We, the undersigned, confirm that we are members of [ ] and confirm that we are currently registered to vote locally at the address given and give consent for the Council to verify this. Address where registered to No Name (PRINTED) Postcode Signature vote (PRINTED) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
We, the undersigned, confirm that we are members of [ ] and confirm that we are currently registered to vote locally at the address given and give consent for the Council to verify this. No Name (PRINTED) Address where registered to vote (PRINTED) Postcode Signature 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21