Dear Sir/Madam Register of Electors

Customer & Workforce Services Bev Messinger Director of Customer & Workforce Services Council House Earl Street Coventry CV1 5RR

Please contact Electoral services Direct line 024 7683 3034 Fax 024 7683 3204 Electoral.services@coventry.gov.uk

Please find attached a Voter Registration form. You can only vote in elections if your name is on the register of electors. We update the register every autumn, but we can also add names throughout the year. All you have to do is fill in this form. Who can register to vote? Anyone aged 16 or over (but you cannot vote until you are 18) Citizens of the Republic of Ireland and other European Union member states British & qualifying Commonwealth citizens* (* Qualifying Commonwealth citizens means Commonwealth citizens who have leave to enter or remain in the UK, or do not require such leave)

When you send us your form we will add you to our list of new applications and confirm this in writing to you. Any elector can then object to your name being added to the register. If this happens we will write to you. If your application is not objected to, we will update your registration in accordance with the schedule overleaf. We will also tell the Electoral Registration Officer for your old address that you have moved, so that your name can be removed from that register. People who live at two homes (including students) are allowed to register at both. If you do not want to be removed from your other address, please explain why on your form. The edited register is available for general sale and can be used for any purpose. The edited register can be bought by any person, company or commercial organisation and can be used for commercial activities such as marketing. If you want to opt out of having your details appear on the edited register, please tick the box on the form. There are special rules about names being added to the voters list during an election period. Because of these, you may not be able to vote at that election if you are added during this time.

If we get your form on or before Monday 12 December Tuesday 10 January 2012 Wednesday 8 February 2012 Friday 9 March 2012 Wednesday 18 April 2012 Thursday 10 May 2012 Friday 8 June 2012

Your details will be changed on Tuesday 3 January 2012 Wednesday 1 February 2012 Thursday 1 March 2012 Monday 2 April 2012 Thursday 26 April 2012 Friday 1 June 2012 Monday 2 July 2012

Forms received between 9 June and 7 September (during annual update of Electoral Register) will not be added until the new Register is published on 16 October 2012 If you have any further queries please contact a member of staff who will be pleased to assist you.

Yours faithfully

For the Electoral Registration Officer.

For Office Use

Polling District

Your Name
Surname Date of Birth / /

Voter Registration Form

First Names (in full)

Please complete ONE form for each person applying. If you require more forms, please photocopy this form or contact the Electoral Registration Officer for more. Please use CAPITAL LETTERS

Nationality Please state your nationality If you are 16 or 17 please give Jury Service : 70 or over - please tick box Aged 69 Please give date of birth / /

Your Current Address

I apply to be registered at the following address, at which I am now living. I moved in on : / /

Your Former Address

I was living at the following address. I no longer live there.

Post Code Local Council for your old address (if known) We will tell the Electoral Registration Officer for your previous address that you have moved, so that your name can be removed from that register. If you do not want to be taken off that register, please explain why:

Which Register

(see accompanying letter for further details) Tick box if appropriate

I apply for my name to be excluded from the edited register

Postal Vote
If you would like us to send you an application form, please tick box

Your Signature

Each person has to sign his or her form. If it is not signed, the form will be sent back to you. It is an offence to make a false statement on this form; the maximum fine is 5,000.

As far as I know the details on this form are true and accurate (please tick box to confirm) I have read the accompanying letter and I am eligible to register (please tick box to confirm) Signed: Dated: Please provide the following information so that we can contact you if there is something that is not declared on this form. This information is not essential and will not be disclosed to anyone. Daytime phone number e-mail address:

Please return this form to : Electoral Services, Council House, Earl Street, Coventry, CV1 5RR Tel; 02476 833034; Fax 02476 833204