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Gibraltar Parliament : Application to Vote by Proxy

Organisation : The Gibraltar Parliament
Facility : Application to Vote by Proxy
Territory : Gibraltar

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Application to Vote by Proxy :

Please write in BLACK INK and use BLOCK CAPITALS. Please read the notes before completing this form

Related : Gibraltar Parliament Voter Registration Form :

About you
** First names (in full):
** Surname
** Date of birth

Address :
where you are registered to vote

Reason for application :
(Illness, working away, on a course, holiday please give full details.)

My Proxy : (Who do you want to vote on your behalf.)
** Name of Proxy
** Address of Proxy
** Your relationship to proxy (if any)

Your declaration :
The details on this form are true and accurate. I have consulted the person named in section 4 above and confirm that that person is capable of being and willing to be appointed to vote as my proxy.
Your signature

Your daytime telephone number or email.
(You do not have to give these but it may help us resolve any queries quickly.

Support for this application :
** Name of support
** Address of support
** Qualification of support

Supporters declaration :
** I am properly qualified to support this application.
** I am not related to the person.
** I am over 18 years old.

I am treating the applicant for long – term illness or disability, or the person is receiving care from me
I know the person applying (In the case of self employed applicants
(* Please delete as applicable )

Notes about this form :
** Your application DOES NOT have to be supported if;
** you are applying because you are registered blind (please provide your registered number)
** you are applying due to temporary illness, work commitments or away on holiday.

** Your application DOES have to be supported if;
** you have a long term illness or disability which makes it difficult for you to vote in person.
(Your application must be supported by a registered medical practitioner, a registered nurse or Christian science practitioner. If you are in a residential home
** sheltered housing, the matron, home care director or warden may support your application.)

** your job, or that of your spouse, may take you away from home for long periods at a time (e.g. travelling salesman, long distance lorry driver)
( Your application must be supported by your employer or your spouse’s employer. If you are self-employed, then the support must be 18 or over, know you and must not be related to you.)
Helpline: (+350) 200 78420

How do I apply to vote by proxy? :
1 Fill in the proxy vote application form.
2 Make sure you complete all sections of the form and supply your date of birth and signature.
3 Return your form as soon as possible to the address shown below.
The Counting Officer
Parliament House
156 Main Street

Please note : That your application form must arrive at your electoral registration office by 5pm on Wednesday 15th June 2016

More information :
If you need more forms or have any questions about voting by post, go to or contact your electoral registration office.

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