Signature or mark ... have a serious illness, a disability or are in an advanced state of pregnancy, or ... By applying
POSTAL VOTE / ELECTORAL VISITOR VOTE APPLICATION Applications must be received by 7pm on the Wednesday before Polling Day. Ballot material is not available until after candidate nominations close. Completed applications can be emailed
[email protected], faxed (07) 3036 5778, or posted to GPO Box 1393 BRISBANE QLD 4001.
By applying online or by phone for a postal vote you will not be required to complete this form.
www
ecq.qld.gov.au
1300 881 665
This form must be completed for an Electoral Visitor Vote.
Please tick (
) 1 only
Voter details
Electoral Visitor Vote
Postal Vote
Name Surname
Given Names
Date of birth
Former name
/
Contact No.
/
Enrolled address
Postcode ?
Delivery details (if different from enrolled address)
! Ballot material cannot be emailed or faxed.
Postcode
Electoral Visitor Votes only Please tick (
) the
reason you qualify for an Electoral Visitor Vote below:
have a serious illness, a disability or are in an advanced state of pregnancy, or are caring for a person who is ill, has a disability or is in an advanced stage of pregnancy. If you qualify, a Polling Official will attend your address during normal business hours to allow you to cast your vote. If you do not qualify, ballot material will be posted to you.
Signature or mark Your signature or mark
A person granted Power of Attorney cannot sign this application in that capacity.
Signature of witness confirming your identity
Only if applicant cannot sign and makes a mark. Any adult can witness the mark.
Form 12
