The National Assembly for Wales Referendum (Assembly Act Provisions) (Referendum Question, Date of Referendum Etc.) Order 2010

Article 28

SCHEDULE 6 APPENDIX OF FORMS

Note : Subject to article 28(2), the forms contained in this appendix may be adapted in accordance with article 28(1).

Form A	Form of Proxy paper	86
Form B	Form of Postal voting statement	89
Form C	Statement as to postal ballot papers	93
Form D	Form of ballot paper	98
Form E	Form of corresponding number list	102
Form F	Elector’s form of poll card	103
Form G	Proxy’s form of poll card	106
Form H	Postal voter’s form of poll card	109
Form I	Postal proxy voter’s form of poll card	112
Form J	Form of corresponding number list for use by presiding officers	116
Form K	Form of direction for the guidance of voters in voting	117
Form L	Form of certificate of employment	118
Form M	Form of declaration to be made by the companion of a voter with disabilities	119
Form N	Form of certificate by Counting Officer under section 128(5) of the Political Parties, Elections and Referendums Act 2000	120
Form O	Form of certificate by Chief Counting Officer under section 128(6) of the Political Parties, Elections and Referendums Act 2000	121

Paragraph 5(9) of Schedule 1

Form A: Form of proxy paper

Paragraph 1(2) of Schedule 2 and Rule 12 (1)(b) of Schedule 3

Form B: Form of postal voting statement

Paragraph 27(1)(b) of Schedule 2

Form C: Statement as to postal ballot papers

Rule 6(2) of Schedule 3

Form D: Form of ballot paper

Rule 7(2) of Schedule 3

Form E: Form of corresponding number list

Rule 15(5) of Schedule 3

Form F: Elector’s form of poll card

Rule 15(6) of Schedule 3

Form G: Proxy’s form of poll card

Rule 15(7) of Schedule 3

Form H: Postal voter’s form of poll card

Rule 15(8) of Schedule 3

Form I: Postal proxy voter’s form of poll card

Rule 16(3)(d) of Schedule 3

Form J: Form of corresponding number list for use by presiding officers in polling stations

Rule 16(14) of Schedule 3

Form K: Form of directions for the guidance of voters in voting

Rule 20(6) of Schedule 3

Form L: Form of certificate of employment

Rule 27(6)(a) of Schedule 3

Form M: Form of declaration to be made by the companion of a voter with disabilities

Rule 39(1)(a) of Schedule 3

Form N: Form of certificate by Counting Officer under section 128(5) of the Political Parties, Elections and Referendums Act 2000

Rule 40(1) of Schedule 3

Form O: Form of certificate by Chief Counting Officer under section 128(6) of the Political Parties, Elections and Referendums Act 2000