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2016 Guidelines for Use of the Lists of Electors

Annex A – Declaration Template for Lists Distributed to
Members of Parliament

Declaration Regarding the Use of the Lists of Electors

[Members of Parliament]

I, [insert name of individual to whom list is provided], do solemnly declare the following:

Signature: ________________________________ [individual to whom list is provided]

Signature of witness: _______________________ [person responsible for privacy safeguards]

This ______ [day] of __________________ [month], _______ [year].

Note: A copy of this declaration should be kept on file by the person designated by the member of Parliament as responsible for privacy safeguards.