Application for Personal Security Protection
FORM 8A
Subsection [34]
APPLICATION FOR PERSONAL SECURITY PROTECTION
|Municipality / School Division: ___________________________________________________ |
|1. Name: |2. Telephone: |
|3. Address: |4. Postal Code: |
I declare that I am making this application for reasons of personal security and that:
• I am a Canadian citizen;
• I am at least 18 years of age on or before election day:
• I have resided in the municipality for six months prior to election day; OR I am a registered owner of land in the municipality;
• I am not otherwise disqualified by law from voting;
• for reasons of personal security I wish to have my personal information omitted; or obscured from the voters list and from any other records prepared under The Municipal Councils and School Boards Elections Act.
______________________________________________ ________________________
Signature of Applicant Date
Applicants are required to provide proof of identity by providing:
a) an official document issued by a federal, provincial or municipal government that contains the person’s name, address and photograph. (example: driver’s license or passport); or
b) at least two other documents that provide evidence of the person.
______________________________________________ ________________________
Signature of Senior Election Official Date
To be retained by the SEO in a sealed envelope.
-----------------------
Office Use: (Check √ )
□ Required official identification provided (photocopies accepted)
□ Personal Security Certificate given to voter
Voter ID number: Electoral Division (ED) Code __________
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