Electoral Regulations 1996

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 —

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 1 inserted: Gazette 8 Nov 1996 p. 6268; amended: SL 2022/195 r. 18(1).]

[Form 2 deleted: Gazette 8 Nov 1996 p. 6268.]

[Forms 3 and 4 deleted: SL 2024/124 r. 46.]