Form 2
Notification of Change of Registered Particulars
(Section 10A)
After you have completed and printed this application form, sign and forward it to the Parliamentary Registry Office by fax at 292-0207 or via mail to P.O. Box HM 3272, Hamilton HM PX or by hand to #60 Reid Street, Hamilton.
Surname
Maiden Name
Forename(s) (state your full name)
I,
House/Building Name
Apartment # or Name
House/Street #
of,
Road/Street Name
  
Parish
Postal Code
Assessment #
 
(state full residential address)
date of birth
(mm/dd/yy)
currently registered in the parliamentary register of the
(name of constituency living in)
constituency hereby notify the Parliamentary Registrar --
NAME CHANGE
that I have changed my name from
to
(state your former name)
(state your current name)
and I attach the following document certifying change of name
(type of document)
ADDRESS CHANGE
that I have changed my address from
(state your former residential address including postcode and land valuation assessment number)
and that I now reside at
(state your current residential address including postcode and land valuation assessment number)
and that I wish to have my name removed from the parliamentary register for the constituency where
I was previously registered.
Email Address
Applicant Signature
_____________________________________
Telephone No.
Dated
_______________________
Home:
Business:
 
For office use only
Registered By
_____________________________________
Dated
_______________________

Click Here to Read Important Notes
Warning: A person who knowingly makes a statement which is false in a material particular or submits any document in support of the application which is false in a material particular or which has been altered without lawful authority is guilty of an offence and liable to 12 months imprisonment or a fine of $500 or both.