In
Triplicate
ELECTIONS
(CONDUCT OF ELECTIONS)
REGULATIONS 1981
FORM 4
[Regulation 4( 3 )]
NOMINATION PAPER
Parliamentary Constituency of*** .................................................
___________________________________________________________________________
(1) PARTICULARS OF CANDIDATE
Full Name : ............................................................................................................
(Block Letters)
I.C. No.* : ...............................................................................................................
Other names, if any** ................................................................................................
Occupation, if any** ...................................................................................................
Residential Address ...................................................................................................
Address within the Constituency ................................................................................
................................................................................................................................
____________________________________________________________________________
(2) PARTICULARS OF PROPOSER AND SECONDER
| Name
in block letters |
I.C.
No. |
Proposer
: ..................................................................................................................
Seconder : ..................................................................................................................
We,
the undersigned, electors for the above Constituency nominate
the above as a proper and suitable person to serve as a member
of the Dewan Rakyat for the said Constituency and we certify that
to the best of our belief he is qualified for election as a member
in accordance with the provisions of the Constitution of Malaysia.
_____________________________________________________________________
* As shown on original I.C. or temporary receipt issued by the
Registration Department.
** If none, write "Nil".
*** State the constituency in which the candidate seeks election.
As show
