N.I.ELECTION OF DISTRICT COUNCILLORS
I ( name in full) ................................................................................
of ( home address in full ....................................................................................................
hereby consent to my nomination as a candidate for election as councillor for the........................................ district electoral area in the district of ........................................
I declare that I have attained the age of 21 years and that I am a Commonwealth citizen or[F1, citizen of the Republic of Ireland or a citizen of another Member State of the European Community] and—
F1SI 1995/1948
| *Delete whichever is inappropriate | * (a) I am a local elector for the district of the council; or | |
| * (b) during the whole of the period of twelve months preceding the day of the poll:— | ||
| ....................* (i) I have occupied as owner or tenant land in that district, or | ||
| ....................* (ii) resided in that district; or | ||
| * (c) my principal or only place of work during that twelve months has been in that district. | ||
I further declare that to the best of my knowledge and belief I am not disqualified for being elected by reason of any disqualification contained in section 4 of the Local Government Act (Northern Ireland) 1972, a copy of which is printed overleaf.
[F2I declare that, if elected, I will not by word or deed express support for or approval of—
(a)any organisation that is for the time being a proscribed organisation specified in Schedule 2 to the Northern Ireland (Emergency Provisions) Act 1978; or
(b)acts of terrorism (that is to say, violence for political ends) connected with the affairs of Northern Ireland.]
Signed ........................................
Date ........................................
Signed in my presence
Signature of witness ................................................................................
Name and address................................................................................
of witness (in................................................................................
CAPITAL LETTERS)................................................................................