This page contains an image of a sample statement of the vote. It is prefilled with example information. The information is as follows:
In box B Valid votes cast, Sum of all numbers in A
In box C Rejected ballots, copy from envelope: rejected ballots EC 50440 .
In box D Total votes cast B + C Total- Voted on the list - Copy Total from line 3 of Last Page of the List
In box E Total Spoiled ballots, Copy from Envelope: Spoiled Ballots EC 50430 for advance polls, add all 4 envelopes
In box F Unused ballots, Copy from Envelope: Stubs and Unused Ballots EC 50420
In box G D+E+F Total, These values should be identical Total ballots supplied - If you have more than one Record of Ballots, add Total number of ballots from each sheet together
Witness signatures - Sign