Form No. 16.

 

Consecutive
number
given sach
voter as he
applies for
ballot

 

 

POLL BOOK.
. Particulars of persons applying
Particulars of Voter for Ballot papers after another
| person has voted as such person
| — -
| Form , |
| | Consecu- ; number (a) ' (b) | Consecu-
. | ») | tive No. | of oaths tive No. {
None ot | Oceupa- Postal | of voter | if any | Reeord that | Record that | Name , of voter ere thet
| . +2 ° | on list voter is | oath sworn | voter had | on list of ,
| ot voters. required | or refused | voted | voters

 

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(b) When Ballot put into Ballot Box insert ‘‘ voted ”.

 

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: (a) if swort insert “sworn . and number of the Oath : “if refused ingert “ refused to be sworn’.

 

 

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SECTION 67 (4).

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tions if
Remarks

 

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