral District of ............................................................ for the following reasons: .............................................................................................................................. .............................................................................................................................. .............................................................................................................................. .............................................................................................................................. .............................................................................................................................. .............................................................................................................................. .............................................................................................................................. .............................................................................................................................. ..............................................................................................................................
Signature of Claimant					Date

Form 7

Western Australia

Electoral Act 1907 (s.48(2)(a))

ELECTOR’S OBJECTION TO ENROLMENT

To the Electoral Commissioner:

District
Surname
Given names
Residential Address	Street No.		Street Name
	Suburb				Postcode
Phone numbers	(Home)			(Work)
Fax number		E‑mail
I wish to object to the name of ............................................................ being on the roll for the State Electoral District of ............................................................ for the following reasons: .............................................................................................................................. .............................................................................................................................. .............................................................................................................................. .............................................................................................................................. .............................................................................................................................. .............................................................................................................................. .............................................................................................................................. .............................................................................................................................. .............................................................................................................................. I enclose a deposit of $2.00
Signature of Objector					Date

Form 8

Western Australia

Electoral Act 1907 (s.48(3)(a))

ENROLMENT OFFICER’S OBJECTION TO ENROLMENT

To: ........................................................................................... :

You are currently enrolled on the State Electoral roll for the State Electoral District of ................................... . However, your enrolment is objected to because I have the following reasons for believing that your name should not be retained on the roll:

.................................................................................................................................

Unless the attached notice of appeal (Form 9) is completed and signed by you and returned to me within .................................... days of the date of this notice, your name will be removed from the State Electoral Roll.

.........................................................................

ENROLMENT OFFICER

.........................................................................

Date

Form 9

Western Australia

Electoral Act 1907 (s.48(3)(a))

NOTICE OF APPEAL AGAINST ENROLMENT OFFICER’S OBJECTION TO ENROLMENT

To the Enrolment Officer:

District
Surname
Given names
Residential Address	Street No.		Street Name
	Suburb				Postcode
Phone numbers	(Home)			(Work)
Fax number		E‑mail
I wish to appeal against your objection to the retention of my name on the roll for the State Electoral District of ............................................................ for the following reasons: ......................................................................................................................... ......................................................................................................................... ......................................................................................................................... ......................................................................................................................... ......................................................................................................................... ......................................................................................................................... ......................................................................................................................... ......................................................................................................................... .........................................................................................................................
Signature of Elector						Date

Form 10

Western Australia

Electoral Act 1907 (s.51B(1), (2))

REQUEST BY AN ELECTOR FOR ADDRESS NOT TO BE SHOWN ON ELECTORAL ROLL

Please do not show my address on the electoral roll

1	SURNAME or FAMILY NAME ................ ALL CHRISTIAN or GIVEN NAMES .......
2	RESIDENTIAL ADDRESS ........................
3	DAYTIME PHONE NUMBER for contact (if convenient) ............................................
4	POSTAL ADDRESS .................................. If this address is the same as shown at 2, print “AS ABOVE”	Postcode
5	OCCUPATION ..........................................
6	SEX .............................................................	o Male o Female
7	DATE OF BIRTH ......................................	Day Month Year
8	I REQUEST THAT MY ADDRESS .......... (Please tick the appropriate box) NOTE: A statutory declaration must be completed attesting to the existence of the risk(s) claimed and forwarded with this application. That declaration may be made by the elector or some other person able to attest to the facts.	(a) onot be entered on the electoral roll. An Electoral Enrolment Form claiming enrolment for my address is attached; OR (b) obe removed from the electoral roll.
		Having my address shown on the electoral roll places the personal safety of myself or members of my family at personal risk.

9	I ALSO REQUEST THAT MY NAME BE OMITTED WHEN THE ROLL OR INFORMATION ON THE ROLL IS MADE AVAILABLE FOR INSPECTION OR PURCHASE BY THE PUBLIC UNDER SECTION 25 OF THE ACT (Tick the box if required)	o

10 0	I ALSO APPLY TO BE REGISTERED AS A GENERAL EARLY VOTER UNDER SECTION 93 OF THE ACT (Tick the box if required)	o
		..................................................................... Signature or mark of applicant (Not required if applicant makes the declaration below. Please ensure that the declaration is made before this application is sent to the Electoral Commissioner)

Statutory declaration as to risk I solemnly and sincerely declare that the risk referred to in 8 above is as follows: ................................................................................................................................................ ................................................................................................................................................ ................................................................................................................................................ ................................................................................................................................................ And I make this declaration by virtue of section 106 of the Evidence Act 1906. ................................................................ Signature of declarant Declared at .................................................................................................... this ..................... day of .............................................................................................................before me ................................................................... Commissioner for Declarations Justice of the Peace Police Officer or other person authorised by the Declarations and Attestations Act 1913

Form 11

Western Australia

Electoral Act 1907 (s.56(a))

NOTIFICATION OF DEATHS OF PERSONS NOT UNDER 17

FOR MONTH OF ...................................

Surname .................................................................................................................

Given name ............................................................................................................

Date of birth ...........................................................................................................

Late address ...........................................................................................................

Age and sex ...........................................................................................................

Date of death .........................................................................................................

Late occupation......................................................................................................

(repeated as necessary)

..............................................................

Registrar General

___________________

[Forms 12 and 13 deleted]

Form 14

Western Australia

Electoral Act 1907 (s.59(a))

PERSONS OF THE KIND REFERRED TO IN

SECTION 18(c)(i)‑(vi) DETAINED IN CUSTODY

To the Electoral Commissioner

List of persons of the age of 17 years or over who are attainted of treason, are under sentence or sentences of imprisonment of or totalling one year or longer, or are subject to an order, direction or sentence, as the case may be, to be detained or kept in my custody under section 19(6a), 631, 652, 653, 693(4), 661 or 662 of The Criminal Code and received by me during the 3 months ended ......................................................................................................................

Surname

Christian or

Given Names

Date of

Birth

Sex

Address Occupation

Immediately Prior to

Admission

..........................................................................................................................

Date Chief Executive Officer,

Ministry of Justice

Form 15

Western Australia

Electoral Act 1907 (s.59(b))

LIST OF NAMES OF MENTALLY IMPAIRED DEFENDANTS

To the Electoral Commissioner

Western Australian Electoral Commission

In accordance with the requirements of section 59(b) of the Electoral Act 1907 the following is a list of persons who became mentally impaired defendants (as defined in part 5 of the Criminal Law (Mentally Impaired Defendants) Act 1996) during the 3 months ended on the ............./............/.............

Date Became Mentally Impaired Defendant	Particulars of Persons
Date Became Mentally Impaired Defendant	Full Name	Date of Birth	Sex	Former Address	Former Occupation

Dated this ........................ day of ...........................................................................

..............................................................................

Secretary

Mentally Impaired Defendants

Review Board

Form 16

Western Australia

Electoral Act 1907 (ss.64(1) and 69)

WRIT

Writ for elections in all the electoral districts to elect members of the Legislative Assembly

To the Electoral Commissioner:

I direct you to proceed with elections in all the electoral districts to elect one member of the Legislative Assembly for each district.

I fix the following days for the purposes of each of those elections:

Last day for the nomination of candidates:

............... day, .......................................................... 20..........

Polling day:

Saturday, .................................................................. 20..........

Last day for the return of the writ:

............... day, ........................................................... 20..........

Dated ..................................... 20..................................................................

Governor

(Reverse)

Certificate

I certify that the results of the elections held under this writ were as follows:

Electoral districtElected candidateDate of declaration

................................................................................................................

[continue for each district]

Dated ........................................... 20 ............................................................

Electoral Commissioner

Form 17

Western Australia

Electoral Act 1907 (ss.64(2) and 69)

WRIT

Writ for elections in all the electoral regions to elect members of the Legislative Council

To the Electoral Commissioner:

I direct you to proceed with elections in all the electoral regions to elect:

(a)7 members of the Legislative Council for each of the electoral regions known, respectively, as the North Metropolitan Region and the South West Region; and

(b)5 members of the Legislative Council for each of the electoral regions known, respectively, as the South Metropolitan Region, the East Metropolitan Region, the Agricultural Region and the Mining and Pastoral Region.

I fix the following days for the purposes of each of those elections:

Last day for the nomination of candidates:

............... day, .......................................................... 20..........

Polling day:

Saturday, ................................................................. 20..........

Last day for the return of the writ:

............... day, .......................................................... 20..........

Dated .......................................... 20 ............................................................

Governor

(Reverse)

Certificate

I certify that the results of the elections held under this writ were as follows:

Electoral regionElected candidatesDate of declaration

.................................................................................................................

........................................

[continue for each region]

Dated ........................................ 20 .............................................................

Electoral Commissioner

Form 18

Western Australia

Electoral Act 1907 (ss.67(1) and 69)

WRIT

Writ for an election in an electoral district to elect a member of the Legislative Assembly to fill a vacancy in accordance with a resolution of that House

To the Electoral Commissioner:

I, ..............................................., the Speaker of the Legislative Assembly, acting upon a resolution passed by the Legislative Assembly under section 67(1) of the Electoral Act 1907 on .................................. 20......, direct you to proceed with an election in the ......................................... electoral district to elect a member of the Legislative Assembly for that district.

I fix the following days for the purposes of that election:

Last day for the nomination of candidates:

............... day, .......................................................... 20..........

Polling day:

Saturday, ................................................................. 20..........

Last day for the return of the writ:

............... day, .......................................................... 20..........

Dated ......................................................................................................

Speaker

(Reverse)

Certificate

I certify that the result of the election held under this writ was as follows:

Elected candidateDate of declaration

........................................................................

Dated .......................................... 20 ..............................................................

Electoral Commissioner

Form 19

Western Australia

Electoral Act 1907 (ss.67(2) and 69)

WRIT

Writ for an election in an electoral district to elect a member of the Legislative Assembly to fill a vacancy as directed by the Speaker

To the Electoral Commissioner:

I, ..............................................., the Speaker of the Legislative Assembly, acting under section 67(2) of the Electoral Act 1907, direct you to proceed to supply with an election in the ................................................ electoral district to elect a member of the Legislative Assembly for that district.

I fix the following days for the purposes of that election:

Last day for the nomination of candidates:

............... day, .......................................................... 20..........

Polling day:

Saturday, ................................................................. 20..........

Last day for the return of the writ:

............... day, .......................................................... 20..........

Dated .......................................... 20 ..............................................................

Speaker

(Reverse)

Certificate

I certify that the result of the election held under this writ was as follows:

Elected candidateDate of declaration

........................................................................

Dated .......................................... 20 ..............................................................

Electoral Commissioner

Form 20

Western Australia

Electoral Act 1907 (ss.67(3) and 69)

WRIT

Writ for an election in an electoral district to elect a member of the Legislative Assembly to fill a vacancy if there is no Speaker or the Speaker is absent

To the Electoral Commissioner:

I direct you to proceed with an election in the ........................................ electoral district to elect a member of the Legislative Assembly for that district.

I fix the following days for the purposes of that election:

Last day for the nomination of candidates:

............... day, .................................................... 20..........

Polling day:

Saturday, ........................................................... 20..........

Last day for the return of the writ:

............... day, ................................................... 20..........

Dated ........................................................................................................

Governor

(Reverse)

Certificate

I certify that the result of the election held under this writ was as follows:

Elected candidateDate of declaration

........................................................................

Dated ...................................... 20 ..............................................................

Electoral Commissioner

Form 21

Western Australia

Electoral Act 1907 (ss.156E and 69)

WRIT

Writ for an election in an electoral region to elect a member of the Legislative Council to fill a vacancy

To the Electoral Commissioner:

I direct you to proceed with an election in the ........................................ electoral region to elect a member of the Legislative Council for that region.

I fix the following days for the purposes of that election:

Last day for the nomination of candidates:

............... day, .......................................................... 20..........

Polling day:

Saturday, ................................................................. 20..........

Last day for the return of the writ:

............... day, .......................................................... 20..........

Dated ...................................... 20 ..............................................................

Governor

(Reverse)

Certificate

I certify that the result of the election held under this writ was as follows:

Elected candidateDate of declaration

........................................................................

Dated ...................................... 20 ..............................................................

Electoral Commissioner

Form 22

Western Australia

Electoral Act 1907 (ss.88(2) and 69)

WRIT

Writ for a new election in an electoral district when an election is deemed to have wholly failed under section 88(2)

To the Electoral Commissioner:

I direct that, in place of the election fixed for .................................. 20..........., you proceed with a new election in the ............................................... electoral district to elect a member of the Legislative Assembly for that district.

I fix the following days for the purposes of that election:

Last day for the nomination of candidates:

............... day, .......................................................... 20..........

Polling day:

Saturday, ................................................................ 20..........

Last day for the return of the writ:

............... day, ......................................................... 20........

Dated ...................................... 20 ..............................................................

Governor/Speaker

[as the case requires]

(Reverse)

Certificate

I certify that the result of the election held under this writ was as follows:

Elected candidateDate of declaration

........................................................................

Dated ...................................... 20 ..............................................................

Electoral Commissioner

Form 23

Western Australia

Electoral Act 1907 (ss.88(2) and 69)

WRIT

Writ for a new election in an electoral region when an election is deemed to have wholly failed under section 88(2)

To the Electoral Commissioner:

I direct that, in place of the election fixed for ................................... 20..........., you proceed with a new election in the ............................................... electoral region to elect ........ member(s) of the Legislative Council for that region.

I fix the following days for the purposes of that election:

Last day for the nomination of candidates:

............... day, .......................................................... 20..........

Polling day:

Saturday, ................................................................ 20..........

Last day for the return of the writ:

............... day, ......................................................... 20..........

Dated ...................................... 20 ..............................................................

Governor

(Reverse)

Certificate

I certify that the result of the election held under this writ was as follows:

Elected candidate(s)Date of declaration

........................................................................
[continue as required]

Dated ...................................... 20 ..............................................................

Electoral Commissioner

Form 23A

Western Australia

Electoral Act 1907 (ss.89(1) and 69)

WRIT

Writ for a supplementary election in an electoral district when an election is deemed to have wholly failed under section 89(1)

To the Electoral Commissioner:

I direct that, because of the failure of the election fixed for ................................... 20........., you proceed with a supplementary election in the ............................................... electoral district to elect a member of the Legislative Assembly for that district.

I fix the following days for the purposes of that election:

Last day for the nomination of candidates:

............... day, .......................................................... 20..........

Polling day:

Saturday, ................................................................. 20..........

Last day for the return of the writ:

............... day, .......................................................... 20..........

Dated ...................................... 20 ..............................................................

Governor/Speaker

[as the case requires]

(Reverse)

Certificate

I certify that the result of the election held under this writ was as follows:

Elected candidateDate of declaration

........................................................................

Dated ...................................... 20 ..............................................................

Electoral Commissioner

Form 23B

Western Australia

Electoral Act 1907 (ss.89(1) and 69)

WRIT

Writ for a supplementary election in an electoral region when an election is deemed to have wholly failed under section 89(1)

To the Electoral Commissioner:

I direct that, because of the failure of the election fixed for ................................... 20..........., you proceed with a supplementary election in the ............................................... electoral region to elect ........ member(s) of the Legislative Council for that region.

I fix the following days for the purposes of that election:

Last day for the nomination of candidates:

............... day, .......................................................... 20..........

Polling day:

Saturday, .................................................................. 20..........

Last day for the return of the writ:

............... day, .......................................................... 20........

Dated ...................................... 20 ..............................................................

Governor

(Reverse)

Certificate

I certify that the result of the election held under this writ was as follows:

Elected candidate(s)Date of declaration

........................................................................
[continue as required]

Dated ...................................... 20 ..............................................................

Electoral Commissioner

Form 23C

Western Australia

Electoral Act 1907 (ss.89(2) and 69)

WRIT

Writ for a supplementary election in an electoral region when an election is deemed to have partially failed under section 89(2)

To the Electoral Commissioner:

I direct that, because of the partial failure of the election held on .................................. 20..........., you proceed with a supplementary election in the ............................................... electoral region to elect ........ member(s) of the Legislative Council for that region.

I fix the following days for the purposes of that election:

Last day for the nomination of candidates:

............... day, .......................................................... 20..........

Polling day:

Saturday, ................................................................. 20..........

Last day for the return of the writ:

............... day, .......................................................... 20..........

Dated ...................................... 20 ..............................................................

Governor

(Reverse)

Certificate

I certify that the result of the election held under this writ was as follows:

Elected candidate(s)Date of declaration

........................................................................
[continue as required]

Dated ...................................... 20 ..............................................................

Electoral Commissioner

Form 23D

Western Australia

Electoral Act 1907 (ss.172(1)(c) and 69)

WRIT

Writ for a new election in an electoral district when an election has been declared absolutely void

To the Electoral Commissioner:

I direct that, because of the election held on .................................. 20..........., being declared absolutely void, you proceed with a new election in the ............................................... electoral district to elect a member of the Legislative Assembly for that district.

I fix the following days for the purposes of that election:

Last day for the nomination of candidates:

............... day, .......................................................... 20..........

Polling day:

Saturday, ................................................................ 20..........

Last day for the return of the writ:

............... day, ......................................................... 20..........

Dated ...................................... 20 ..............................................................

Governor/Speaker

[as the case requires]

(Reverse)

Certificate

I certify that the result of the election held under this writ was as follows:

Elected candidateDate of declaration

........................................................................

Dated ...................................... 20 ..............................................................

Electoral Commissioner

Form 23E

Western Australia

Electoral Act 1907 (ss.172(1)(c) and 69)

WRIT

Writ for a new election in an electoral region when an election has been declared absolutely void

To the Electoral Commissioner:

I direct that, because of the election held on .................................. 20..........., being declared absolutely void, you proceed with a new election in the ............................................... electoral region to elect ........ member(s) of the Legislative Council for that region.

I fix the following days for the purposes of that election:

Last day for the nomination of candidates:

............... day, .......................................................... 20..........

Polling day:

Saturday, ................................................................. 20..........

Last day for the return of the writ:

............... day, .......................................................... 20..........

Dated ...................................... 20 ..............................................................

Governor

(Reverse)

Certificate

I certify that the result of the election held under this writ was as follows:

Elected candidate(s)Date of declaration

........................................................................
[continue as required]

Dated ...................................... 20 ..............................................................

Electoral Commissioner

Form 23F

Western Australia

Electoral Act 1907 (s.67(4))

Certificate of death of a member of the Legislative Assembly

To the Governor (or Speaker):

We, the undersigned, being 2 members of the Legislative Assembly, certify that .............................................................., a member of the Legislative Assembly serving for the ................................................. electoral district, died on the ..................................................... 20......, and we give you this notice to the intent that you may cause the writ to be issued for the election of a member to supply the vacancy caused by the death of that member.

Dated: .................................. 20.....................................................

Member for the

.............................................

electoral district

.............................................

Member for the

.............................................

electoral district

[Form 24 deleted]

Form 25

Western Australia

Electoral Act 1907 (s.87A(2))

RETURNING OFFICER’S RECEIPT FOR NOMINATION AND DEPOSIT

I acknowledge receipt of a deposit of $250 cash/bank or other financial institution cheque payable to the Electoral Commissioner* and a nomination paper in respect of ..................................................................................................

(name of candidate)

...................................................................................................................

DateReturning Officer

........................................................

District or Region

* Strike out whichever is not applicable

Form 26

Western Australia

Electoral Act 1907 (s.90)

APPLICATION FOR AN EARLY BALLOT PAPER
ELECTOR TO COMPLETE — PLEASE PRINT CLEARLY IN BLACK INK
SURNAME OR FAMILY NAME
GIVEN NAMES
ADDRESS AS ENROLLED OR FOR WHICH ENROLMENT IS CLAIMED

	Postcode
PHONE NUMBERS	Home		Work
DATE OF BIRTH	/ /

I am an elector for the				District

and am entitled to apply for an early ballot paper. I request that voting material be sent to me at:


Postcode
(If the same as your address as enrolled, print “As above”)
		/ /
Signature or mark of applicant				Date
		/ /
Signature of authorised witness (only if applicant makes a mark)				Date


FOR ISSUING OFFICERS USE ONLY
DATE RECEIVED		NO.
SIGNATURE
PLACE OF ISSUE

Form 27

Western Australia

Electoral Act 1907 (s.90(7))

REJECTION OF WRITTEN APPLICATION FOR EARLY BALLOT PAPER

To ....................................................................................... :

I refer to your application for an early ballot paper for .........................................

.................................................................................................................................

(nature and date of election to be inserted)

Your application has been rejected for the following reasons:

.................................................................................................................................

.........................................................

ISSUING OFFICER

.........................................................

DATE

Form 28

Front of ballot paper envelope flap:
................................................................................................................................

Authorised witness to complete			You MUST fill in your name, address and sign this certificate
FULL NAME		EARLY VOTE – DECLARATION OF ELECTOR Electoral Act 1907 (s.90(4)(c) and (4b)(a), s.92)
		If you need assistance you may appoint an elector to fill in this form and mark the ballot paper. He or she must complete the section overleaf.
ADDRESS		FULL NAME
		ADDRESS AS ENROLLED
SIGNATURE OF WITNESS:	Signed before me on / /	DATE OF BIRTH		/ /
An authorised witness may be anyone over the age of 18 years and must not be a candidate in this election. The person need not be on a Western Australian electoral roll.		I declare that — ·I am the elector on whose application this ballot paper(s) was issued for the election on Saturday / / ; ·I am entitled to apply for an early ballot paper(s); ·I have not already voted at that election; and ·I live at, or have, within the 3 months prior to election day, lived at the above enrolled address.
		SIGNATURE OF ELECTOR			DATE / /
		If the elector is able to sign the Declaration of Elector but is unable to vote without assistance, and no other elector is appointed as an assistant, the elector may request the authorised witness to mark the ballot paper(s) on his/her behalf.

Reverse of ballot paper envelope flap:

.................................................................................................................................................................................

Where an elector requires assistance (and the assistant is not the authorised witness), assistant to complete this section
I have been appointed by the elector to mark the ballot paper or papers on his/her behalf.
NAME OF ASSISTANT
ADDRESS OF ASSISTANT
SIGNATURE OF ASSISTANT
An assistant must not be a candidate in this election and must be on a Western Australian electoral roll.

Form 29

Western Australia

Electoral Act 1907 (s.92(6))

DECLARATION OF AN ELECTOR WHO HAS NOT RECEIVED AN EARLY BALLOT PAPER

I, ........................................................................................................................

(name in full)

of .......................................................................................................................

(address)

declare that I have not received an early ballot paper for which I applied for the election being held on ............................................................... and I now wish to vote personally at this polling place.

...................................................................

Signature of elector

Declared before me on ......................................................................................

(date)

at ....................................... polling place in the .................................. District.

..................................................................

Signature of presiding officer

Form 30

Western Australia

Electoral Act 1907 (s.99A)

[Regulation 14(b)(i)]


	DECLARATION OF ABSENT VOTER

Electoral District of
TO THE ELECTORAL COMMISSIONER I declare that I am the person enrolled as —
Surname

Christian or Given Names

Address (as enrolled, or as claimed to be enrolled)


Date of Birth		/ /

Former Surname or Family Name
for the above electoral district and that I live at, or have, within the 3 months prior to election day, lived at the above enrolled address and am qualified to vote for that district.

Signature of Elector

Signature of (Asst.) Pres. Officer

at Polling Place

Date		/ /

Form 31

Western Australia

Electoral Act 1907 (ss.119(4), 122(1), 122A)

[Regulation 15(a)(i)]

DECLARATION OF PROVISIONAL

VOTER

Electoral

District of

TO THE ELECTORAL COMMISSIONER

Surname

Former Surname or

Family Name

Christian or

Given Names

Address

(as enrolled, or as claimed to be enrolled)

Date of Birth

/ /

Declare that I have claimed to be enrolled and am entitled to be on the roll and to vote for the above electoral district and that I live at, or have, within the 3 months prior to election day, lived at the above address and accordingly claim a vote pursuant to —

TICK APPLICABLE BOX

oSECTION 122A — Name not on roll

oSECTION 122A — Name marked off in error, etc

oSECTION 122(2) — Marked for objection — 47(3)(g)

oSECTION 119(4) — Objection by a Scrutineer — On the grounds that:

...........................................................................................................

Signature of Claimant

Signature of Presiding Officer

Polling Place

Date

/ /

Form 32

Western Australia

Electoral Act 1907 (s.150)

STATISTICAL RETURN

.............................................(District (or Region)) ...........................................(Date of election)

Total
Votes

I certify that this return is correct.

...................................................
Signature of Returning Officer

[This return may be made in a written or electronic form.]

...................................................
Date

[This return may be made in a written or electronic form.]

Ballot papers
rejected as
informal

Total Valid
Votes

Details of count of valid votes

Candidate

Polling
Places

Remote areas

Special
Institutions
and hospitals

Total:

Ordinary
Votes

Postal Votes

Absent Votes

Provisional
Votes

Total

Form 33

Western Australia

Electoral Act 1907 (s.156(6) and (9))

APPARENT FAILURE TO VOTE — (1) PENALTY NOTICE

Name and address of elector:

Electoral district:

Dear elector

It appears from the Electoral Commission’s records that you did not vote at the State election held on .............................................................

The law requires that all electors must vote at State elections. An elector who fails to vote commits an offence unless he or she has a valid and sufficient reason for not voting (such as being out of the State or being seriously ill or injured so as to be unable to go to a polling place).

To resolve this matter please complete the form on the back of this notice and return it to the Electoral Commission in the enclosed envelope before........................................................................................

If you do not return this form by that date you may be prosecuted in court or the matter may be referred to the Fines Enforcement Registry — which may lead to your driver’s licence or vehicle licence being cancelled.

If you did vote you should fill in Part A of the form.

If you have a valid and sufficient reason for having not voted you should fill in Part B of the form.

If you did not vote and you do not have a valid and sufficient reason you may pay a modified penalty of $20(2) and that will be the end of the matter. To do this you should fill in Part C — of the form and send your payment with the form. If you do not pay the modified penalty you may be prosecuted in court or the matter may be referred to the Fines Enforcement Registry — which may lead to your driver’s licence or vehicle licence being cancelled.

This matter cannot be settled by telephone. If you have any more information you wish to give to the Electoral Commission you must put it in writing and send it with this form. You may attach more pages if you need to.

If you (the elector) are unable to fill in this form because your are away from home or are physically incapacitated, another elector may fill it in for you, as long as that other elector has personal knowledge of the facts.

........................................................... ..............................................................

Electoral Commissioner Date

[Back of Form 33]

APPARENT FAILURE TO VOTE — (1) PENALTY NOTICE

Please print your details on this form and tick the appropriate boxes.

Elector’s details

Full name:

Residential address:

Daytime phone number [if convenient]

( )

Fill in Part A OR Part B OR Part C

Part

I did vote at the State election. I voted:

oat ..........................................................................................

(name of polling place)

oby lodging a postal vote

Part

I had a valid and sufficient reason for not voting.

I did not vote because:............................................................................

.................................................................................................................

Part

I did not vote at the State election and I wish to pay the modified penalty of $20(2) to put an end to this matter.

Method of payment:

ocash[if paying in cash please deliver this form to the Electoral Commission in person. Do not send cash through the post]

ocheque or money order made payable to the WA

Electoral Commission

oby credit card

Type of card:............................................

Card number:............................................

Expiry date:............................................

Signature:............................................

[Note: Payment of this penalty fully discharges any liability in relation to your apparent failure to vote. However if your cheque or credit card payment is dishonoured, you will be treated as if you had not paid.]

Signature:

Date:

If you have completed this form on behalf of the elector, please print your full name and daytime telephone number.

Name: Phone: ( )

Making a false or misleading statement in this form is an offence.

Notes

(1)In a notice under section 156(9) of the Act insert “SECOND”.

(2)If this is the elector’s second or subsequent offence replace with “$50”.

Form 34

Western Australia

Electoral Act 1907 (s.156(12))

FAILURE TO VOTE — FINAL NOTICE

Name and address of elector:

Electoral district

Dear elector

Thank you for returning the Penalty Notice in relation to your apparent failure to vote at the State election held on .......................................................................

In that notice (1)

you indicated that you voted at ................................................. . The Electoral Commission has re‑checked it records for that polling place but is still unable to find any record of you having voted.

you indicated that you posted a postal vote on ......................... . The Electoral Commission has re‑checked its records of postal votes for your electoral district but is still unable to find any record of your vote having been received.

you indicated that you did not vote and gave your reason for not doing so.

The Electoral Commissioner has considered your reason but is unable to accept it as a valid and sufficient reason for not voting.

The Electoral Commissioner therefore considers that you have committed an offence by failing to vote without a valid and sufficient reason.

If you wish to avoid this matter being dealt with in court or by the Fines Enforcement Registry you may pay a modified penalty of $20(2) and that will be the end of the matter.

To do this you should fill in the form on the back of this notice and send it and your payment to the Electoral Commission in the enclosed envelope before ............................................

If you (the elector) are unable to fill in this form because you are away from home or are physically incapacitated, another elector may fill it in for you, as long as that other elector has personal knowledge of the facts.

............................................................... ..............................................................

Electoral Commissioner Date

[Back of Form 34]

FAILURE TO VOTE — FINAL NOTICE

Please print your details on this form and tick the appropriate boxes.

Elector’s details

Full name:

Residential address:

Daytime phone number [if convenient]

( )

I did not vote at the State election and I wish to pay the modified penalty of $20(2) to put an end to this matter.

Method of payment:

ocash[if paying in cash please deliver this form to the Electoral Commission in person. Do not send cash through the post]

ocheque or money order made payable to the WA Electoral Commission

oby credit card

Type of card:.............................................................

Card number:.............................................................

Expiry date:.............................................................

Signature:.............................................................

[Note: Payment of this penalty fully discharges any liability in relation to your failure to vote. However if your cheque or credit card payment is dishonoured, you will be treated as if you had not paid.]

Signature:

Date:

If you have completed this form on behalf of the elector, please print your full name and daytime telephone number.

Name: Phone: ( )

Making a false or misleading statement in this form is an offence.

Notes:

(1)Insert text in box applicable to the case.

(2)If this is the elector’s second or subsequent offence replace with “$50”.

Form 35

Western Australia

Electoral Act 1907 (s.156C(1)(a))

NOTIFICATION OF A VACANCY IN THE

LEGISLATIVE COUNCIL

Take notice that a vacancy in the Legislative Council has occurred for the seat in the..................................Region to which the Hon...............................had most recently been elected.

This notice is published under section 156C(1)(a) because —

1. I have been informed of the vacancy by His/Her Excellency the Governor; and

2. I am satisfied that it is practicable to fill the vacancy under sections 156C and 156D of the Electoral Act 1907.

............................................................... .............................................................

Date Electoral Commissioner

.................................................................

Address

Form 36

Western Australia

Electoral Act 1907 (s.156C(5))

NOMINATION TO FILL A VACANCY IN THE LEGISLATIVE COUNCIL UNDER SECTION 156C

To the Electoral Commissioner

I, the undersigned, being a qualified person as defined in section 156A of the Electoral Act 1907, by this notice consent to act as a member of the Legislative Council in the...............................................Region referred to in your notice of.............................................................

Surname..................................................................................................................

Given names ..........................................................................................................

Residence ...............................................................................................................

Occupation .............................................................................................................

Form of name

printed on the ballot paper .....................................................................................

.......................................................... ..............................................................

Signature of witness who Signature of Candidate

must be an elector

.....................................................................

Date

Form 37

Western Australia

Electoral Act 1907 (s.113(4)(a))

WATERMARK

elect

[Schedule 3 amended in Gazette 8 November 1996 pp.6269‑77; 6 December 1996 pp.6723‑4; 12 December 1997 p.7259; 20 November 1998 p.6265; 20 October 2000 pp.5929‑48; 10 November 2000 pp.6170‑80.]

Notes

1This is a compilation of the Electoral Regulations 1996 and includes the amendments referred to in the following Table.

Compilation table

Citation	Gazettal	Commencement
Electoral Regulations 1996	10 Oct 1996 pp.5321-91	10 Oct 1996
Electoral Amendment Regulations 1996	8 Nov 1996 pp.6267-77	9 Nov 1996 (see regulation 2 and Gazette 8 Nov 1996 p.6265)
Electoral Amendment Regulations (No. 2) 1996	6 Dec 1996 pp.6723-4	6 Dec 1996
Electoral Amendment Regulations 1997	12 Dec 1997 p.7259	12 Dec 1997
Electoral Amendment Regulations 1998	20 Nov 1998 pp.6264-5	1 Dec 1998 (see regulation 2)
Electoral Amendment Regulations 2000	18 Apr 2000 p.1976	18 Apr 2000
Electoral Amendment Regulations (No. 2) 2000	20 Oct 2000 pp.5925-48	21 Oct 2000 (see regulation 2 and Gazette 20 Oct 2000 p.5899)
Electoral Amendment Regulations (No. 3) 2000	10 Nov 2000 pp.6163-80	11 Nov 2000 (see regulation 2 and Gazette 10 Nov 2000 p.6193 )