A person is disqualified for registration if -

1. he has ceased to be a Commonwealth citizen; or
2. he has ceased to be ordinarily resident in Bermuda; or
3. he is registered in the parliamentary register of another constituency; or
4. he is disqualified from voting at a parliamentary election under section 71 of the Parliamentary Election Act, 1978; or
5. he is in prison or detained in a senior training school or having been sentenced to a term of imprisonment, preventitive detention or corrective training the adjusted term of his sentence has not yet expired, whether or not he is at large on licence, unless he has been granted a free pardon or has been granted remission under section 10 of the Prisons Act, 1979; or
6. he is a person suffering from mental disorder within the meaning of the Mental Health Act 1968 or adjudged to be of unsound mind under any statutory provision.

1. A member of an applicant's household who applies for registration on behalf of such applicant must ensure the accuracy of the information provided on this form.
2. This form may be completed in person at the offices of the Parliamentary Registrar, #7 Burnaby Street, Hamilton, or may be delivered to the offices of the Parliamentary Registrar, Parliament Street, Hamilton.

• You are required to notify the Parliamentary Registrar of any change in your registered particulars within 28 days from the date of such change.