Election in the............................................................constituency.F1 or district electoral area.

Date of publication of notice of election............................................................

Name of candidate ............................................................

I solemnly and sincerely declare as follows:—

1. I am the person named above as a candidate at this election [and was my own election agent] or I was at this election the election agent of the person named above as a candidate.

2. I have examined the return of election expenses [about to be]transmittedF2 (or at a local election, delivered) by my election agent [by me] to the returning officer, of which a copy is now shown to me and marked , and to the best of my knowledge and belief it is a complete and correct return as required by law.

3. To the best of my knowledge and belief, all expenses shown in the return as paid were paid by my election agent [by me], except as otherwise stated F3. . . .

F4. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  Signature of declarant............................................................

F5. . .

F5. . .

F5. . .

F5. . .

(NOTE.— Where there has been a change of election agent, suitable variations may be introduced into the declaration as to expenses.