Home
Results
Boundaries
FAQ
To Be Completed by Persons NOT REGISTERED
Gender:
Male
Female
Surname:
Maiden Name
Forename(s):
Date of Birth
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sept
Oct
Nov
Dec
Year
House Name/Apt No.
Road/Street Name
Parish:
Hamilton
Paget
Pembroke
Sandys
Smiths
Southampton
StGeorges
Warwick
Devonshire
Postal Code:
Assessment Number:
I hereby apply to be registered in the parliamentary register of the following constituency:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
I declare the applicant was born in: (if applicable
I declare the applicant possesses Bermudian Status, granted on: (if applicable)
If status granted, please provide scan of Status Certificate:
I declare that the applicant: (check all that apply)
is a commonwealth citizen
does not possess Bermudian status but was registered as an elector on 1 May 1976
is not registered in the parliamentary register of any other constituency
has not applied to be registered as an elector in any other constituency
is not disqualified for registration as an elector
Contact Details
Home Telephone
Work Telephone
Email:
Enter the code
Powered By ChronoForms - ChronoEngine.com
