nomination paper - elections in canadaelections.ca/pol/can/formsreg/ec20010_e.pdfec 20010 (05/2019)...
TRANSCRIPT
EC 20010 (052019)
Nomination Paperof a Candidate at a Federal General Election or By-election
As required under section 66 of the Canada Elections Act (CEA)
TO BE FILED AFTER THE ISSUE OF THE NOTICE OF ELECTION PURSUANT TO SUBSECTION 67(1) OF THE CEA All fields marked with are mandatory
Candidate Name (Full name of candidate)
First name Last name
Electoral District
Name of electoral district
Office Use Only
Candidate registration
Date received
EC 20010 (052019)
Table of Contents
General Information 2
Section A ndash Candidate Information (Mandatory) 4
Section B ndash Campaign Delegate (Optional) 8
Section C ndash Official Agent (Mandatory) 10
Section D ndash Auditor (Optional) 12
Section E ndash Campaign Office (Optional) 14
Section F ndash Electors Consenting To Candidacy (Mandatory) 15
Section G ndash Are You Ready To Submit Your Nomination 31
1
EC 20010 (052019)
0BGeneral Information
Candidate Qualifications Any Canadian citizen aged 18 or older on election day can run for election unless deemed to be ineligible under section 65 of the Canada Elections Act (CEA) which states that the following persons are not eligible to be a candidate
bull a person who is not qualified as an elector on the date on which his or her Nomination Paper isfiled
bull a person who is disentitled under paragraph 502(3)(a) while they are so disentitled
bull a member of the legislative assembly of a province
bull the Chief Electoral Officer
bull a judge appointed by the Governor in Council other than a citizenship judge appointed underthe Citizenship Act
bull a person who is imprisoned in a correctional institution
bull an election officer and
bull a person who was a candidate in a previous election and for whom a return report document ordeclaration has not been provided under subsection 47759(1) if the time and any extension forproviding it have expired
You may seek election in only one electoral district at a time however you are not required to be a resident of that electoral district The relevant procedures and candidate responsibilities are set out in Part 6 of the CEA
Candidate Identification and Use of an Alternative Name When filing your Nomination Paper you must provide proof of your identity to the returning officer You can submit identification documents directly or copies may be provided by the person filing the Nomination Paper as long as the copies are signed by you
If you want to appear on the ballot under an alternative name you must supply documentation to the returning officer proving that you are commonly known by that name This will be required when you want to use a different given name (even if it is a normal abbreviation of the name) or a different last name (eg your married name if it is not your legal last name) For additional information including the lists of authorized identification documents and documents to support that you are commonly known by a different name please consult the Candidate List of Authorized ID (EC 20014) available on the How to become a candidate page on the Elections Canada website
Political Party Endorsement If you are running as an endorsed candidate of a political party your party must submit a document indicating that they have endorsed you to the Chief Electoral Officer no later than 24 hours before the close of the nomination period The returning officer cannot confirm your Nomination Paper until the party has confirmed their endorsement of you We suggest you contact your political party prior to submitting your Nomination Paper to confirm that this information has been submitted
2
EC 20010 (052019)
1BGeneral Information
Collecting Signatures of Electors Consenting to Candidacy You must supply the names addresses and signatures of at least 100 qualified electors (Canadian citizens at least 18 years old on election day) who ordinarily reside in the electoral district where you intend to run as a candidate Elections Canada recommends that you collect 150 or more signatures to ensure that you meet this requirement Note In the larger or remote electoral districts listed in Schedule 3 of the CEA the required minimum number of signatures is 50 Note For the next general election the previously prescribed pages for collecting signatures (Part 7 of the Nomination Paper) will be accepted
Deadline to Submit Nomination Paper The completed Nomination Paper and all associated supporting documents must be submitted to the returning officer Nominations may be submitted by either you or your campaign delegate In accordance with the CEA the Nomination Paper must be filed between the day the returning officer publishes the Notice of Election and the close of nominations 21 days before election day at 200 pm local time The returning office contact information will be available on the Elections Canada website once the writ of election is issued We suggest making an appointment with the returning officer early during the nomination period so there is sufficient time if required to correct the Nomination Paper before the close of nominations
Offence It is an offence under section 89 and paragraph 486(3)(a) of the CEA to consent to be a candidate when you are not eligible It is also an offence under paragraph 499(2)(a) and subsection 549(3) of the CEA to falsely take an oath that is provided for by the CEA
Public Inspection Any person may examine the completed Nomination Paper at the office of the returning officer during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document The Nomination Paper may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
For More Information If you require additional information visit the How to become a candidate page on the Elections Canada website or contact the Political Entities Support Network directly
Telephone 1-800-486-6563TTY 1-800-361-8935Email CSEP-PESCelectionscaMail Elections Canada
30 Victoria StreetGatineau QuebecK1A 0M6
3
EC 20010 (052019)
SECTION A ndash 2BCandidate Information (Mandatory)
All fields marked with are mandatory
Electoral district
Print the name of the electoral district you are running in You may run in only one electoral district at a time You do not need to reside in the district
Name of electoral district
Candidate name
Print your first name and last name The name must not include any title degree or other prefix or suffix When you file the Nomination Paper you must provide the returning officer with proof of identity that matches the first and last name as identified below CEA 66(2) 67(2)(a)(b)
First name(s) Last name
Name on ballot
You may request an alternative name to appear on the ballot however you must provide the returning officer with sufficient documentation that you are commonly known by that name For more information on authorized proof see the How to become a candidate webpage at electionsca CEA 67(5)
Ballot name
Option 1 Use first and last name as provided above (leave fields below blank)
Option 2 Use other name (complete fields below)
Ballot first name(s) Ballot last name
Political affiliation
State your political affiliation (name of the registered or eligible political party or ldquoIndependentrdquo) In the absence of a stated political affiliation a series of black dashes will appear under your name on the ballot Note In order to have a political party affiliation on the ballot the party must file an endorsement with Elections Canada It is strongly recommended you confirm with your political party and local returning officer to better ensure that your name has been submitted
Political affiliation
4
ndash
EC 20010 (052019)
25BSECTION A ndash Candidate Information (Mandatory)
All fields marked with are mandatory
Candidate information
Gender Date of birth (YYYY-MM-DD) Language of correspondence
English French
Contact information
Upon confirmation of the nomination Elections Canada will send to the email address listed below an invitation to the Political Entities Service Centre (PESC) online portal
Primary phone number Ext Alternate phone number Ext Fax number
Residential address
Unit Street Street name
City ProvinceTerritory Postal code
Mailing address Same as residential address
Unit Street Street name
City ProvinceTerritory Postal code
5
EC 20010 (052019)
26BSECTION A ndash Candidate Information (Mandatory)
All fields marked with are mandatory
Candidate occupation
State the occupation you are commonly known by in your place of ordinary residence Please note that the term ldquoMember of Parliamentrdquo is not an occupation but a title and will not be accepted The term ldquoparliamentarianrdquo however is acceptable CEA 66(3)
Occupation
Sharing of information with the Conflict of Interest and Ethics Commissioner and the House of Commons including the Library of Parliament
To help new members of Parliament Elections Canada will share the name gender residential address telephone number email address occupation preferred language of correspondence electoral district and political party affiliation of candidates who authorize Elections Canada to share their information with the Conflict of Interest and Ethics Commissioner and the House of Commons which includes the Library of Parliament
Do you authorize Elections Canada to share your personal information with the Conflict of Interest and Ethics Commissioner and the House of Commons including the Library of Parliament
Yes No
Privacy notice
Personal information in this Nomination Paper and all associated supporting documents are collected to determine your eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
Any person at the returning office may examine the completed Nomination Paper during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
Subject to consent your contact information may be shared with the House of Commons Conflict of Interest and Ethics Commissioner and Library of Parliament for orientation and communication purposes for new Members of Parliament If you provide a URL it may be posted on Elections Canadarsquos website to increase electorsrsquo accessibility to the electoral framework and democratic process
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information
Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB may be found on the Elections Canada website
6
a
b
c
EC 20010 (052019)
SECTION A ndash Candidate Declaration and Signature (Mandatory)
All fields marked with are mandatory
Candidatersquos declaration
I the undersigned do hereby solemnly declare that
1 my name (including any alternative name I wish to have appear on the ballot) my addressand occupation are as stated in section A of this Nomination Paper
2 I designate the permanent residential address in this Nomination Paper as the address forservice of process and papers under the Canada Elections Act
3 the name and address of my official agent and the name address and occupation of myauditor (if applicable) are as stated in sections C and D of this Nomination Paper
4 the information regarding my political affiliation is as stated in section A of this NominationPaper and
5 where applicable if the returning officer is unable to verify that I have been endorsed by thepolitical party identified in section A of this Nomination Paper I wish to
Have the word ldquoindependentrdquo appear under my name on the ballot
have no designation of political affiliation (meaning that a series of black dashes will appear under my name on the ballot) or
withdraw my Nomination paper
I further state that
1 I consent to the nomination
2 I am a Canadian citizen at least 18 years of age on election day
3 as per section 65 of the Canada Elections Act I am not ineligible to be a candidate
4 I consent to allowing my official agent and candidate campaign delegate (if applicable) toaccess on my behalf electoral materials online or at the local Elections Canada officeincluding the lists of electors distributed by Elections Canada and
5 I am aware of my obligations under the Canada Elections Act
Candidate signature Date (YYYY-MM-DD)
Signature of person receiving the solemn declaration
As per subsection 549(1) of the Canada Elections Act the solemn declaration must be witnessed by a judge an election officer a unit election officer as defined in section 177 a notary public a provincial court judge a justice of the peace or a commissioner for taking oaths in the province
Signature of person receiving the solemn declaration Date (YYYY-MM-DD)
7
ndash
EC 20010 (052019)
SECTION B ndash 3BCampaign Delegate (Optional)
If appointing a campaign delegate all fields marked with are mandatory
Campaign delegate information
A candidate may authorize another individual (referred to in the Nomination Paper as the campaign delegate) to act on their behalf during the election The campaign delegate can submit the Nomination Paper and all associated supporting documents CEA 67(7) Note The campaign delegate does not have access to the candidatersquos financial returns
First name Last name Language of correspondence
English French
Contact information
Upon confirmation of the nomination Elections Canada will send to the email address listed below an invitation to the Political Entities Service Centre (PESC) online portal
Primary phone number Ext Alternate phone number Ext Fax number
Residential address
Unit Street Street name
City ProvinceTerritory Postal code
Mailing address Same as residential address
Unit Street Street name
City ProvinceTerritory Postal code
8
EC 20010 (052019)
SECTION B ndash Campaign Delegate ndash Privacy Notice and Declaration (Optional)
If appointing a campaign delegate all fields marked with are mandatory
Privacy notice
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA) Any person at the returning office may examine the completed Nomination Paper during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
Candidate authorization of the campaign delegate
As per subsection 66(1)(h) of the Canada Elections Act I authorize the individual identified in this section to act as my campaign delegate
Candidate signature Date (YYYY-MM-DD)
Candidate campaign delegate signature
I the undersigned candidate campaign delegate for the candidate named in this Nomination Paper state that
1 I hereby agree to act as the authorized person for the candidate named herein for the purposes of theCanada Elections Act
2 I am fully aware of the duties and responsibilities imposed on me by the Canada Elections Act
Campaign delegate signature Date (YYYY-MM-DD)
9
ndash
EC 20010 (052019)
SECTION C ndash 4BOfficial Agent (Mandatory)
All fields marked with are mandatory
Official agent information
The official agent is responsible for administering the campaignrsquos financial transactions and reporting those transactions to Elections Canada as required by the CEA For more information consult the Political Financing Handbook for Candidates and Official Agents Note The candidate official agent and auditor must all be different people
First name Last name Language of correspondence
English French
Contact information
Upon confirmation of the nomination Elections Canada will send to the email address listed below an invitation to the Political Entities Service Centre (PESC) online portal
Primary phone number Ext Alternate phone number Ext Fax number
Residential address Unit Street Street name
City ProvinceTerritory Postal code
Mailing address Same as residential address
Unit Street Street name
City ProvinceTerritory Postal code
10
EC 20010 (052019)
24BSECTION C ndash Official Agent ndash Privacy Notice and Declaration (Mandatory)
All fields marked with are mandatory
Privacy notice
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA) Any person at the returning office may examine the completed Nomination Paper during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
Official agent signature
I the undersigned official agent for the candidate named in this Nomination Paper hereby agree to act as official agent for the candidate named herein for the purposes of the Canada Elections Act I further state that
1 I am fully aware of the duties and responsibilities imposed on me by the Canada Elections Act
2 I am capable of entering into contracts in the provinceterritory in which this electoral district is located
3 I am eligible to act as official agent pursuant to section 4772 of the Canada Elections Act
Section 4772 of the Canada Elections Act states The following persons are ineligible to be an official agenta candidate an election officer or a member of the staff of a returning office an undischarged bankrupt anauditor appointed as required by this Act a person who is not qualified as an elector and a person who doesnot have the capacity to enter into contracts in the province in which they ordinarily reside
Official agent signature Date (YYYY-MM-DD)
11
EC 20010 (052019)
SECTION D ndash 5B Auditor (Optional)
If appointing an auditor all fields marked with are mandatory
Auditor information An auditor must be appointed if bull the candidatersquos campaign accepts contributions of $10000 or more bull the candidatersquos campaign incurs expenses of $10000 or more or bull the candidate receives 10 or more of votes cast in the electoral district If at the time of filing the Nomination Paper none of the above applies you do not need to appoint an auditor though you may still choose to do so If the above requirements are later met you must appoint an auditor without delay A person or partnership who wants to act as a candidatersquos auditor must be or have every partner be recognized as a professional accountant under provincial or territorial legislation CEA 4773(1) For more information consult the Political Financing Handbook for Candidates and Official Agents
First name Last name Language of correspondence
English French
Contact information Upon confirmation of the nomination Elections Canada will send to the email address listed below an invitation to the Political Entities Service Centre (PESC) online portal
Primary phone number Ext Alternate phone number Ext Fax number
Auditor organizational information Name of firm Occupation of auditor Professional designation
CPA FCPA
Designation registration number Make cheque payable to
Address (where cheque is sent) Unit Street Street name
City ProvinceTerritory Postal code
12
EC 20010 (052019)
SECTION D ndash Auditor ndash Privacy Notice and Declaration (Optional)
If appointing an auditor all fields marked with are mandatory
Privacy notice
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA) Any person at the returning office may examine the completed Nomination Paper during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information
Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
Auditor signature
I the undersigned hereby agree to act as the auditor for the candidate named in this Nomination Paper I further state that I am aware of the duties and responsibilities of this position under the Canada Elections Act and I am qualified to act as auditor under subsection 4773(1) and (2) of the Canada Elections Act
Auditor signature Date (YYYY-MM-DD)
13
EC 20010 (052019)
SECTION E ndash 6BCampaign Office (Optional)
Contact information to be made available on the Elections Canada website (optional)
Please note You may provide a telephone number andor a link to your website or social media platform of choice when filing your Nomination Paper with Elections Canada You do not have to provide this information but it is intended to help electors access campaign information Elections Canada may provide this information as part of the Voter Information Service Please include the full website address including prefix (http https)
Telephone number to be posted on electionsca
Website to be posted on electionsca (including prefix http https)
Campaign office address (optional)
Unit Street Street name
City ProvinceTerritory Postal code
14
SECTION F ndash 7BElectors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
15
8BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
16
9BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
17
10BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
18
11BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
19
12BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
20
13BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
21
14BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
22
15BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
23
16BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
24
17BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
25
18BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
26
19BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
27
20BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
28
21BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
29
22BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
30
EC 20010 (022019)
SECTION G ndash 23B Are You Ready to Submit Your Nomination
Have you completed the Nomination Paper (EC 20010)
bull Are all mandatory fields in sections AndashE complete
bull Have you collected the required number of signatures from qualified electors in section F
o For most electoral districts 100 electors must consent to your candidacy
o For electoral districts identified in Schedule 3 only 50 electors are required
o To ensure a smooth nomination process Elections Canada recommends collecting signatures from at least 150 electors
Do you have authorized proof of identify
bull For a list of authorized identification visit the Elections Canada website
bull If a campaign delegate is submitting on your behalf they must bring a copy of your identification documents signed by you
bull If you want an alternative name to appear on the ballot additional documentation is required visit electionsca for details
Are you endorsed by a political party
bull Make sure your party has submitted the required documentation to Elections Canada attesting your designated political affiliation
Have you made a nomination appointment
bull To facilitate the nomination process make an appointment with the returning officer to finalize the filing of the complete nomination package
bull The nomination period closes 21 days before election day at 200 pm local time
31
- Nomination Paperof a Candidate at a Federal General Election or By-election
- Table of Contents
- General Information
- SECTION A ndash Candidate Information (Mandatory)
- SECTION B ndash Campaign Delegate (Optional)
- SECTION C ndash Official Agent (Mandatory)
- SECTION D ndash Auditor (Optional)
- SECTION E ndash Campaign Office (Optional)
- SECTION F ndash Electors Consenting to Candidacy (Mandatory)
-
- Name of electoral district
- Political affiliation
- Telephone number to be posted on electionsca
- Website to be posted on electionsca including prefix http https
- Printed name of elector1
- Full residential address street numbernamecity1
- Postal code1
- Elector signature1
- Witness initials1
- Internal use only1
- Printed name of elector2
- Full residential address street numbernamecity2
- Postal code2
- Elector signature2
- Witness initials2
- Internal use only2
- Printed name of elector3
- Full residential address street numbernamecity3
- Postal code3
- Elector signature3
- Witness initials3
- Internal use only3
- Printed name of elector4
- Full residential address street numbernamecity4
- Postal code4
- Elector signature4
- Witness initials4
- Internal use only4
- Printed name of elector5
- Full residential address street numbernamecity5
- Postal code5
- Elector signature5
- Witness initials5
- Internal use only5
- Printed name of elector6
- Full residential address street numbernamecity6
- Postal code6
- Elector signature6
- Witness initials6
- Internal use only6
- Printed name of elector7
- Full residential address street numbernamecity7
- Postal code7
- Elector signature7
- Witness initials7
- Internal use only7
- Printed name of elector8
- Full residential address street numbernamecity8
- Postal code8
- Elector signature8
- Witness initials8
- Internal use only8
- Printed name of elector9
- Full residential address street numbernamecity9
- Postal code9
- Elector signature9
- Witness initials9
- Internal use only9
- Printed name of elector10
- Full residential address street numbernamecity10
- Postal code10
- Elector signature10
- Witness initials10
- Internal use only10
- Printed name of elector1_2
- Full residential address street numbernamecity1_2
- Postal code1_2
- Elector signature1_2
- Witness initials1_2
- Internal use only1_2
- Printed name of elector2_2
- Full residential address street numbernamecity2_2
- Postal code2_2
- Elector signature2_2
- Witness initials2_2
- Internal use only2_2
- Printed name of elector3_2
- Full residential address street numbernamecity3_2
- Postal code3_2
- Elector signature3_2
- Witness initials3_2
- Internal use only3_2
- Printed name of elector4_2
- Full residential address street numbernamecity4_2
- Postal code4_2
- Elector signature4_2
- Witness initials4_2
- Internal use only4_2
- Printed name of elector5_2
- Full residential address street numbernamecity5_2
- Postal code5_2
- Elector signature5_2
- Witness initials5_2
- Internal use only5_2
- Printed name of elector6_2
- Full residential address street numbernamecity6_2
- Postal code6_2
- Elector signature6_2
- Witness initials6_2
- Internal use only6_2
- Printed name of elector7_2
- Full residential address street numbernamecity7_2
- Postal code7_2
- Elector signature7_2
- Witness initials7_2
- Internal use only7_2
- Printed name of elector8_2
- Full residential address street numbernamecity8_2
- Postal code8_2
- Elector signature8_2
- Witness initials8_2
- Internal use only8_2
- Printed name of elector9_2
- Full residential address street numbernamecity9_2
- Postal code9_2
- Elector signature9_2
- Witness initials9_2
- Internal use only9_2
- Printed name of elector10_2
- Full residential address street numbernamecity10_2
- Postal code10_2
- Elector signature10_2
- Witness initials10_2
- Internal use only10_2
- Printed name of elector1_3
- Full residential address street numbernamecity1_3
- Postal code1_3
- Elector signature1_3
- Witness initials1_3
- Internal use only1_3
- Printed name of elector2_3
- Full residential address street numbernamecity2_3
- Postal code2_3
- Elector signature2_3
- Witness initials2_3
- Internal use only2_3
- Printed name of elector3_3
- Full residential address street numbernamecity3_3
- Postal code3_3
- Elector signature3_3
- Witness initials3_3
- Internal use only3_3
- Printed name of elector4_3
- Full residential address street numbernamecity4_3
- Postal code4_3
- Elector signature4_3
- Witness initials4_3
- Internal use only4_3
- Printed name of elector5_3
- Full residential address street numbernamecity5_3
- Postal code5_3
- Elector signature5_3
- Witness initials5_3
- Internal use only5_3
- Printed name of elector6_3
- Full residential address street numbernamecity6_3
- Postal code6_3
- Elector signature6_3
- Witness initials6_3
- Internal use only6_3
- Printed name of elector7_3
- Full residential address street numbernamecity7_3
- Postal code7_3
- Elector signature7_3
- Witness initials7_3
- Internal use only7_3
- Printed name of elector8_3
- Full residential address street numbernamecity8_3
- Postal code8_3
- Elector signature8_3
- Witness initials8_3
- Internal use only8_3
- Printed name of elector9_3
- Full residential address street numbernamecity9_3
- Postal code9_3
- Elector signature9_3
- Witness initials9_3
- Internal use only9_3
- Printed name of elector10_3
- Full residential address street numbernamecity10_3
- Postal code10_3
- Elector signature10_3
- Witness initials10_3
- Internal use only10_3
- Printed name of elector1_4
- Full residential address street numbernamecity1_4
- Postal code1_4
- Elector signature1_4
- Witness initials1_4
- Internal use only1_4
- Printed name of elector2_4
- Full residential address street numbernamecity2_4
- Postal code2_4
- Elector signature2_4
- Witness initials2_4
- Internal use only2_4
- Printed name of elector3_4
- Full residential address street numbernamecity3_4
- Postal code3_4
- Elector signature3_4
- Witness initials3_4
- Internal use only3_4
- Printed name of elector4_4
- Full residential address street numbernamecity4_4
- Postal code4_4
- Elector signature4_4
- Witness initials4_4
- Internal use only4_4
- Printed name of elector5_4
- Full residential address street numbernamecity5_4
- Postal code5_4
- Elector signature5_4
- Witness initials5_4
- Internal use only5_4
- Printed name of elector6_4
- Full residential address street numbernamecity6_4
- Postal code6_4
- Elector signature6_4
- Witness initials6_4
- Internal use only6_4
- Printed name of elector7_4
- Full residential address street numbernamecity7_4
- Postal code7_4
- Elector signature7_4
- Witness initials7_4
- Internal use only7_4
- Printed name of elector8_4
- Full residential address street numbernamecity8_4
- Postal code8_4
- Elector signature8_4
- Witness initials8_4
- Internal use only8_4
- Printed name of elector9_4
- Full residential address street numbernamecity9_4
- Postal code9_4
- Elector signature9_4
- Witness initials9_4
- Internal use only9_4
- Printed name of elector10_4
- Full residential address street numbernamecity10_4
- Postal code10_4
- Elector signature10_4
- Witness initials10_4
- Internal use only10_4
- Printed name of elector1_5
- Full residential address street numbernamecity1_5
- Postal code1_5
- Elector signature1_5
- Witness initials1_5
- Internal use only1_5
- Printed name of elector2_5
- Full residential address street numbernamecity2_5
- Postal code2_5
- Elector signature2_5
- Witness initials2_5
- Internal use only2_5
- Printed name of elector3_5
- Full residential address street numbernamecity3_5
- Postal code3_5
- Elector signature3_5
- Witness initials3_5
- Internal use only3_5
- Printed name of elector4_5
- Full residential address street numbernamecity4_5
- Postal code4_5
- Elector signature4_5
- Witness initials4_5
- Internal use only4_5
- Printed name of elector5_5
- Full residential address street numbernamecity5_5
- Postal code5_5
- Elector signature5_5
- Witness initials5_5
- Internal use only5_5
- Printed name of elector6_5
- Full residential address street numbernamecity6_5
- Postal code6_5
- Elector signature6_5
- Witness initials6_5
- Internal use only6_5
- Printed name of elector7_5
- Full residential address street numbernamecity7_5
- Postal code7_5
- Elector signature7_5
- Witness initials7_5
- Internal use only7_5
- Printed name of elector8_5
- Full residential address street numbernamecity8_5
- Postal code8_5
- Elector signature8_5
- Witness initials8_5
- Internal use only8_5
- Printed name of elector9_5
- Full residential address street numbernamecity9_5
- Postal code9_5
- Elector signature9_5
- Witness initials9_5
- Internal use only9_5
- Printed name of elector10_5
- Full residential address street numbernamecity10_5
- Postal code10_5
- Elector signature10_5
- Witness initials10_5
- Internal use only10_5
- Printed name of elector1_6
- Full residential address street numbernamecity1_6
- Postal code1_6
- Elector signature1_6
- Witness initials1_6
- Internal use only1_6
- Printed name of elector2_6
- Full residential address street numbernamecity2_6
- Postal code2_6
- Elector signature2_6
- Witness initials2_6
- Internal use only2_6
- Printed name of elector3_6
- Full residential address street numbernamecity3_6
- Postal code3_6
- Elector signature3_6
- Witness initials3_6
- Internal use only3_6
- Printed name of elector4_6
- Full residential address street numbernamecity4_6
- Postal code4_6
- Elector signature4_6
- Witness initials4_6
- Internal use only4_6
- Printed name of elector5_6
- Full residential address street numbernamecity5_6
- Postal code5_6
- Elector signature5_6
- Witness initials5_6
- Internal use only5_6
- Printed name of elector6_6
- Full residential address street numbernamecity6_6
- Postal code6_6
- Elector signature6_6
- Witness initials6_6
- Internal use only6_6
- Printed name of elector7_6
- Full residential address street numbernamecity7_6
- Postal code7_6
- Elector signature7_6
- Witness initials7_6
- Internal use only7_6
- Printed name of elector8_6
- Full residential address street numbernamecity8_6
- Postal code8_6
- Elector signature8_6
- Witness initials8_6
- Internal use only8_6
- Printed name of elector9_6
- Full residential address street numbernamecity9_6
- Postal code9_6
- Elector signature9_6
- Witness initials9_6
- Internal use only9_6
- Printed name of elector10_6
- Full residential address street numbernamecity10_6
- Postal code10_6
- Elector signature10_6
- Witness initials10_6
- Internal use only10_6
- Printed name of elector1_7
- Full residential address street numbernamecity1_7
- Postal code1_7
- Elector signature1_7
- Witness initials1_7
- Internal use only1_7
- Printed name of elector2_7
- Full residential address street numbernamecity2_7
- Postal code2_7
- Elector signature2_7
- Witness initials2_7
- Internal use only2_7
- Printed name of elector3_7
- Full residential address street numbernamecity3_7
- Postal code3_7
- Elector signature3_7
- Witness initials3_7
- Internal use only3_7
- Printed name of elector4_7
- Full residential address street numbernamecity4_7
- Postal code4_7
- Elector signature4_7
- Witness initials4_7
- Internal use only4_7
- Printed name of elector5_7
- Full residential address street numbernamecity5_7
- Postal code5_7
- Elector signature5_7
- Witness initials5_7
- Internal use only5_7
- Printed name of elector6_7
- Full residential address street numbernamecity6_7
- Postal code6_7
- Elector signature6_7
- Witness initials6_7
- Internal use only6_7
- Printed name of elector7_7
- Full residential address street numbernamecity7_7
- Postal code7_7
- Elector signature7_7
- Witness initials7_7
- Internal use only7_7
- Printed name of elector8_7
- Full residential address street numbernamecity8_7
- Postal code8_7
- Elector signature8_7
- Witness initials8_7
- Internal use only8_7
- Printed name of elector9_7
- Full residential address street numbernamecity9_7
- Postal code9_7
- Elector signature9_7
- Witness initials9_7
- Internal use only9_7
- Printed name of elector10_7
- Full residential address street numbernamecity10_7
- Postal code10_7
- Elector signature10_7
- Witness initials10_7
- Internal use only10_7
- Printed name of elector1_8
- Full residential address street numbernamecity1_8
- Postal code1_8
- Elector signature1_8
- Witness initials1_8
- Internal use only1_8
- Printed name of elector2_8
- Full residential address street numbernamecity2_8
- Postal code2_8
- Elector signature2_8
- Witness initials2_8
- Internal use only2_8
- Printed name of elector3_8
- Full residential address street numbernamecity3_8
- Postal code3_8
- Elector signature3_8
- Witness initials3_8
- Internal use only3_8
- Printed name of elector4_8
- Full residential address street numbernamecity4_8
- Postal code4_8
- Elector signature4_8
- Witness initials4_8
- Internal use only4_8
- Printed name of elector5_8
- Full residential address street numbernamecity5_8
- Postal code5_8
- Elector signature5_8
- Witness initials5_8
- Internal use only5_8
- Printed name of elector6_8
- Full residential address street numbernamecity6_8
- Postal code6_8
- Elector signature6_8
- Witness initials6_8
- Internal use only6_8
- Printed name of elector7_8
- Full residential address street numbernamecity7_8
- Postal code7_8
- Elector signature7_8
- Witness initials7_8
- Internal use only7_8
- Printed name of elector8_8
- Full residential address street numbernamecity8_8
- Postal code8_8
- Elector signature8_8
- Witness initials8_8
- Internal use only8_8
- Printed name of elector9_8
- Full residential address street numbernamecity9_8
- Postal code9_8
- Elector signature9_8
- Witness initials9_8
- Internal use only9_8
- Printed name of elector10_8
- Full residential address street numbernamecity10_8
- Postal code10_8
- Elector signature10_8
- Witness initials10_8
- Internal use only10_8
- Printed name of elector1_9
- Full residential address street numbernamecity1_9
- Postal code1_9
- Elector signature1_9
- Witness initials1_9
- Internal use only1_9
- Printed name of elector2_9
- Full residential address street numbernamecity2_9
- Postal code2_9
- Elector signature2_9
- Witness initials2_9
- Internal use only2_9
- Printed name of elector3_9
- Full residential address street numbernamecity3_9
- Postal code3_9
- Elector signature3_9
- Witness initials3_9
- Internal use only3_9
- Printed name of elector4_9
- Full residential address street numbernamecity4_9
- Postal code4_9
- Elector signature4_9
- Witness initials4_9
- Internal use only4_9
- Printed name of elector5_9
- Full residential address street numbernamecity5_9
- Postal code5_9
- Elector signature5_9
- Witness initials5_9
- Internal use only5_9
- Printed name of elector6_9
- Full residential address street numbernamecity6_9
- Postal code6_9
- Elector signature6_9
- Witness initials6_9
- Internal use only6_9
- Printed name of elector7_9
- Full residential address street numbernamecity7_9
- Postal code7_9
- Elector signature7_9
- Witness initials7_9
- Internal use only7_9
- Printed name of elector8_9
- Full residential address street numbernamecity8_9
- Postal code8_9
- Elector signature8_9
- Witness initials8_9
- Internal use only8_9
- Printed name of elector9_9
- Full residential address street numbernamecity9_9
- Postal code9_9
- Elector signature9_9
- Witness initials9_9
- Internal use only9_9
- Printed name of elector10_9
- Full residential address street numbernamecity10_9
- Postal code10_9
- Elector signature10_9
- Witness initials10_9
- Internal use only10_9
- Printed name of elector1_10
- Full residential address street numbernamecity1_10
- Postal code1_10
- Elector signature1_10
- Witness initials1_10
- Internal use only1_10
- Printed name of elector2_10
- Full residential address street numbernamecity2_10
- Postal code2_10
- Elector signature2_10
- Witness initials2_10
- Internal use only2_10
- Printed name of elector3_10
- Full residential address street numbernamecity3_10
- Postal code3_10
- Elector signature3_10
- Witness initials3_10
- Internal use only3_10
- Printed name of elector4_10
- Full residential address street numbernamecity4_10
- Postal code4_10
- Elector signature4_10
- Witness initials4_10
- Internal use only4_10
- Printed name of elector5_10
- Full residential address street numbernamecity5_10
- Postal code5_10
- Elector signature5_10
- Witness initials5_10
- Internal use only5_10
- Printed name of elector6_10
- Full residential address street numbernamecity6_10
- Postal code6_10
- Elector signature6_10
- Witness initials6_10
- Internal use only6_10
- Printed name of elector7_10
- Full residential address street numbernamecity7_10
- Postal code7_10
- Elector signature7_10
- Witness initials7_10
- Internal use only7_10
- Printed name of elector8_10
- Full residential address street numbernamecity8_10
- Postal code8_10
- Elector signature8_10
- Witness initials8_10
- Internal use only8_10
- Printed name of elector9_10
- Full residential address street numbernamecity9_10
- Postal code9_10
- Elector signature9_10
- Witness initials9_10
- Internal use only9_10
- Printed name of elector10_10
- Full residential address street numbernamecity10_10
- Postal code10_10
- Elector signature10_10
- Witness initials10_10
- Internal use only10_10
- Printed name of elector1_11
- Full residential address street numbernamecity1_11
- Postal code1_11
- Elector signature1_11
- Witness initials1_11
- Internal use only1_11
- Printed name of elector2_11
- Full residential address street numbernamecity2_11
- Postal code2_11
- Elector signature2_11
- Witness initials2_11
- Internal use only2_11
- Printed name of elector3_11
- Full residential address street numbernamecity3_11
- Postal code3_11
- Elector signature3_11
- Witness initials3_11
- Internal use only3_11
- Printed name of elector4_11
- Full residential address street numbernamecity4_11
- Postal code4_11
- Elector signature4_11
- Witness initials4_11
- Internal use only4_11
- Printed name of elector5_11
- Full residential address street numbernamecity5_11
- Postal code5_11
- Elector signature5_11
- Witness initials5_11
- Internal use only5_11
- Printed name of elector6_11
- Full residential address street numbernamecity6_11
- Postal code6_11
- Elector signature6_11
- Witness initials6_11
- Internal use only6_11
- Printed name of elector7_11
- Full residential address street numbernamecity7_11
- Postal code7_11
- Elector signature7_11
- Witness initials7_11
- Internal use only7_11
- Printed name of elector8_11
- Full residential address street numbernamecity8_11
- Postal code8_11
- Elector signature8_11
- Witness initials8_11
- Internal use only8_11
- Printed name of elector9_11
- Full residential address street numbernamecity9_11
- Postal code9_11
- Elector signature9_11
- Witness initials9_11
- Internal use only9_11
- Printed name of elector10_11
- Full residential address street numbernamecity10_11
- Postal code10_11
- Elector signature10_11
- Witness initials10_11
- Internal use only10_11
- Printed name of elector1_12
- Full residential address street numbernamecity1_12
- Postal code1_12
- Elector signature1_12
- Witness initials1_12
- Internal use only1_12
- Printed name of elector2_12
- Full residential address street numbernamecity2_12
- Postal code2_12
- Elector signature2_12
- Witness initials2_12
- Internal use only2_12
- Printed name of elector3_12
- Full residential address street numbernamecity3_12
- Postal code3_12
- Elector signature3_12
- Witness initials3_12
- Internal use only3_12
- Printed name of elector4_12
- Full residential address street numbernamecity4_12
- Postal code4_12
- Elector signature4_12
- Witness initials4_12
- Internal use only4_12
- Printed name of elector5_12
- Full residential address street numbernamecity5_12
- Postal code5_12
- Elector signature5_12
- Witness initials5_12
- Internal use only5_12
- Printed name of elector6_12
- Full residential address street numbernamecity6_12
- Postal code6_12
- Elector signature6_12
- Witness initials6_12
- Internal use only6_12
- Printed name of elector7_12
- Full residential address street numbernamecity7_12
- Postal code7_12
- Elector signature7_12
- Witness initials7_12
- Internal use only7_12
- Printed name of elector8_12
- Full residential address street numbernamecity8_12
- Postal code8_12
- Elector signature8_12
- Witness initials8_12
- Internal use only8_12
- Printed name of elector9_12
- Full residential address street numbernamecity9_12
- Postal code9_12
- Elector signature9_12
- Witness initials9_12
- Internal use only9_12
- Printed name of elector10_12
- Full residential address street numbernamecity10_12
- Postal code10_12
- Elector signature10_12
- Witness initials10_12
- Internal use only10_12
- Printed name of elector1_13
- Full residential address street numbernamecity1_13
- Postal code1_13
- Elector signature1_13
- Witness initials1_13
- Internal use only1_13
- Printed name of elector2_13
- Full residential address street numbernamecity2_13
- Postal code2_13
- Elector signature2_13
- Witness initials2_13
- Internal use only2_13
- Printed name of elector3_13
- Full residential address street numbernamecity3_13
- Postal code3_13
- Elector signature3_13
- Witness initials3_13
- Internal use only3_13
- Printed name of elector4_13
- Full residential address street numbernamecity4_13
- Postal code4_13
- Elector signature4_13
- Witness initials4_13
- Internal use only4_13
- Printed name of elector5_13
- Full residential address street numbernamecity5_13
- Postal code5_13
- Elector signature5_13
- Witness initials5_13
- Internal use only5_13
- Printed name of elector6_13
- Full residential address street numbernamecity6_13
- Postal code6_13
- Elector signature6_13
- Witness initials6_13
- Internal use only6_13
- Printed name of elector7_13
- Full residential address street numbernamecity7_13
- Postal code7_13
- Elector signature7_13
- Witness initials7_13
- Internal use only7_13
- Printed name of elector8_13
- Full residential address street numbernamecity8_13
- Postal code8_13
- Elector signature8_13
- Witness initials8_13
- Internal use only8_13
- Printed name of elector9_13
- Full residential address street numbernamecity9_13
- Postal code9_13
- Elector signature9_13
- Witness initials9_13
- Internal use only9_13
- Printed name of elector10_13
- Full residential address street numbernamecity10_13
- Postal code10_13
- Elector signature10_13
- Witness initials10_13
- Internal use only10_13
- Printed name of elector1_14
- Full residential address street numbernamecity1_14
- Postal code1_14
- Elector signature1_14
- Witness initials1_14
- Internal use only1_14
- Printed name of elector2_14
- Full residential address street numbernamecity2_14
- Postal code2_14
- Elector signature2_14
- Witness initials2_14
- Internal use only2_14
- Printed name of elector3_14
- Full residential address street numbernamecity3_14
- Postal code3_14
- Elector signature3_14
- Witness initials3_14
- Internal use only3_14
- Printed name of elector4_14
- Full residential address street numbernamecity4_14
- Postal code4_14
- Elector signature4_14
- Witness initials4_14
- Internal use only4_14
- Printed name of elector5_14
- Full residential address street numbernamecity5_14
- Postal code5_14
- Elector signature5_14
- Witness initials5_14
- Internal use only5_14
- Printed name of elector6_14
- Full residential address street numbernamecity6_14
- Postal code6_14
- Elector signature6_14
- Witness initials6_14
- Internal use only6_14
- Printed name of elector7_14
- Full residential address street numbernamecity7_14
- Postal code7_14
- Elector signature7_14
- Witness initials7_14
- Internal use only7_14
- Printed name of elector8_14
- Full residential address street numbernamecity8_14
- Postal code8_14
- Elector signature8_14
- Witness initials8_14
- Internal use only8_14
- Printed name of elector9_14
- Full residential address street numbernamecity9_14
- Postal code9_14
- Elector signature9_14
- Witness initials9_14
- Internal use only9_14
- Printed name of elector10_14
- Full residential address street numbernamecity10_14
- Postal code10_14
- Elector signature10_14
- Witness initials10_14
- Internal use only10_14
- Printed name of elector1_15
- Full residential address street numbernamecity1_15
- Postal code1_15
- Elector signature1_15
- Witness initials1_15
- Internal use only1_15
- Printed name of elector2_15
- Full residential address street numbernamecity2_15
- Postal code2_15
- Elector signature2_15
- Witness initials2_15
- Internal use only2_15
- Printed name of elector3_15
- Full residential address street numbernamecity3_15
- Postal code3_15
- Elector signature3_15
- Witness initials3_15
- Internal use only3_15
- Printed name of elector4_15
- Full residential address street numbernamecity4_15
- Postal code4_15
- Elector signature4_15
- Witness initials4_15
- Internal use only4_15
- Printed name of elector5_15
- Full residential address street numbernamecity5_15
- Postal code5_15
- Elector signature5_15
- Witness initials5_15
- Internal use only5_15
- Printed name of elector6_15
- Full residential address street numbernamecity6_15
- Postal code6_15
- Elector signature6_15
- Witness initials6_15
- Internal use only6_15
- Printed name of elector7_15
- Full residential address street numbernamecity7_15
- Postal code7_15
- Elector signature7_15
- Witness initials7_15
- Internal use only7_15
- Printed name of elector8_15
- Full residential address street numbernamecity8_15
- Postal code8_15
- Elector signature8_15
- Witness initials8_15
- Internal use only8_15
- Printed name of elector9_15
- Full residential address street numbernamecity9_15
- Postal code9_15
- Elector signature9_15
- Witness initials9_15
- Internal use only9_15
- Printed name of elector10_15
- Full residential address street numbernamecity10_15
- Postal code10_15
- Elector signature10_15
- Witness initials10_15
- Internal use only10_15
- Printed name of elector1_16
- Full residential address street numbernamecity1_16
- Postal code1_16
- Elector signature1_16
- Witness initials1_16
- Internal use only1_16
- Printed name of elector2_16
- Full residential address street numbernamecity2_16
- Postal code2_16
- Elector signature2_16
- Witness initials2_16
- Internal use only2_16
- Printed name of elector3_16
- Full residential address street numbernamecity3_16
- Postal code3_16
- Elector signature3_16
- Witness initials3_16
- Internal use only3_16
- Printed name of elector4_16
- Full residential address street numbernamecity4_16
- Postal code4_16
- Elector signature4_16
- Witness initials4_16
- Internal use only4_16
- Printed name of elector5_16
- Full residential address street numbernamecity5_16
- Postal code5_16
- Elector signature5_16
- Witness initials5_16
- Internal use only5_16
- Printed name of elector6_16
- Full residential address street numbernamecity6_16
- Postal code6_16
- Elector signature6_16
- Witness initials6_16
- Internal use only6_16
- Printed name of elector7_16
- Full residential address street numbernamecity7_16
- Postal code7_16
- Elector signature7_16
- Witness initials7_16
- Internal use only7_16
- Printed name of elector8_16
- Full residential address street numbernamecity8_16
- Postal code8_16
- Elector signature8_16
- Witness initials8_16
- Internal use only8_16
- Printed name of elector9_16
- Full residential address street numbernamecity9_16
- Postal code9_16
- Elector signature9_16
- Witness initials9_16
- Internal use only9_16
- Printed name of elector10_16
- Full residential address street numbernamecity10_16
- Postal code10_16
- Elector signature10_16
- Witness initials10_16
- Internal use only10_16
- Have you completed the Nomination Paper EC 20010 Off
- Do you have authorized proof of identify Off
- Are you endorsed by a political party Off
- Have you made a nomination appointment Off
- Last name - Candidate Name
- First name - Candidate Name
- Name of electoral district- Candidate Information
- First name - Candidate Information
- Last name - Candidate Information
- Ballot Name Off
- Ballot First name(s)
- Ballot Last name(s)
- Gender -Candidate information
- Date of birth (YYY-MM-DD) - Gender -Candidate information
- language of correspondence - Candidate information Off
- Email -Contact information
- Primary phone number - Contact information
- Ext - Primary phone number
- Alternate phone number - Contact information
- Ext - Alternate phone number
- Fax number- Alternate phone number
- Unit -Residential address
- Street -Residential address
- Street name -Residential address
- City -Residential address
- ProvinceTerritory -Residential address
- Postal code - -Residential address
- Mailing address - same as residential address Off
- Occupation- Candidate occupation
- Sharing of information with the Conflict of Interest and Ethics Commissioner and the House of Commons including the Library of Parliament Off
- where applicable if the returning officer is unable to verify that I have been endorsed by the political party identified in section A of this Nomination Paper I wish to Off
- Date of Signature (YYYY-MM-DD) - Candidate signature
- Date of Signature (YYYY-MM-DD) -Signature of person receiving the solemn declaration
- Campaign delegate information
- First name - Campaign delegate information
- Last name - Campaign delegate information
- Language of correspondence - Campaign delegate information Off
- Email - Contact information -Campaign Delegate
- Primary phone number - Contact information -Campaign Delegate
- Primary phone number EXT - Contact information -Campaign Delegate
- Alternate phone number - Contact information -Campaign Delegate
- Alternate phone number EXT - Contact information -Campaign Delegate
- Fax nmuber- Contact information -Campaign Delegate
- Street - Residential address -Campaign delegate
- Street name - Residential address -Campaign delegate
- City - Residential address -Campaign delegate
- ProvinceTerritory - Residential address -Campaign delegate
- Postal Code - Residential address -Campaign delegate
- Campaign delegate - Mailing address ndash Same as residential address Off
- Unit - Residential address -Campaign delegate
- Date (YYYY-MM-DD) - Candidate authorization Signature
- Date (YYYY-MM-DD) - Candidate campaign Signature
- First name - Official agent information
- Last name - Official agent information
- Language of correspondence - Official agent information Off
- Email - Official agent information
- Primary phone number - Official agent information
- Primary phone number EXT - Official agent information
- Alternate phone number EXT - Official agent information
- Alternate phone number - Official agent information
- Fax number - Official agent information
- Unit -Residential address - Official Agent
- Street name -Residential address - Official Agent
- City -Residential address - Official Agent
- Street -Residential address - Official Agent
- ProvinceTerritory -Residential address - Official Agent
- Postal code-Residential address - Official Agent
- Mailing address ndash Same as residential address- Official Agent Off
- Date (YYYY-MM-DD) - Official agent signature
- First name - Auditor information
- Last name - Auditor information
- Language of correspondence - Auditor information Off
- Email - Auditor information
- Primary phone number - Auditor information
- Primary phone number EXT- Auditor information
- Alternate phone number - Auditor information
- Alternate phone number EXT- Auditor information
- Fax number - Auditor information
- Name of firm- Auditor organizational information
- Occupation of auditor - Auditor organizational information
- Professional designation - Auditor organizational information Off
- Designation registration number
- Make cheque payable to
- Unit - Address (where cheque is sent)
- Street - Address (where cheque is sent)
- Street name - Address (where cheque is sent)
- City - Address (where cheque is sent)
- ProvinceTerritory - Address (where cheque is sent)
- Postal code - Address (where cheque is sent)
- Date (YYY-MM-DD) - Auditor signature
- Unit - Campaign office address (optional)
- Street - Campaign office address (optional)
- Street name - Campaign office address (optional)
- City - Campaign office address (optional)
- ProvinceTerritory- Campaign office address (optional)
- Postal code - Campaign office address (optional)
- Name of witness
- Full address of witness
- Name of candidate
- Electoral district
- Year
- Name of candidate2
- Electoral district2
- Year2
- Name of witness2
- Full address of witness2
- Name of candidate3
- Electoral district3
- Year3
- Full address of witness3
- Name of witness3
- Name of candidate 4
- Electoral district4
- Year4
- Full address of witness 4
- Name of witness 4
- Name of candidate5
- Electoral district5
- Year5
- Full address of witness5
- Name of witness5
- Name of candidate6
- Electoral district6
- Year6
- Name of witness6
- Full address of witness6
- Name of candidate7
- Electoral district7
- Year7
- Full address of witness7
- Name of witness7
- Name of candidate8
- Electoral district8
- Year8
- Full address of witness8
- Name of witness8
- Name of candidate9
- Electoral district9
- Year9
- Full address of witness 9
- Name of witness 9
- Name of candidate10
- Electoral district10
- Year10
- Full address of witness10
- Name of witness10
- Name of candidate11
- Electoral district11
- Year11
- Full address of witness11
- Name of witness11
- Name of candidate12
- Electoral district12
- Year12
- Full address of witness12
- Name of witness12
- Name of candidate13
- Electoral district13
- Year13
- Full address of witness13
- Name of witness13
- Name of candidate14
- Electoral district14
- Year14
- Name of witness14
- Full address of witness14
- Name of candidate1
- Electoral district1
- Year1
- Name of witness1
- Full address of witness1
- Name of candidate15
- Electoral district15
- Year15
- Name of witness15
- Full address of witness15
- unit -Mailing address
- Street -Mailing address
- Street name -Mailing address
- City -Mailing address
- ProvinceTerritory -Mailing address
- Postal code -Mailing address
- Unit - Mailing address -Campaign delegate
- Street - Mailing address -Campaign delegate
- Street name - Mailing address -Campaign delegate
- City - Mailing address -Campaign delegate
- ProvinceTerritory- Mailing address -Campaign delegate
- Postal code- Mailing address -Campaign delegate
- Unit -Mailing address - Official Agent
- Street -Mailing address - Official Agent
- Street name -Mailing address - Official Agent
- city -Mailing address - Official Agent
- ProvinceTerritory-Mailing address - Official Agent
- Postal code-Mailing address - Official Agent
EC 20010 (052019)
Table of Contents
General Information 2
Section A ndash Candidate Information (Mandatory) 4
Section B ndash Campaign Delegate (Optional) 8
Section C ndash Official Agent (Mandatory) 10
Section D ndash Auditor (Optional) 12
Section E ndash Campaign Office (Optional) 14
Section F ndash Electors Consenting To Candidacy (Mandatory) 15
Section G ndash Are You Ready To Submit Your Nomination 31
1
EC 20010 (052019)
0BGeneral Information
Candidate Qualifications Any Canadian citizen aged 18 or older on election day can run for election unless deemed to be ineligible under section 65 of the Canada Elections Act (CEA) which states that the following persons are not eligible to be a candidate
bull a person who is not qualified as an elector on the date on which his or her Nomination Paper isfiled
bull a person who is disentitled under paragraph 502(3)(a) while they are so disentitled
bull a member of the legislative assembly of a province
bull the Chief Electoral Officer
bull a judge appointed by the Governor in Council other than a citizenship judge appointed underthe Citizenship Act
bull a person who is imprisoned in a correctional institution
bull an election officer and
bull a person who was a candidate in a previous election and for whom a return report document ordeclaration has not been provided under subsection 47759(1) if the time and any extension forproviding it have expired
You may seek election in only one electoral district at a time however you are not required to be a resident of that electoral district The relevant procedures and candidate responsibilities are set out in Part 6 of the CEA
Candidate Identification and Use of an Alternative Name When filing your Nomination Paper you must provide proof of your identity to the returning officer You can submit identification documents directly or copies may be provided by the person filing the Nomination Paper as long as the copies are signed by you
If you want to appear on the ballot under an alternative name you must supply documentation to the returning officer proving that you are commonly known by that name This will be required when you want to use a different given name (even if it is a normal abbreviation of the name) or a different last name (eg your married name if it is not your legal last name) For additional information including the lists of authorized identification documents and documents to support that you are commonly known by a different name please consult the Candidate List of Authorized ID (EC 20014) available on the How to become a candidate page on the Elections Canada website
Political Party Endorsement If you are running as an endorsed candidate of a political party your party must submit a document indicating that they have endorsed you to the Chief Electoral Officer no later than 24 hours before the close of the nomination period The returning officer cannot confirm your Nomination Paper until the party has confirmed their endorsement of you We suggest you contact your political party prior to submitting your Nomination Paper to confirm that this information has been submitted
2
EC 20010 (052019)
1BGeneral Information
Collecting Signatures of Electors Consenting to Candidacy You must supply the names addresses and signatures of at least 100 qualified electors (Canadian citizens at least 18 years old on election day) who ordinarily reside in the electoral district where you intend to run as a candidate Elections Canada recommends that you collect 150 or more signatures to ensure that you meet this requirement Note In the larger or remote electoral districts listed in Schedule 3 of the CEA the required minimum number of signatures is 50 Note For the next general election the previously prescribed pages for collecting signatures (Part 7 of the Nomination Paper) will be accepted
Deadline to Submit Nomination Paper The completed Nomination Paper and all associated supporting documents must be submitted to the returning officer Nominations may be submitted by either you or your campaign delegate In accordance with the CEA the Nomination Paper must be filed between the day the returning officer publishes the Notice of Election and the close of nominations 21 days before election day at 200 pm local time The returning office contact information will be available on the Elections Canada website once the writ of election is issued We suggest making an appointment with the returning officer early during the nomination period so there is sufficient time if required to correct the Nomination Paper before the close of nominations
Offence It is an offence under section 89 and paragraph 486(3)(a) of the CEA to consent to be a candidate when you are not eligible It is also an offence under paragraph 499(2)(a) and subsection 549(3) of the CEA to falsely take an oath that is provided for by the CEA
Public Inspection Any person may examine the completed Nomination Paper at the office of the returning officer during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document The Nomination Paper may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
For More Information If you require additional information visit the How to become a candidate page on the Elections Canada website or contact the Political Entities Support Network directly
Telephone 1-800-486-6563TTY 1-800-361-8935Email CSEP-PESCelectionscaMail Elections Canada
30 Victoria StreetGatineau QuebecK1A 0M6
3
EC 20010 (052019)
SECTION A ndash 2BCandidate Information (Mandatory)
All fields marked with are mandatory
Electoral district
Print the name of the electoral district you are running in You may run in only one electoral district at a time You do not need to reside in the district
Name of electoral district
Candidate name
Print your first name and last name The name must not include any title degree or other prefix or suffix When you file the Nomination Paper you must provide the returning officer with proof of identity that matches the first and last name as identified below CEA 66(2) 67(2)(a)(b)
First name(s) Last name
Name on ballot
You may request an alternative name to appear on the ballot however you must provide the returning officer with sufficient documentation that you are commonly known by that name For more information on authorized proof see the How to become a candidate webpage at electionsca CEA 67(5)
Ballot name
Option 1 Use first and last name as provided above (leave fields below blank)
Option 2 Use other name (complete fields below)
Ballot first name(s) Ballot last name
Political affiliation
State your political affiliation (name of the registered or eligible political party or ldquoIndependentrdquo) In the absence of a stated political affiliation a series of black dashes will appear under your name on the ballot Note In order to have a political party affiliation on the ballot the party must file an endorsement with Elections Canada It is strongly recommended you confirm with your political party and local returning officer to better ensure that your name has been submitted
Political affiliation
4
ndash
EC 20010 (052019)
25BSECTION A ndash Candidate Information (Mandatory)
All fields marked with are mandatory
Candidate information
Gender Date of birth (YYYY-MM-DD) Language of correspondence
English French
Contact information
Upon confirmation of the nomination Elections Canada will send to the email address listed below an invitation to the Political Entities Service Centre (PESC) online portal
Primary phone number Ext Alternate phone number Ext Fax number
Residential address
Unit Street Street name
City ProvinceTerritory Postal code
Mailing address Same as residential address
Unit Street Street name
City ProvinceTerritory Postal code
5
EC 20010 (052019)
26BSECTION A ndash Candidate Information (Mandatory)
All fields marked with are mandatory
Candidate occupation
State the occupation you are commonly known by in your place of ordinary residence Please note that the term ldquoMember of Parliamentrdquo is not an occupation but a title and will not be accepted The term ldquoparliamentarianrdquo however is acceptable CEA 66(3)
Occupation
Sharing of information with the Conflict of Interest and Ethics Commissioner and the House of Commons including the Library of Parliament
To help new members of Parliament Elections Canada will share the name gender residential address telephone number email address occupation preferred language of correspondence electoral district and political party affiliation of candidates who authorize Elections Canada to share their information with the Conflict of Interest and Ethics Commissioner and the House of Commons which includes the Library of Parliament
Do you authorize Elections Canada to share your personal information with the Conflict of Interest and Ethics Commissioner and the House of Commons including the Library of Parliament
Yes No
Privacy notice
Personal information in this Nomination Paper and all associated supporting documents are collected to determine your eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
Any person at the returning office may examine the completed Nomination Paper during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
Subject to consent your contact information may be shared with the House of Commons Conflict of Interest and Ethics Commissioner and Library of Parliament for orientation and communication purposes for new Members of Parliament If you provide a URL it may be posted on Elections Canadarsquos website to increase electorsrsquo accessibility to the electoral framework and democratic process
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information
Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB may be found on the Elections Canada website
6
a
b
c
EC 20010 (052019)
SECTION A ndash Candidate Declaration and Signature (Mandatory)
All fields marked with are mandatory
Candidatersquos declaration
I the undersigned do hereby solemnly declare that
1 my name (including any alternative name I wish to have appear on the ballot) my addressand occupation are as stated in section A of this Nomination Paper
2 I designate the permanent residential address in this Nomination Paper as the address forservice of process and papers under the Canada Elections Act
3 the name and address of my official agent and the name address and occupation of myauditor (if applicable) are as stated in sections C and D of this Nomination Paper
4 the information regarding my political affiliation is as stated in section A of this NominationPaper and
5 where applicable if the returning officer is unable to verify that I have been endorsed by thepolitical party identified in section A of this Nomination Paper I wish to
Have the word ldquoindependentrdquo appear under my name on the ballot
have no designation of political affiliation (meaning that a series of black dashes will appear under my name on the ballot) or
withdraw my Nomination paper
I further state that
1 I consent to the nomination
2 I am a Canadian citizen at least 18 years of age on election day
3 as per section 65 of the Canada Elections Act I am not ineligible to be a candidate
4 I consent to allowing my official agent and candidate campaign delegate (if applicable) toaccess on my behalf electoral materials online or at the local Elections Canada officeincluding the lists of electors distributed by Elections Canada and
5 I am aware of my obligations under the Canada Elections Act
Candidate signature Date (YYYY-MM-DD)
Signature of person receiving the solemn declaration
As per subsection 549(1) of the Canada Elections Act the solemn declaration must be witnessed by a judge an election officer a unit election officer as defined in section 177 a notary public a provincial court judge a justice of the peace or a commissioner for taking oaths in the province
Signature of person receiving the solemn declaration Date (YYYY-MM-DD)
7
ndash
EC 20010 (052019)
SECTION B ndash 3BCampaign Delegate (Optional)
If appointing a campaign delegate all fields marked with are mandatory
Campaign delegate information
A candidate may authorize another individual (referred to in the Nomination Paper as the campaign delegate) to act on their behalf during the election The campaign delegate can submit the Nomination Paper and all associated supporting documents CEA 67(7) Note The campaign delegate does not have access to the candidatersquos financial returns
First name Last name Language of correspondence
English French
Contact information
Upon confirmation of the nomination Elections Canada will send to the email address listed below an invitation to the Political Entities Service Centre (PESC) online portal
Primary phone number Ext Alternate phone number Ext Fax number
Residential address
Unit Street Street name
City ProvinceTerritory Postal code
Mailing address Same as residential address
Unit Street Street name
City ProvinceTerritory Postal code
8
EC 20010 (052019)
SECTION B ndash Campaign Delegate ndash Privacy Notice and Declaration (Optional)
If appointing a campaign delegate all fields marked with are mandatory
Privacy notice
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA) Any person at the returning office may examine the completed Nomination Paper during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
Candidate authorization of the campaign delegate
As per subsection 66(1)(h) of the Canada Elections Act I authorize the individual identified in this section to act as my campaign delegate
Candidate signature Date (YYYY-MM-DD)
Candidate campaign delegate signature
I the undersigned candidate campaign delegate for the candidate named in this Nomination Paper state that
1 I hereby agree to act as the authorized person for the candidate named herein for the purposes of theCanada Elections Act
2 I am fully aware of the duties and responsibilities imposed on me by the Canada Elections Act
Campaign delegate signature Date (YYYY-MM-DD)
9
ndash
EC 20010 (052019)
SECTION C ndash 4BOfficial Agent (Mandatory)
All fields marked with are mandatory
Official agent information
The official agent is responsible for administering the campaignrsquos financial transactions and reporting those transactions to Elections Canada as required by the CEA For more information consult the Political Financing Handbook for Candidates and Official Agents Note The candidate official agent and auditor must all be different people
First name Last name Language of correspondence
English French
Contact information
Upon confirmation of the nomination Elections Canada will send to the email address listed below an invitation to the Political Entities Service Centre (PESC) online portal
Primary phone number Ext Alternate phone number Ext Fax number
Residential address Unit Street Street name
City ProvinceTerritory Postal code
Mailing address Same as residential address
Unit Street Street name
City ProvinceTerritory Postal code
10
EC 20010 (052019)
24BSECTION C ndash Official Agent ndash Privacy Notice and Declaration (Mandatory)
All fields marked with are mandatory
Privacy notice
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA) Any person at the returning office may examine the completed Nomination Paper during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
Official agent signature
I the undersigned official agent for the candidate named in this Nomination Paper hereby agree to act as official agent for the candidate named herein for the purposes of the Canada Elections Act I further state that
1 I am fully aware of the duties and responsibilities imposed on me by the Canada Elections Act
2 I am capable of entering into contracts in the provinceterritory in which this electoral district is located
3 I am eligible to act as official agent pursuant to section 4772 of the Canada Elections Act
Section 4772 of the Canada Elections Act states The following persons are ineligible to be an official agenta candidate an election officer or a member of the staff of a returning office an undischarged bankrupt anauditor appointed as required by this Act a person who is not qualified as an elector and a person who doesnot have the capacity to enter into contracts in the province in which they ordinarily reside
Official agent signature Date (YYYY-MM-DD)
11
EC 20010 (052019)
SECTION D ndash 5B Auditor (Optional)
If appointing an auditor all fields marked with are mandatory
Auditor information An auditor must be appointed if bull the candidatersquos campaign accepts contributions of $10000 or more bull the candidatersquos campaign incurs expenses of $10000 or more or bull the candidate receives 10 or more of votes cast in the electoral district If at the time of filing the Nomination Paper none of the above applies you do not need to appoint an auditor though you may still choose to do so If the above requirements are later met you must appoint an auditor without delay A person or partnership who wants to act as a candidatersquos auditor must be or have every partner be recognized as a professional accountant under provincial or territorial legislation CEA 4773(1) For more information consult the Political Financing Handbook for Candidates and Official Agents
First name Last name Language of correspondence
English French
Contact information Upon confirmation of the nomination Elections Canada will send to the email address listed below an invitation to the Political Entities Service Centre (PESC) online portal
Primary phone number Ext Alternate phone number Ext Fax number
Auditor organizational information Name of firm Occupation of auditor Professional designation
CPA FCPA
Designation registration number Make cheque payable to
Address (where cheque is sent) Unit Street Street name
City ProvinceTerritory Postal code
12
EC 20010 (052019)
SECTION D ndash Auditor ndash Privacy Notice and Declaration (Optional)
If appointing an auditor all fields marked with are mandatory
Privacy notice
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA) Any person at the returning office may examine the completed Nomination Paper during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information
Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
Auditor signature
I the undersigned hereby agree to act as the auditor for the candidate named in this Nomination Paper I further state that I am aware of the duties and responsibilities of this position under the Canada Elections Act and I am qualified to act as auditor under subsection 4773(1) and (2) of the Canada Elections Act
Auditor signature Date (YYYY-MM-DD)
13
EC 20010 (052019)
SECTION E ndash 6BCampaign Office (Optional)
Contact information to be made available on the Elections Canada website (optional)
Please note You may provide a telephone number andor a link to your website or social media platform of choice when filing your Nomination Paper with Elections Canada You do not have to provide this information but it is intended to help electors access campaign information Elections Canada may provide this information as part of the Voter Information Service Please include the full website address including prefix (http https)
Telephone number to be posted on electionsca
Website to be posted on electionsca (including prefix http https)
Campaign office address (optional)
Unit Street Street name
City ProvinceTerritory Postal code
14
SECTION F ndash 7BElectors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
15
8BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
16
9BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
17
10BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
18
11BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
19
12BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
20
13BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
21
14BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
22
15BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
23
16BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
24
17BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
25
18BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
26
19BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
27
20BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
28
21BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
29
22BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
30
EC 20010 (022019)
SECTION G ndash 23B Are You Ready to Submit Your Nomination
Have you completed the Nomination Paper (EC 20010)
bull Are all mandatory fields in sections AndashE complete
bull Have you collected the required number of signatures from qualified electors in section F
o For most electoral districts 100 electors must consent to your candidacy
o For electoral districts identified in Schedule 3 only 50 electors are required
o To ensure a smooth nomination process Elections Canada recommends collecting signatures from at least 150 electors
Do you have authorized proof of identify
bull For a list of authorized identification visit the Elections Canada website
bull If a campaign delegate is submitting on your behalf they must bring a copy of your identification documents signed by you
bull If you want an alternative name to appear on the ballot additional documentation is required visit electionsca for details
Are you endorsed by a political party
bull Make sure your party has submitted the required documentation to Elections Canada attesting your designated political affiliation
Have you made a nomination appointment
bull To facilitate the nomination process make an appointment with the returning officer to finalize the filing of the complete nomination package
bull The nomination period closes 21 days before election day at 200 pm local time
31
- Nomination Paperof a Candidate at a Federal General Election or By-election
- Table of Contents
- General Information
- SECTION A ndash Candidate Information (Mandatory)
- SECTION B ndash Campaign Delegate (Optional)
- SECTION C ndash Official Agent (Mandatory)
- SECTION D ndash Auditor (Optional)
- SECTION E ndash Campaign Office (Optional)
- SECTION F ndash Electors Consenting to Candidacy (Mandatory)
-
- Name of electoral district
- Political affiliation
- Telephone number to be posted on electionsca
- Website to be posted on electionsca including prefix http https
- Printed name of elector1
- Full residential address street numbernamecity1
- Postal code1
- Elector signature1
- Witness initials1
- Internal use only1
- Printed name of elector2
- Full residential address street numbernamecity2
- Postal code2
- Elector signature2
- Witness initials2
- Internal use only2
- Printed name of elector3
- Full residential address street numbernamecity3
- Postal code3
- Elector signature3
- Witness initials3
- Internal use only3
- Printed name of elector4
- Full residential address street numbernamecity4
- Postal code4
- Elector signature4
- Witness initials4
- Internal use only4
- Printed name of elector5
- Full residential address street numbernamecity5
- Postal code5
- Elector signature5
- Witness initials5
- Internal use only5
- Printed name of elector6
- Full residential address street numbernamecity6
- Postal code6
- Elector signature6
- Witness initials6
- Internal use only6
- Printed name of elector7
- Full residential address street numbernamecity7
- Postal code7
- Elector signature7
- Witness initials7
- Internal use only7
- Printed name of elector8
- Full residential address street numbernamecity8
- Postal code8
- Elector signature8
- Witness initials8
- Internal use only8
- Printed name of elector9
- Full residential address street numbernamecity9
- Postal code9
- Elector signature9
- Witness initials9
- Internal use only9
- Printed name of elector10
- Full residential address street numbernamecity10
- Postal code10
- Elector signature10
- Witness initials10
- Internal use only10
- Printed name of elector1_2
- Full residential address street numbernamecity1_2
- Postal code1_2
- Elector signature1_2
- Witness initials1_2
- Internal use only1_2
- Printed name of elector2_2
- Full residential address street numbernamecity2_2
- Postal code2_2
- Elector signature2_2
- Witness initials2_2
- Internal use only2_2
- Printed name of elector3_2
- Full residential address street numbernamecity3_2
- Postal code3_2
- Elector signature3_2
- Witness initials3_2
- Internal use only3_2
- Printed name of elector4_2
- Full residential address street numbernamecity4_2
- Postal code4_2
- Elector signature4_2
- Witness initials4_2
- Internal use only4_2
- Printed name of elector5_2
- Full residential address street numbernamecity5_2
- Postal code5_2
- Elector signature5_2
- Witness initials5_2
- Internal use only5_2
- Printed name of elector6_2
- Full residential address street numbernamecity6_2
- Postal code6_2
- Elector signature6_2
- Witness initials6_2
- Internal use only6_2
- Printed name of elector7_2
- Full residential address street numbernamecity7_2
- Postal code7_2
- Elector signature7_2
- Witness initials7_2
- Internal use only7_2
- Printed name of elector8_2
- Full residential address street numbernamecity8_2
- Postal code8_2
- Elector signature8_2
- Witness initials8_2
- Internal use only8_2
- Printed name of elector9_2
- Full residential address street numbernamecity9_2
- Postal code9_2
- Elector signature9_2
- Witness initials9_2
- Internal use only9_2
- Printed name of elector10_2
- Full residential address street numbernamecity10_2
- Postal code10_2
- Elector signature10_2
- Witness initials10_2
- Internal use only10_2
- Printed name of elector1_3
- Full residential address street numbernamecity1_3
- Postal code1_3
- Elector signature1_3
- Witness initials1_3
- Internal use only1_3
- Printed name of elector2_3
- Full residential address street numbernamecity2_3
- Postal code2_3
- Elector signature2_3
- Witness initials2_3
- Internal use only2_3
- Printed name of elector3_3
- Full residential address street numbernamecity3_3
- Postal code3_3
- Elector signature3_3
- Witness initials3_3
- Internal use only3_3
- Printed name of elector4_3
- Full residential address street numbernamecity4_3
- Postal code4_3
- Elector signature4_3
- Witness initials4_3
- Internal use only4_3
- Printed name of elector5_3
- Full residential address street numbernamecity5_3
- Postal code5_3
- Elector signature5_3
- Witness initials5_3
- Internal use only5_3
- Printed name of elector6_3
- Full residential address street numbernamecity6_3
- Postal code6_3
- Elector signature6_3
- Witness initials6_3
- Internal use only6_3
- Printed name of elector7_3
- Full residential address street numbernamecity7_3
- Postal code7_3
- Elector signature7_3
- Witness initials7_3
- Internal use only7_3
- Printed name of elector8_3
- Full residential address street numbernamecity8_3
- Postal code8_3
- Elector signature8_3
- Witness initials8_3
- Internal use only8_3
- Printed name of elector9_3
- Full residential address street numbernamecity9_3
- Postal code9_3
- Elector signature9_3
- Witness initials9_3
- Internal use only9_3
- Printed name of elector10_3
- Full residential address street numbernamecity10_3
- Postal code10_3
- Elector signature10_3
- Witness initials10_3
- Internal use only10_3
- Printed name of elector1_4
- Full residential address street numbernamecity1_4
- Postal code1_4
- Elector signature1_4
- Witness initials1_4
- Internal use only1_4
- Printed name of elector2_4
- Full residential address street numbernamecity2_4
- Postal code2_4
- Elector signature2_4
- Witness initials2_4
- Internal use only2_4
- Printed name of elector3_4
- Full residential address street numbernamecity3_4
- Postal code3_4
- Elector signature3_4
- Witness initials3_4
- Internal use only3_4
- Printed name of elector4_4
- Full residential address street numbernamecity4_4
- Postal code4_4
- Elector signature4_4
- Witness initials4_4
- Internal use only4_4
- Printed name of elector5_4
- Full residential address street numbernamecity5_4
- Postal code5_4
- Elector signature5_4
- Witness initials5_4
- Internal use only5_4
- Printed name of elector6_4
- Full residential address street numbernamecity6_4
- Postal code6_4
- Elector signature6_4
- Witness initials6_4
- Internal use only6_4
- Printed name of elector7_4
- Full residential address street numbernamecity7_4
- Postal code7_4
- Elector signature7_4
- Witness initials7_4
- Internal use only7_4
- Printed name of elector8_4
- Full residential address street numbernamecity8_4
- Postal code8_4
- Elector signature8_4
- Witness initials8_4
- Internal use only8_4
- Printed name of elector9_4
- Full residential address street numbernamecity9_4
- Postal code9_4
- Elector signature9_4
- Witness initials9_4
- Internal use only9_4
- Printed name of elector10_4
- Full residential address street numbernamecity10_4
- Postal code10_4
- Elector signature10_4
- Witness initials10_4
- Internal use only10_4
- Printed name of elector1_5
- Full residential address street numbernamecity1_5
- Postal code1_5
- Elector signature1_5
- Witness initials1_5
- Internal use only1_5
- Printed name of elector2_5
- Full residential address street numbernamecity2_5
- Postal code2_5
- Elector signature2_5
- Witness initials2_5
- Internal use only2_5
- Printed name of elector3_5
- Full residential address street numbernamecity3_5
- Postal code3_5
- Elector signature3_5
- Witness initials3_5
- Internal use only3_5
- Printed name of elector4_5
- Full residential address street numbernamecity4_5
- Postal code4_5
- Elector signature4_5
- Witness initials4_5
- Internal use only4_5
- Printed name of elector5_5
- Full residential address street numbernamecity5_5
- Postal code5_5
- Elector signature5_5
- Witness initials5_5
- Internal use only5_5
- Printed name of elector6_5
- Full residential address street numbernamecity6_5
- Postal code6_5
- Elector signature6_5
- Witness initials6_5
- Internal use only6_5
- Printed name of elector7_5
- Full residential address street numbernamecity7_5
- Postal code7_5
- Elector signature7_5
- Witness initials7_5
- Internal use only7_5
- Printed name of elector8_5
- Full residential address street numbernamecity8_5
- Postal code8_5
- Elector signature8_5
- Witness initials8_5
- Internal use only8_5
- Printed name of elector9_5
- Full residential address street numbernamecity9_5
- Postal code9_5
- Elector signature9_5
- Witness initials9_5
- Internal use only9_5
- Printed name of elector10_5
- Full residential address street numbernamecity10_5
- Postal code10_5
- Elector signature10_5
- Witness initials10_5
- Internal use only10_5
- Printed name of elector1_6
- Full residential address street numbernamecity1_6
- Postal code1_6
- Elector signature1_6
- Witness initials1_6
- Internal use only1_6
- Printed name of elector2_6
- Full residential address street numbernamecity2_6
- Postal code2_6
- Elector signature2_6
- Witness initials2_6
- Internal use only2_6
- Printed name of elector3_6
- Full residential address street numbernamecity3_6
- Postal code3_6
- Elector signature3_6
- Witness initials3_6
- Internal use only3_6
- Printed name of elector4_6
- Full residential address street numbernamecity4_6
- Postal code4_6
- Elector signature4_6
- Witness initials4_6
- Internal use only4_6
- Printed name of elector5_6
- Full residential address street numbernamecity5_6
- Postal code5_6
- Elector signature5_6
- Witness initials5_6
- Internal use only5_6
- Printed name of elector6_6
- Full residential address street numbernamecity6_6
- Postal code6_6
- Elector signature6_6
- Witness initials6_6
- Internal use only6_6
- Printed name of elector7_6
- Full residential address street numbernamecity7_6
- Postal code7_6
- Elector signature7_6
- Witness initials7_6
- Internal use only7_6
- Printed name of elector8_6
- Full residential address street numbernamecity8_6
- Postal code8_6
- Elector signature8_6
- Witness initials8_6
- Internal use only8_6
- Printed name of elector9_6
- Full residential address street numbernamecity9_6
- Postal code9_6
- Elector signature9_6
- Witness initials9_6
- Internal use only9_6
- Printed name of elector10_6
- Full residential address street numbernamecity10_6
- Postal code10_6
- Elector signature10_6
- Witness initials10_6
- Internal use only10_6
- Printed name of elector1_7
- Full residential address street numbernamecity1_7
- Postal code1_7
- Elector signature1_7
- Witness initials1_7
- Internal use only1_7
- Printed name of elector2_7
- Full residential address street numbernamecity2_7
- Postal code2_7
- Elector signature2_7
- Witness initials2_7
- Internal use only2_7
- Printed name of elector3_7
- Full residential address street numbernamecity3_7
- Postal code3_7
- Elector signature3_7
- Witness initials3_7
- Internal use only3_7
- Printed name of elector4_7
- Full residential address street numbernamecity4_7
- Postal code4_7
- Elector signature4_7
- Witness initials4_7
- Internal use only4_7
- Printed name of elector5_7
- Full residential address street numbernamecity5_7
- Postal code5_7
- Elector signature5_7
- Witness initials5_7
- Internal use only5_7
- Printed name of elector6_7
- Full residential address street numbernamecity6_7
- Postal code6_7
- Elector signature6_7
- Witness initials6_7
- Internal use only6_7
- Printed name of elector7_7
- Full residential address street numbernamecity7_7
- Postal code7_7
- Elector signature7_7
- Witness initials7_7
- Internal use only7_7
- Printed name of elector8_7
- Full residential address street numbernamecity8_7
- Postal code8_7
- Elector signature8_7
- Witness initials8_7
- Internal use only8_7
- Printed name of elector9_7
- Full residential address street numbernamecity9_7
- Postal code9_7
- Elector signature9_7
- Witness initials9_7
- Internal use only9_7
- Printed name of elector10_7
- Full residential address street numbernamecity10_7
- Postal code10_7
- Elector signature10_7
- Witness initials10_7
- Internal use only10_7
- Printed name of elector1_8
- Full residential address street numbernamecity1_8
- Postal code1_8
- Elector signature1_8
- Witness initials1_8
- Internal use only1_8
- Printed name of elector2_8
- Full residential address street numbernamecity2_8
- Postal code2_8
- Elector signature2_8
- Witness initials2_8
- Internal use only2_8
- Printed name of elector3_8
- Full residential address street numbernamecity3_8
- Postal code3_8
- Elector signature3_8
- Witness initials3_8
- Internal use only3_8
- Printed name of elector4_8
- Full residential address street numbernamecity4_8
- Postal code4_8
- Elector signature4_8
- Witness initials4_8
- Internal use only4_8
- Printed name of elector5_8
- Full residential address street numbernamecity5_8
- Postal code5_8
- Elector signature5_8
- Witness initials5_8
- Internal use only5_8
- Printed name of elector6_8
- Full residential address street numbernamecity6_8
- Postal code6_8
- Elector signature6_8
- Witness initials6_8
- Internal use only6_8
- Printed name of elector7_8
- Full residential address street numbernamecity7_8
- Postal code7_8
- Elector signature7_8
- Witness initials7_8
- Internal use only7_8
- Printed name of elector8_8
- Full residential address street numbernamecity8_8
- Postal code8_8
- Elector signature8_8
- Witness initials8_8
- Internal use only8_8
- Printed name of elector9_8
- Full residential address street numbernamecity9_8
- Postal code9_8
- Elector signature9_8
- Witness initials9_8
- Internal use only9_8
- Printed name of elector10_8
- Full residential address street numbernamecity10_8
- Postal code10_8
- Elector signature10_8
- Witness initials10_8
- Internal use only10_8
- Printed name of elector1_9
- Full residential address street numbernamecity1_9
- Postal code1_9
- Elector signature1_9
- Witness initials1_9
- Internal use only1_9
- Printed name of elector2_9
- Full residential address street numbernamecity2_9
- Postal code2_9
- Elector signature2_9
- Witness initials2_9
- Internal use only2_9
- Printed name of elector3_9
- Full residential address street numbernamecity3_9
- Postal code3_9
- Elector signature3_9
- Witness initials3_9
- Internal use only3_9
- Printed name of elector4_9
- Full residential address street numbernamecity4_9
- Postal code4_9
- Elector signature4_9
- Witness initials4_9
- Internal use only4_9
- Printed name of elector5_9
- Full residential address street numbernamecity5_9
- Postal code5_9
- Elector signature5_9
- Witness initials5_9
- Internal use only5_9
- Printed name of elector6_9
- Full residential address street numbernamecity6_9
- Postal code6_9
- Elector signature6_9
- Witness initials6_9
- Internal use only6_9
- Printed name of elector7_9
- Full residential address street numbernamecity7_9
- Postal code7_9
- Elector signature7_9
- Witness initials7_9
- Internal use only7_9
- Printed name of elector8_9
- Full residential address street numbernamecity8_9
- Postal code8_9
- Elector signature8_9
- Witness initials8_9
- Internal use only8_9
- Printed name of elector9_9
- Full residential address street numbernamecity9_9
- Postal code9_9
- Elector signature9_9
- Witness initials9_9
- Internal use only9_9
- Printed name of elector10_9
- Full residential address street numbernamecity10_9
- Postal code10_9
- Elector signature10_9
- Witness initials10_9
- Internal use only10_9
- Printed name of elector1_10
- Full residential address street numbernamecity1_10
- Postal code1_10
- Elector signature1_10
- Witness initials1_10
- Internal use only1_10
- Printed name of elector2_10
- Full residential address street numbernamecity2_10
- Postal code2_10
- Elector signature2_10
- Witness initials2_10
- Internal use only2_10
- Printed name of elector3_10
- Full residential address street numbernamecity3_10
- Postal code3_10
- Elector signature3_10
- Witness initials3_10
- Internal use only3_10
- Printed name of elector4_10
- Full residential address street numbernamecity4_10
- Postal code4_10
- Elector signature4_10
- Witness initials4_10
- Internal use only4_10
- Printed name of elector5_10
- Full residential address street numbernamecity5_10
- Postal code5_10
- Elector signature5_10
- Witness initials5_10
- Internal use only5_10
- Printed name of elector6_10
- Full residential address street numbernamecity6_10
- Postal code6_10
- Elector signature6_10
- Witness initials6_10
- Internal use only6_10
- Printed name of elector7_10
- Full residential address street numbernamecity7_10
- Postal code7_10
- Elector signature7_10
- Witness initials7_10
- Internal use only7_10
- Printed name of elector8_10
- Full residential address street numbernamecity8_10
- Postal code8_10
- Elector signature8_10
- Witness initials8_10
- Internal use only8_10
- Printed name of elector9_10
- Full residential address street numbernamecity9_10
- Postal code9_10
- Elector signature9_10
- Witness initials9_10
- Internal use only9_10
- Printed name of elector10_10
- Full residential address street numbernamecity10_10
- Postal code10_10
- Elector signature10_10
- Witness initials10_10
- Internal use only10_10
- Printed name of elector1_11
- Full residential address street numbernamecity1_11
- Postal code1_11
- Elector signature1_11
- Witness initials1_11
- Internal use only1_11
- Printed name of elector2_11
- Full residential address street numbernamecity2_11
- Postal code2_11
- Elector signature2_11
- Witness initials2_11
- Internal use only2_11
- Printed name of elector3_11
- Full residential address street numbernamecity3_11
- Postal code3_11
- Elector signature3_11
- Witness initials3_11
- Internal use only3_11
- Printed name of elector4_11
- Full residential address street numbernamecity4_11
- Postal code4_11
- Elector signature4_11
- Witness initials4_11
- Internal use only4_11
- Printed name of elector5_11
- Full residential address street numbernamecity5_11
- Postal code5_11
- Elector signature5_11
- Witness initials5_11
- Internal use only5_11
- Printed name of elector6_11
- Full residential address street numbernamecity6_11
- Postal code6_11
- Elector signature6_11
- Witness initials6_11
- Internal use only6_11
- Printed name of elector7_11
- Full residential address street numbernamecity7_11
- Postal code7_11
- Elector signature7_11
- Witness initials7_11
- Internal use only7_11
- Printed name of elector8_11
- Full residential address street numbernamecity8_11
- Postal code8_11
- Elector signature8_11
- Witness initials8_11
- Internal use only8_11
- Printed name of elector9_11
- Full residential address street numbernamecity9_11
- Postal code9_11
- Elector signature9_11
- Witness initials9_11
- Internal use only9_11
- Printed name of elector10_11
- Full residential address street numbernamecity10_11
- Postal code10_11
- Elector signature10_11
- Witness initials10_11
- Internal use only10_11
- Printed name of elector1_12
- Full residential address street numbernamecity1_12
- Postal code1_12
- Elector signature1_12
- Witness initials1_12
- Internal use only1_12
- Printed name of elector2_12
- Full residential address street numbernamecity2_12
- Postal code2_12
- Elector signature2_12
- Witness initials2_12
- Internal use only2_12
- Printed name of elector3_12
- Full residential address street numbernamecity3_12
- Postal code3_12
- Elector signature3_12
- Witness initials3_12
- Internal use only3_12
- Printed name of elector4_12
- Full residential address street numbernamecity4_12
- Postal code4_12
- Elector signature4_12
- Witness initials4_12
- Internal use only4_12
- Printed name of elector5_12
- Full residential address street numbernamecity5_12
- Postal code5_12
- Elector signature5_12
- Witness initials5_12
- Internal use only5_12
- Printed name of elector6_12
- Full residential address street numbernamecity6_12
- Postal code6_12
- Elector signature6_12
- Witness initials6_12
- Internal use only6_12
- Printed name of elector7_12
- Full residential address street numbernamecity7_12
- Postal code7_12
- Elector signature7_12
- Witness initials7_12
- Internal use only7_12
- Printed name of elector8_12
- Full residential address street numbernamecity8_12
- Postal code8_12
- Elector signature8_12
- Witness initials8_12
- Internal use only8_12
- Printed name of elector9_12
- Full residential address street numbernamecity9_12
- Postal code9_12
- Elector signature9_12
- Witness initials9_12
- Internal use only9_12
- Printed name of elector10_12
- Full residential address street numbernamecity10_12
- Postal code10_12
- Elector signature10_12
- Witness initials10_12
- Internal use only10_12
- Printed name of elector1_13
- Full residential address street numbernamecity1_13
- Postal code1_13
- Elector signature1_13
- Witness initials1_13
- Internal use only1_13
- Printed name of elector2_13
- Full residential address street numbernamecity2_13
- Postal code2_13
- Elector signature2_13
- Witness initials2_13
- Internal use only2_13
- Printed name of elector3_13
- Full residential address street numbernamecity3_13
- Postal code3_13
- Elector signature3_13
- Witness initials3_13
- Internal use only3_13
- Printed name of elector4_13
- Full residential address street numbernamecity4_13
- Postal code4_13
- Elector signature4_13
- Witness initials4_13
- Internal use only4_13
- Printed name of elector5_13
- Full residential address street numbernamecity5_13
- Postal code5_13
- Elector signature5_13
- Witness initials5_13
- Internal use only5_13
- Printed name of elector6_13
- Full residential address street numbernamecity6_13
- Postal code6_13
- Elector signature6_13
- Witness initials6_13
- Internal use only6_13
- Printed name of elector7_13
- Full residential address street numbernamecity7_13
- Postal code7_13
- Elector signature7_13
- Witness initials7_13
- Internal use only7_13
- Printed name of elector8_13
- Full residential address street numbernamecity8_13
- Postal code8_13
- Elector signature8_13
- Witness initials8_13
- Internal use only8_13
- Printed name of elector9_13
- Full residential address street numbernamecity9_13
- Postal code9_13
- Elector signature9_13
- Witness initials9_13
- Internal use only9_13
- Printed name of elector10_13
- Full residential address street numbernamecity10_13
- Postal code10_13
- Elector signature10_13
- Witness initials10_13
- Internal use only10_13
- Printed name of elector1_14
- Full residential address street numbernamecity1_14
- Postal code1_14
- Elector signature1_14
- Witness initials1_14
- Internal use only1_14
- Printed name of elector2_14
- Full residential address street numbernamecity2_14
- Postal code2_14
- Elector signature2_14
- Witness initials2_14
- Internal use only2_14
- Printed name of elector3_14
- Full residential address street numbernamecity3_14
- Postal code3_14
- Elector signature3_14
- Witness initials3_14
- Internal use only3_14
- Printed name of elector4_14
- Full residential address street numbernamecity4_14
- Postal code4_14
- Elector signature4_14
- Witness initials4_14
- Internal use only4_14
- Printed name of elector5_14
- Full residential address street numbernamecity5_14
- Postal code5_14
- Elector signature5_14
- Witness initials5_14
- Internal use only5_14
- Printed name of elector6_14
- Full residential address street numbernamecity6_14
- Postal code6_14
- Elector signature6_14
- Witness initials6_14
- Internal use only6_14
- Printed name of elector7_14
- Full residential address street numbernamecity7_14
- Postal code7_14
- Elector signature7_14
- Witness initials7_14
- Internal use only7_14
- Printed name of elector8_14
- Full residential address street numbernamecity8_14
- Postal code8_14
- Elector signature8_14
- Witness initials8_14
- Internal use only8_14
- Printed name of elector9_14
- Full residential address street numbernamecity9_14
- Postal code9_14
- Elector signature9_14
- Witness initials9_14
- Internal use only9_14
- Printed name of elector10_14
- Full residential address street numbernamecity10_14
- Postal code10_14
- Elector signature10_14
- Witness initials10_14
- Internal use only10_14
- Printed name of elector1_15
- Full residential address street numbernamecity1_15
- Postal code1_15
- Elector signature1_15
- Witness initials1_15
- Internal use only1_15
- Printed name of elector2_15
- Full residential address street numbernamecity2_15
- Postal code2_15
- Elector signature2_15
- Witness initials2_15
- Internal use only2_15
- Printed name of elector3_15
- Full residential address street numbernamecity3_15
- Postal code3_15
- Elector signature3_15
- Witness initials3_15
- Internal use only3_15
- Printed name of elector4_15
- Full residential address street numbernamecity4_15
- Postal code4_15
- Elector signature4_15
- Witness initials4_15
- Internal use only4_15
- Printed name of elector5_15
- Full residential address street numbernamecity5_15
- Postal code5_15
- Elector signature5_15
- Witness initials5_15
- Internal use only5_15
- Printed name of elector6_15
- Full residential address street numbernamecity6_15
- Postal code6_15
- Elector signature6_15
- Witness initials6_15
- Internal use only6_15
- Printed name of elector7_15
- Full residential address street numbernamecity7_15
- Postal code7_15
- Elector signature7_15
- Witness initials7_15
- Internal use only7_15
- Printed name of elector8_15
- Full residential address street numbernamecity8_15
- Postal code8_15
- Elector signature8_15
- Witness initials8_15
- Internal use only8_15
- Printed name of elector9_15
- Full residential address street numbernamecity9_15
- Postal code9_15
- Elector signature9_15
- Witness initials9_15
- Internal use only9_15
- Printed name of elector10_15
- Full residential address street numbernamecity10_15
- Postal code10_15
- Elector signature10_15
- Witness initials10_15
- Internal use only10_15
- Printed name of elector1_16
- Full residential address street numbernamecity1_16
- Postal code1_16
- Elector signature1_16
- Witness initials1_16
- Internal use only1_16
- Printed name of elector2_16
- Full residential address street numbernamecity2_16
- Postal code2_16
- Elector signature2_16
- Witness initials2_16
- Internal use only2_16
- Printed name of elector3_16
- Full residential address street numbernamecity3_16
- Postal code3_16
- Elector signature3_16
- Witness initials3_16
- Internal use only3_16
- Printed name of elector4_16
- Full residential address street numbernamecity4_16
- Postal code4_16
- Elector signature4_16
- Witness initials4_16
- Internal use only4_16
- Printed name of elector5_16
- Full residential address street numbernamecity5_16
- Postal code5_16
- Elector signature5_16
- Witness initials5_16
- Internal use only5_16
- Printed name of elector6_16
- Full residential address street numbernamecity6_16
- Postal code6_16
- Elector signature6_16
- Witness initials6_16
- Internal use only6_16
- Printed name of elector7_16
- Full residential address street numbernamecity7_16
- Postal code7_16
- Elector signature7_16
- Witness initials7_16
- Internal use only7_16
- Printed name of elector8_16
- Full residential address street numbernamecity8_16
- Postal code8_16
- Elector signature8_16
- Witness initials8_16
- Internal use only8_16
- Printed name of elector9_16
- Full residential address street numbernamecity9_16
- Postal code9_16
- Elector signature9_16
- Witness initials9_16
- Internal use only9_16
- Printed name of elector10_16
- Full residential address street numbernamecity10_16
- Postal code10_16
- Elector signature10_16
- Witness initials10_16
- Internal use only10_16
- Have you completed the Nomination Paper EC 20010 Off
- Do you have authorized proof of identify Off
- Are you endorsed by a political party Off
- Have you made a nomination appointment Off
- Last name - Candidate Name
- First name - Candidate Name
- Name of electoral district- Candidate Information
- First name - Candidate Information
- Last name - Candidate Information
- Ballot Name Off
- Ballot First name(s)
- Ballot Last name(s)
- Gender -Candidate information
- Date of birth (YYY-MM-DD) - Gender -Candidate information
- language of correspondence - Candidate information Off
- Email -Contact information
- Primary phone number - Contact information
- Ext - Primary phone number
- Alternate phone number - Contact information
- Ext - Alternate phone number
- Fax number- Alternate phone number
- Unit -Residential address
- Street -Residential address
- Street name -Residential address
- City -Residential address
- ProvinceTerritory -Residential address
- Postal code - -Residential address
- Mailing address - same as residential address Off
- Occupation- Candidate occupation
- Sharing of information with the Conflict of Interest and Ethics Commissioner and the House of Commons including the Library of Parliament Off
- where applicable if the returning officer is unable to verify that I have been endorsed by the political party identified in section A of this Nomination Paper I wish to Off
- Date of Signature (YYYY-MM-DD) - Candidate signature
- Date of Signature (YYYY-MM-DD) -Signature of person receiving the solemn declaration
- Campaign delegate information
- First name - Campaign delegate information
- Last name - Campaign delegate information
- Language of correspondence - Campaign delegate information Off
- Email - Contact information -Campaign Delegate
- Primary phone number - Contact information -Campaign Delegate
- Primary phone number EXT - Contact information -Campaign Delegate
- Alternate phone number - Contact information -Campaign Delegate
- Alternate phone number EXT - Contact information -Campaign Delegate
- Fax nmuber- Contact information -Campaign Delegate
- Street - Residential address -Campaign delegate
- Street name - Residential address -Campaign delegate
- City - Residential address -Campaign delegate
- ProvinceTerritory - Residential address -Campaign delegate
- Postal Code - Residential address -Campaign delegate
- Campaign delegate - Mailing address ndash Same as residential address Off
- Unit - Residential address -Campaign delegate
- Date (YYYY-MM-DD) - Candidate authorization Signature
- Date (YYYY-MM-DD) - Candidate campaign Signature
- First name - Official agent information
- Last name - Official agent information
- Language of correspondence - Official agent information Off
- Email - Official agent information
- Primary phone number - Official agent information
- Primary phone number EXT - Official agent information
- Alternate phone number EXT - Official agent information
- Alternate phone number - Official agent information
- Fax number - Official agent information
- Unit -Residential address - Official Agent
- Street name -Residential address - Official Agent
- City -Residential address - Official Agent
- Street -Residential address - Official Agent
- ProvinceTerritory -Residential address - Official Agent
- Postal code-Residential address - Official Agent
- Mailing address ndash Same as residential address- Official Agent Off
- Date (YYYY-MM-DD) - Official agent signature
- First name - Auditor information
- Last name - Auditor information
- Language of correspondence - Auditor information Off
- Email - Auditor information
- Primary phone number - Auditor information
- Primary phone number EXT- Auditor information
- Alternate phone number - Auditor information
- Alternate phone number EXT- Auditor information
- Fax number - Auditor information
- Name of firm- Auditor organizational information
- Occupation of auditor - Auditor organizational information
- Professional designation - Auditor organizational information Off
- Designation registration number
- Make cheque payable to
- Unit - Address (where cheque is sent)
- Street - Address (where cheque is sent)
- Street name - Address (where cheque is sent)
- City - Address (where cheque is sent)
- ProvinceTerritory - Address (where cheque is sent)
- Postal code - Address (where cheque is sent)
- Date (YYY-MM-DD) - Auditor signature
- Unit - Campaign office address (optional)
- Street - Campaign office address (optional)
- Street name - Campaign office address (optional)
- City - Campaign office address (optional)
- ProvinceTerritory- Campaign office address (optional)
- Postal code - Campaign office address (optional)
- Name of witness
- Full address of witness
- Name of candidate
- Electoral district
- Year
- Name of candidate2
- Electoral district2
- Year2
- Name of witness2
- Full address of witness2
- Name of candidate3
- Electoral district3
- Year3
- Full address of witness3
- Name of witness3
- Name of candidate 4
- Electoral district4
- Year4
- Full address of witness 4
- Name of witness 4
- Name of candidate5
- Electoral district5
- Year5
- Full address of witness5
- Name of witness5
- Name of candidate6
- Electoral district6
- Year6
- Name of witness6
- Full address of witness6
- Name of candidate7
- Electoral district7
- Year7
- Full address of witness7
- Name of witness7
- Name of candidate8
- Electoral district8
- Year8
- Full address of witness8
- Name of witness8
- Name of candidate9
- Electoral district9
- Year9
- Full address of witness 9
- Name of witness 9
- Name of candidate10
- Electoral district10
- Year10
- Full address of witness10
- Name of witness10
- Name of candidate11
- Electoral district11
- Year11
- Full address of witness11
- Name of witness11
- Name of candidate12
- Electoral district12
- Year12
- Full address of witness12
- Name of witness12
- Name of candidate13
- Electoral district13
- Year13
- Full address of witness13
- Name of witness13
- Name of candidate14
- Electoral district14
- Year14
- Name of witness14
- Full address of witness14
- Name of candidate1
- Electoral district1
- Year1
- Name of witness1
- Full address of witness1
- Name of candidate15
- Electoral district15
- Year15
- Name of witness15
- Full address of witness15
- unit -Mailing address
- Street -Mailing address
- Street name -Mailing address
- City -Mailing address
- ProvinceTerritory -Mailing address
- Postal code -Mailing address
- Unit - Mailing address -Campaign delegate
- Street - Mailing address -Campaign delegate
- Street name - Mailing address -Campaign delegate
- City - Mailing address -Campaign delegate
- ProvinceTerritory- Mailing address -Campaign delegate
- Postal code- Mailing address -Campaign delegate
- Unit -Mailing address - Official Agent
- Street -Mailing address - Official Agent
- Street name -Mailing address - Official Agent
- city -Mailing address - Official Agent
- ProvinceTerritory-Mailing address - Official Agent
- Postal code-Mailing address - Official Agent
EC 20010 (052019)
0BGeneral Information
Candidate Qualifications Any Canadian citizen aged 18 or older on election day can run for election unless deemed to be ineligible under section 65 of the Canada Elections Act (CEA) which states that the following persons are not eligible to be a candidate
bull a person who is not qualified as an elector on the date on which his or her Nomination Paper isfiled
bull a person who is disentitled under paragraph 502(3)(a) while they are so disentitled
bull a member of the legislative assembly of a province
bull the Chief Electoral Officer
bull a judge appointed by the Governor in Council other than a citizenship judge appointed underthe Citizenship Act
bull a person who is imprisoned in a correctional institution
bull an election officer and
bull a person who was a candidate in a previous election and for whom a return report document ordeclaration has not been provided under subsection 47759(1) if the time and any extension forproviding it have expired
You may seek election in only one electoral district at a time however you are not required to be a resident of that electoral district The relevant procedures and candidate responsibilities are set out in Part 6 of the CEA
Candidate Identification and Use of an Alternative Name When filing your Nomination Paper you must provide proof of your identity to the returning officer You can submit identification documents directly or copies may be provided by the person filing the Nomination Paper as long as the copies are signed by you
If you want to appear on the ballot under an alternative name you must supply documentation to the returning officer proving that you are commonly known by that name This will be required when you want to use a different given name (even if it is a normal abbreviation of the name) or a different last name (eg your married name if it is not your legal last name) For additional information including the lists of authorized identification documents and documents to support that you are commonly known by a different name please consult the Candidate List of Authorized ID (EC 20014) available on the How to become a candidate page on the Elections Canada website
Political Party Endorsement If you are running as an endorsed candidate of a political party your party must submit a document indicating that they have endorsed you to the Chief Electoral Officer no later than 24 hours before the close of the nomination period The returning officer cannot confirm your Nomination Paper until the party has confirmed their endorsement of you We suggest you contact your political party prior to submitting your Nomination Paper to confirm that this information has been submitted
2
EC 20010 (052019)
1BGeneral Information
Collecting Signatures of Electors Consenting to Candidacy You must supply the names addresses and signatures of at least 100 qualified electors (Canadian citizens at least 18 years old on election day) who ordinarily reside in the electoral district where you intend to run as a candidate Elections Canada recommends that you collect 150 or more signatures to ensure that you meet this requirement Note In the larger or remote electoral districts listed in Schedule 3 of the CEA the required minimum number of signatures is 50 Note For the next general election the previously prescribed pages for collecting signatures (Part 7 of the Nomination Paper) will be accepted
Deadline to Submit Nomination Paper The completed Nomination Paper and all associated supporting documents must be submitted to the returning officer Nominations may be submitted by either you or your campaign delegate In accordance with the CEA the Nomination Paper must be filed between the day the returning officer publishes the Notice of Election and the close of nominations 21 days before election day at 200 pm local time The returning office contact information will be available on the Elections Canada website once the writ of election is issued We suggest making an appointment with the returning officer early during the nomination period so there is sufficient time if required to correct the Nomination Paper before the close of nominations
Offence It is an offence under section 89 and paragraph 486(3)(a) of the CEA to consent to be a candidate when you are not eligible It is also an offence under paragraph 499(2)(a) and subsection 549(3) of the CEA to falsely take an oath that is provided for by the CEA
Public Inspection Any person may examine the completed Nomination Paper at the office of the returning officer during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document The Nomination Paper may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
For More Information If you require additional information visit the How to become a candidate page on the Elections Canada website or contact the Political Entities Support Network directly
Telephone 1-800-486-6563TTY 1-800-361-8935Email CSEP-PESCelectionscaMail Elections Canada
30 Victoria StreetGatineau QuebecK1A 0M6
3
EC 20010 (052019)
SECTION A ndash 2BCandidate Information (Mandatory)
All fields marked with are mandatory
Electoral district
Print the name of the electoral district you are running in You may run in only one electoral district at a time You do not need to reside in the district
Name of electoral district
Candidate name
Print your first name and last name The name must not include any title degree or other prefix or suffix When you file the Nomination Paper you must provide the returning officer with proof of identity that matches the first and last name as identified below CEA 66(2) 67(2)(a)(b)
First name(s) Last name
Name on ballot
You may request an alternative name to appear on the ballot however you must provide the returning officer with sufficient documentation that you are commonly known by that name For more information on authorized proof see the How to become a candidate webpage at electionsca CEA 67(5)
Ballot name
Option 1 Use first and last name as provided above (leave fields below blank)
Option 2 Use other name (complete fields below)
Ballot first name(s) Ballot last name
Political affiliation
State your political affiliation (name of the registered or eligible political party or ldquoIndependentrdquo) In the absence of a stated political affiliation a series of black dashes will appear under your name on the ballot Note In order to have a political party affiliation on the ballot the party must file an endorsement with Elections Canada It is strongly recommended you confirm with your political party and local returning officer to better ensure that your name has been submitted
Political affiliation
4
ndash
EC 20010 (052019)
25BSECTION A ndash Candidate Information (Mandatory)
All fields marked with are mandatory
Candidate information
Gender Date of birth (YYYY-MM-DD) Language of correspondence
English French
Contact information
Upon confirmation of the nomination Elections Canada will send to the email address listed below an invitation to the Political Entities Service Centre (PESC) online portal
Primary phone number Ext Alternate phone number Ext Fax number
Residential address
Unit Street Street name
City ProvinceTerritory Postal code
Mailing address Same as residential address
Unit Street Street name
City ProvinceTerritory Postal code
5
EC 20010 (052019)
26BSECTION A ndash Candidate Information (Mandatory)
All fields marked with are mandatory
Candidate occupation
State the occupation you are commonly known by in your place of ordinary residence Please note that the term ldquoMember of Parliamentrdquo is not an occupation but a title and will not be accepted The term ldquoparliamentarianrdquo however is acceptable CEA 66(3)
Occupation
Sharing of information with the Conflict of Interest and Ethics Commissioner and the House of Commons including the Library of Parliament
To help new members of Parliament Elections Canada will share the name gender residential address telephone number email address occupation preferred language of correspondence electoral district and political party affiliation of candidates who authorize Elections Canada to share their information with the Conflict of Interest and Ethics Commissioner and the House of Commons which includes the Library of Parliament
Do you authorize Elections Canada to share your personal information with the Conflict of Interest and Ethics Commissioner and the House of Commons including the Library of Parliament
Yes No
Privacy notice
Personal information in this Nomination Paper and all associated supporting documents are collected to determine your eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
Any person at the returning office may examine the completed Nomination Paper during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
Subject to consent your contact information may be shared with the House of Commons Conflict of Interest and Ethics Commissioner and Library of Parliament for orientation and communication purposes for new Members of Parliament If you provide a URL it may be posted on Elections Canadarsquos website to increase electorsrsquo accessibility to the electoral framework and democratic process
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information
Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB may be found on the Elections Canada website
6
a
b
c
EC 20010 (052019)
SECTION A ndash Candidate Declaration and Signature (Mandatory)
All fields marked with are mandatory
Candidatersquos declaration
I the undersigned do hereby solemnly declare that
1 my name (including any alternative name I wish to have appear on the ballot) my addressand occupation are as stated in section A of this Nomination Paper
2 I designate the permanent residential address in this Nomination Paper as the address forservice of process and papers under the Canada Elections Act
3 the name and address of my official agent and the name address and occupation of myauditor (if applicable) are as stated in sections C and D of this Nomination Paper
4 the information regarding my political affiliation is as stated in section A of this NominationPaper and
5 where applicable if the returning officer is unable to verify that I have been endorsed by thepolitical party identified in section A of this Nomination Paper I wish to
Have the word ldquoindependentrdquo appear under my name on the ballot
have no designation of political affiliation (meaning that a series of black dashes will appear under my name on the ballot) or
withdraw my Nomination paper
I further state that
1 I consent to the nomination
2 I am a Canadian citizen at least 18 years of age on election day
3 as per section 65 of the Canada Elections Act I am not ineligible to be a candidate
4 I consent to allowing my official agent and candidate campaign delegate (if applicable) toaccess on my behalf electoral materials online or at the local Elections Canada officeincluding the lists of electors distributed by Elections Canada and
5 I am aware of my obligations under the Canada Elections Act
Candidate signature Date (YYYY-MM-DD)
Signature of person receiving the solemn declaration
As per subsection 549(1) of the Canada Elections Act the solemn declaration must be witnessed by a judge an election officer a unit election officer as defined in section 177 a notary public a provincial court judge a justice of the peace or a commissioner for taking oaths in the province
Signature of person receiving the solemn declaration Date (YYYY-MM-DD)
7
ndash
EC 20010 (052019)
SECTION B ndash 3BCampaign Delegate (Optional)
If appointing a campaign delegate all fields marked with are mandatory
Campaign delegate information
A candidate may authorize another individual (referred to in the Nomination Paper as the campaign delegate) to act on their behalf during the election The campaign delegate can submit the Nomination Paper and all associated supporting documents CEA 67(7) Note The campaign delegate does not have access to the candidatersquos financial returns
First name Last name Language of correspondence
English French
Contact information
Upon confirmation of the nomination Elections Canada will send to the email address listed below an invitation to the Political Entities Service Centre (PESC) online portal
Primary phone number Ext Alternate phone number Ext Fax number
Residential address
Unit Street Street name
City ProvinceTerritory Postal code
Mailing address Same as residential address
Unit Street Street name
City ProvinceTerritory Postal code
8
EC 20010 (052019)
SECTION B ndash Campaign Delegate ndash Privacy Notice and Declaration (Optional)
If appointing a campaign delegate all fields marked with are mandatory
Privacy notice
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA) Any person at the returning office may examine the completed Nomination Paper during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
Candidate authorization of the campaign delegate
As per subsection 66(1)(h) of the Canada Elections Act I authorize the individual identified in this section to act as my campaign delegate
Candidate signature Date (YYYY-MM-DD)
Candidate campaign delegate signature
I the undersigned candidate campaign delegate for the candidate named in this Nomination Paper state that
1 I hereby agree to act as the authorized person for the candidate named herein for the purposes of theCanada Elections Act
2 I am fully aware of the duties and responsibilities imposed on me by the Canada Elections Act
Campaign delegate signature Date (YYYY-MM-DD)
9
ndash
EC 20010 (052019)
SECTION C ndash 4BOfficial Agent (Mandatory)
All fields marked with are mandatory
Official agent information
The official agent is responsible for administering the campaignrsquos financial transactions and reporting those transactions to Elections Canada as required by the CEA For more information consult the Political Financing Handbook for Candidates and Official Agents Note The candidate official agent and auditor must all be different people
First name Last name Language of correspondence
English French
Contact information
Upon confirmation of the nomination Elections Canada will send to the email address listed below an invitation to the Political Entities Service Centre (PESC) online portal
Primary phone number Ext Alternate phone number Ext Fax number
Residential address Unit Street Street name
City ProvinceTerritory Postal code
Mailing address Same as residential address
Unit Street Street name
City ProvinceTerritory Postal code
10
EC 20010 (052019)
24BSECTION C ndash Official Agent ndash Privacy Notice and Declaration (Mandatory)
All fields marked with are mandatory
Privacy notice
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA) Any person at the returning office may examine the completed Nomination Paper during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
Official agent signature
I the undersigned official agent for the candidate named in this Nomination Paper hereby agree to act as official agent for the candidate named herein for the purposes of the Canada Elections Act I further state that
1 I am fully aware of the duties and responsibilities imposed on me by the Canada Elections Act
2 I am capable of entering into contracts in the provinceterritory in which this electoral district is located
3 I am eligible to act as official agent pursuant to section 4772 of the Canada Elections Act
Section 4772 of the Canada Elections Act states The following persons are ineligible to be an official agenta candidate an election officer or a member of the staff of a returning office an undischarged bankrupt anauditor appointed as required by this Act a person who is not qualified as an elector and a person who doesnot have the capacity to enter into contracts in the province in which they ordinarily reside
Official agent signature Date (YYYY-MM-DD)
11
EC 20010 (052019)
SECTION D ndash 5B Auditor (Optional)
If appointing an auditor all fields marked with are mandatory
Auditor information An auditor must be appointed if bull the candidatersquos campaign accepts contributions of $10000 or more bull the candidatersquos campaign incurs expenses of $10000 or more or bull the candidate receives 10 or more of votes cast in the electoral district If at the time of filing the Nomination Paper none of the above applies you do not need to appoint an auditor though you may still choose to do so If the above requirements are later met you must appoint an auditor without delay A person or partnership who wants to act as a candidatersquos auditor must be or have every partner be recognized as a professional accountant under provincial or territorial legislation CEA 4773(1) For more information consult the Political Financing Handbook for Candidates and Official Agents
First name Last name Language of correspondence
English French
Contact information Upon confirmation of the nomination Elections Canada will send to the email address listed below an invitation to the Political Entities Service Centre (PESC) online portal
Primary phone number Ext Alternate phone number Ext Fax number
Auditor organizational information Name of firm Occupation of auditor Professional designation
CPA FCPA
Designation registration number Make cheque payable to
Address (where cheque is sent) Unit Street Street name
City ProvinceTerritory Postal code
12
EC 20010 (052019)
SECTION D ndash Auditor ndash Privacy Notice and Declaration (Optional)
If appointing an auditor all fields marked with are mandatory
Privacy notice
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA) Any person at the returning office may examine the completed Nomination Paper during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information
Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
Auditor signature
I the undersigned hereby agree to act as the auditor for the candidate named in this Nomination Paper I further state that I am aware of the duties and responsibilities of this position under the Canada Elections Act and I am qualified to act as auditor under subsection 4773(1) and (2) of the Canada Elections Act
Auditor signature Date (YYYY-MM-DD)
13
EC 20010 (052019)
SECTION E ndash 6BCampaign Office (Optional)
Contact information to be made available on the Elections Canada website (optional)
Please note You may provide a telephone number andor a link to your website or social media platform of choice when filing your Nomination Paper with Elections Canada You do not have to provide this information but it is intended to help electors access campaign information Elections Canada may provide this information as part of the Voter Information Service Please include the full website address including prefix (http https)
Telephone number to be posted on electionsca
Website to be posted on electionsca (including prefix http https)
Campaign office address (optional)
Unit Street Street name
City ProvinceTerritory Postal code
14
SECTION F ndash 7BElectors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
15
8BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
16
9BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
17
10BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
18
11BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
19
12BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
20
13BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
21
14BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
22
15BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
23
16BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
24
17BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
25
18BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
26
19BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
27
20BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
28
21BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
29
22BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
30
EC 20010 (022019)
SECTION G ndash 23B Are You Ready to Submit Your Nomination
Have you completed the Nomination Paper (EC 20010)
bull Are all mandatory fields in sections AndashE complete
bull Have you collected the required number of signatures from qualified electors in section F
o For most electoral districts 100 electors must consent to your candidacy
o For electoral districts identified in Schedule 3 only 50 electors are required
o To ensure a smooth nomination process Elections Canada recommends collecting signatures from at least 150 electors
Do you have authorized proof of identify
bull For a list of authorized identification visit the Elections Canada website
bull If a campaign delegate is submitting on your behalf they must bring a copy of your identification documents signed by you
bull If you want an alternative name to appear on the ballot additional documentation is required visit electionsca for details
Are you endorsed by a political party
bull Make sure your party has submitted the required documentation to Elections Canada attesting your designated political affiliation
Have you made a nomination appointment
bull To facilitate the nomination process make an appointment with the returning officer to finalize the filing of the complete nomination package
bull The nomination period closes 21 days before election day at 200 pm local time
31
- Nomination Paperof a Candidate at a Federal General Election or By-election
- Table of Contents
- General Information
- SECTION A ndash Candidate Information (Mandatory)
- SECTION B ndash Campaign Delegate (Optional)
- SECTION C ndash Official Agent (Mandatory)
- SECTION D ndash Auditor (Optional)
- SECTION E ndash Campaign Office (Optional)
- SECTION F ndash Electors Consenting to Candidacy (Mandatory)
-
- Name of electoral district
- Political affiliation
- Telephone number to be posted on electionsca
- Website to be posted on electionsca including prefix http https
- Printed name of elector1
- Full residential address street numbernamecity1
- Postal code1
- Elector signature1
- Witness initials1
- Internal use only1
- Printed name of elector2
- Full residential address street numbernamecity2
- Postal code2
- Elector signature2
- Witness initials2
- Internal use only2
- Printed name of elector3
- Full residential address street numbernamecity3
- Postal code3
- Elector signature3
- Witness initials3
- Internal use only3
- Printed name of elector4
- Full residential address street numbernamecity4
- Postal code4
- Elector signature4
- Witness initials4
- Internal use only4
- Printed name of elector5
- Full residential address street numbernamecity5
- Postal code5
- Elector signature5
- Witness initials5
- Internal use only5
- Printed name of elector6
- Full residential address street numbernamecity6
- Postal code6
- Elector signature6
- Witness initials6
- Internal use only6
- Printed name of elector7
- Full residential address street numbernamecity7
- Postal code7
- Elector signature7
- Witness initials7
- Internal use only7
- Printed name of elector8
- Full residential address street numbernamecity8
- Postal code8
- Elector signature8
- Witness initials8
- Internal use only8
- Printed name of elector9
- Full residential address street numbernamecity9
- Postal code9
- Elector signature9
- Witness initials9
- Internal use only9
- Printed name of elector10
- Full residential address street numbernamecity10
- Postal code10
- Elector signature10
- Witness initials10
- Internal use only10
- Printed name of elector1_2
- Full residential address street numbernamecity1_2
- Postal code1_2
- Elector signature1_2
- Witness initials1_2
- Internal use only1_2
- Printed name of elector2_2
- Full residential address street numbernamecity2_2
- Postal code2_2
- Elector signature2_2
- Witness initials2_2
- Internal use only2_2
- Printed name of elector3_2
- Full residential address street numbernamecity3_2
- Postal code3_2
- Elector signature3_2
- Witness initials3_2
- Internal use only3_2
- Printed name of elector4_2
- Full residential address street numbernamecity4_2
- Postal code4_2
- Elector signature4_2
- Witness initials4_2
- Internal use only4_2
- Printed name of elector5_2
- Full residential address street numbernamecity5_2
- Postal code5_2
- Elector signature5_2
- Witness initials5_2
- Internal use only5_2
- Printed name of elector6_2
- Full residential address street numbernamecity6_2
- Postal code6_2
- Elector signature6_2
- Witness initials6_2
- Internal use only6_2
- Printed name of elector7_2
- Full residential address street numbernamecity7_2
- Postal code7_2
- Elector signature7_2
- Witness initials7_2
- Internal use only7_2
- Printed name of elector8_2
- Full residential address street numbernamecity8_2
- Postal code8_2
- Elector signature8_2
- Witness initials8_2
- Internal use only8_2
- Printed name of elector9_2
- Full residential address street numbernamecity9_2
- Postal code9_2
- Elector signature9_2
- Witness initials9_2
- Internal use only9_2
- Printed name of elector10_2
- Full residential address street numbernamecity10_2
- Postal code10_2
- Elector signature10_2
- Witness initials10_2
- Internal use only10_2
- Printed name of elector1_3
- Full residential address street numbernamecity1_3
- Postal code1_3
- Elector signature1_3
- Witness initials1_3
- Internal use only1_3
- Printed name of elector2_3
- Full residential address street numbernamecity2_3
- Postal code2_3
- Elector signature2_3
- Witness initials2_3
- Internal use only2_3
- Printed name of elector3_3
- Full residential address street numbernamecity3_3
- Postal code3_3
- Elector signature3_3
- Witness initials3_3
- Internal use only3_3
- Printed name of elector4_3
- Full residential address street numbernamecity4_3
- Postal code4_3
- Elector signature4_3
- Witness initials4_3
- Internal use only4_3
- Printed name of elector5_3
- Full residential address street numbernamecity5_3
- Postal code5_3
- Elector signature5_3
- Witness initials5_3
- Internal use only5_3
- Printed name of elector6_3
- Full residential address street numbernamecity6_3
- Postal code6_3
- Elector signature6_3
- Witness initials6_3
- Internal use only6_3
- Printed name of elector7_3
- Full residential address street numbernamecity7_3
- Postal code7_3
- Elector signature7_3
- Witness initials7_3
- Internal use only7_3
- Printed name of elector8_3
- Full residential address street numbernamecity8_3
- Postal code8_3
- Elector signature8_3
- Witness initials8_3
- Internal use only8_3
- Printed name of elector9_3
- Full residential address street numbernamecity9_3
- Postal code9_3
- Elector signature9_3
- Witness initials9_3
- Internal use only9_3
- Printed name of elector10_3
- Full residential address street numbernamecity10_3
- Postal code10_3
- Elector signature10_3
- Witness initials10_3
- Internal use only10_3
- Printed name of elector1_4
- Full residential address street numbernamecity1_4
- Postal code1_4
- Elector signature1_4
- Witness initials1_4
- Internal use only1_4
- Printed name of elector2_4
- Full residential address street numbernamecity2_4
- Postal code2_4
- Elector signature2_4
- Witness initials2_4
- Internal use only2_4
- Printed name of elector3_4
- Full residential address street numbernamecity3_4
- Postal code3_4
- Elector signature3_4
- Witness initials3_4
- Internal use only3_4
- Printed name of elector4_4
- Full residential address street numbernamecity4_4
- Postal code4_4
- Elector signature4_4
- Witness initials4_4
- Internal use only4_4
- Printed name of elector5_4
- Full residential address street numbernamecity5_4
- Postal code5_4
- Elector signature5_4
- Witness initials5_4
- Internal use only5_4
- Printed name of elector6_4
- Full residential address street numbernamecity6_4
- Postal code6_4
- Elector signature6_4
- Witness initials6_4
- Internal use only6_4
- Printed name of elector7_4
- Full residential address street numbernamecity7_4
- Postal code7_4
- Elector signature7_4
- Witness initials7_4
- Internal use only7_4
- Printed name of elector8_4
- Full residential address street numbernamecity8_4
- Postal code8_4
- Elector signature8_4
- Witness initials8_4
- Internal use only8_4
- Printed name of elector9_4
- Full residential address street numbernamecity9_4
- Postal code9_4
- Elector signature9_4
- Witness initials9_4
- Internal use only9_4
- Printed name of elector10_4
- Full residential address street numbernamecity10_4
- Postal code10_4
- Elector signature10_4
- Witness initials10_4
- Internal use only10_4
- Printed name of elector1_5
- Full residential address street numbernamecity1_5
- Postal code1_5
- Elector signature1_5
- Witness initials1_5
- Internal use only1_5
- Printed name of elector2_5
- Full residential address street numbernamecity2_5
- Postal code2_5
- Elector signature2_5
- Witness initials2_5
- Internal use only2_5
- Printed name of elector3_5
- Full residential address street numbernamecity3_5
- Postal code3_5
- Elector signature3_5
- Witness initials3_5
- Internal use only3_5
- Printed name of elector4_5
- Full residential address street numbernamecity4_5
- Postal code4_5
- Elector signature4_5
- Witness initials4_5
- Internal use only4_5
- Printed name of elector5_5
- Full residential address street numbernamecity5_5
- Postal code5_5
- Elector signature5_5
- Witness initials5_5
- Internal use only5_5
- Printed name of elector6_5
- Full residential address street numbernamecity6_5
- Postal code6_5
- Elector signature6_5
- Witness initials6_5
- Internal use only6_5
- Printed name of elector7_5
- Full residential address street numbernamecity7_5
- Postal code7_5
- Elector signature7_5
- Witness initials7_5
- Internal use only7_5
- Printed name of elector8_5
- Full residential address street numbernamecity8_5
- Postal code8_5
- Elector signature8_5
- Witness initials8_5
- Internal use only8_5
- Printed name of elector9_5
- Full residential address street numbernamecity9_5
- Postal code9_5
- Elector signature9_5
- Witness initials9_5
- Internal use only9_5
- Printed name of elector10_5
- Full residential address street numbernamecity10_5
- Postal code10_5
- Elector signature10_5
- Witness initials10_5
- Internal use only10_5
- Printed name of elector1_6
- Full residential address street numbernamecity1_6
- Postal code1_6
- Elector signature1_6
- Witness initials1_6
- Internal use only1_6
- Printed name of elector2_6
- Full residential address street numbernamecity2_6
- Postal code2_6
- Elector signature2_6
- Witness initials2_6
- Internal use only2_6
- Printed name of elector3_6
- Full residential address street numbernamecity3_6
- Postal code3_6
- Elector signature3_6
- Witness initials3_6
- Internal use only3_6
- Printed name of elector4_6
- Full residential address street numbernamecity4_6
- Postal code4_6
- Elector signature4_6
- Witness initials4_6
- Internal use only4_6
- Printed name of elector5_6
- Full residential address street numbernamecity5_6
- Postal code5_6
- Elector signature5_6
- Witness initials5_6
- Internal use only5_6
- Printed name of elector6_6
- Full residential address street numbernamecity6_6
- Postal code6_6
- Elector signature6_6
- Witness initials6_6
- Internal use only6_6
- Printed name of elector7_6
- Full residential address street numbernamecity7_6
- Postal code7_6
- Elector signature7_6
- Witness initials7_6
- Internal use only7_6
- Printed name of elector8_6
- Full residential address street numbernamecity8_6
- Postal code8_6
- Elector signature8_6
- Witness initials8_6
- Internal use only8_6
- Printed name of elector9_6
- Full residential address street numbernamecity9_6
- Postal code9_6
- Elector signature9_6
- Witness initials9_6
- Internal use only9_6
- Printed name of elector10_6
- Full residential address street numbernamecity10_6
- Postal code10_6
- Elector signature10_6
- Witness initials10_6
- Internal use only10_6
- Printed name of elector1_7
- Full residential address street numbernamecity1_7
- Postal code1_7
- Elector signature1_7
- Witness initials1_7
- Internal use only1_7
- Printed name of elector2_7
- Full residential address street numbernamecity2_7
- Postal code2_7
- Elector signature2_7
- Witness initials2_7
- Internal use only2_7
- Printed name of elector3_7
- Full residential address street numbernamecity3_7
- Postal code3_7
- Elector signature3_7
- Witness initials3_7
- Internal use only3_7
- Printed name of elector4_7
- Full residential address street numbernamecity4_7
- Postal code4_7
- Elector signature4_7
- Witness initials4_7
- Internal use only4_7
- Printed name of elector5_7
- Full residential address street numbernamecity5_7
- Postal code5_7
- Elector signature5_7
- Witness initials5_7
- Internal use only5_7
- Printed name of elector6_7
- Full residential address street numbernamecity6_7
- Postal code6_7
- Elector signature6_7
- Witness initials6_7
- Internal use only6_7
- Printed name of elector7_7
- Full residential address street numbernamecity7_7
- Postal code7_7
- Elector signature7_7
- Witness initials7_7
- Internal use only7_7
- Printed name of elector8_7
- Full residential address street numbernamecity8_7
- Postal code8_7
- Elector signature8_7
- Witness initials8_7
- Internal use only8_7
- Printed name of elector9_7
- Full residential address street numbernamecity9_7
- Postal code9_7
- Elector signature9_7
- Witness initials9_7
- Internal use only9_7
- Printed name of elector10_7
- Full residential address street numbernamecity10_7
- Postal code10_7
- Elector signature10_7
- Witness initials10_7
- Internal use only10_7
- Printed name of elector1_8
- Full residential address street numbernamecity1_8
- Postal code1_8
- Elector signature1_8
- Witness initials1_8
- Internal use only1_8
- Printed name of elector2_8
- Full residential address street numbernamecity2_8
- Postal code2_8
- Elector signature2_8
- Witness initials2_8
- Internal use only2_8
- Printed name of elector3_8
- Full residential address street numbernamecity3_8
- Postal code3_8
- Elector signature3_8
- Witness initials3_8
- Internal use only3_8
- Printed name of elector4_8
- Full residential address street numbernamecity4_8
- Postal code4_8
- Elector signature4_8
- Witness initials4_8
- Internal use only4_8
- Printed name of elector5_8
- Full residential address street numbernamecity5_8
- Postal code5_8
- Elector signature5_8
- Witness initials5_8
- Internal use only5_8
- Printed name of elector6_8
- Full residential address street numbernamecity6_8
- Postal code6_8
- Elector signature6_8
- Witness initials6_8
- Internal use only6_8
- Printed name of elector7_8
- Full residential address street numbernamecity7_8
- Postal code7_8
- Elector signature7_8
- Witness initials7_8
- Internal use only7_8
- Printed name of elector8_8
- Full residential address street numbernamecity8_8
- Postal code8_8
- Elector signature8_8
- Witness initials8_8
- Internal use only8_8
- Printed name of elector9_8
- Full residential address street numbernamecity9_8
- Postal code9_8
- Elector signature9_8
- Witness initials9_8
- Internal use only9_8
- Printed name of elector10_8
- Full residential address street numbernamecity10_8
- Postal code10_8
- Elector signature10_8
- Witness initials10_8
- Internal use only10_8
- Printed name of elector1_9
- Full residential address street numbernamecity1_9
- Postal code1_9
- Elector signature1_9
- Witness initials1_9
- Internal use only1_9
- Printed name of elector2_9
- Full residential address street numbernamecity2_9
- Postal code2_9
- Elector signature2_9
- Witness initials2_9
- Internal use only2_9
- Printed name of elector3_9
- Full residential address street numbernamecity3_9
- Postal code3_9
- Elector signature3_9
- Witness initials3_9
- Internal use only3_9
- Printed name of elector4_9
- Full residential address street numbernamecity4_9
- Postal code4_9
- Elector signature4_9
- Witness initials4_9
- Internal use only4_9
- Printed name of elector5_9
- Full residential address street numbernamecity5_9
- Postal code5_9
- Elector signature5_9
- Witness initials5_9
- Internal use only5_9
- Printed name of elector6_9
- Full residential address street numbernamecity6_9
- Postal code6_9
- Elector signature6_9
- Witness initials6_9
- Internal use only6_9
- Printed name of elector7_9
- Full residential address street numbernamecity7_9
- Postal code7_9
- Elector signature7_9
- Witness initials7_9
- Internal use only7_9
- Printed name of elector8_9
- Full residential address street numbernamecity8_9
- Postal code8_9
- Elector signature8_9
- Witness initials8_9
- Internal use only8_9
- Printed name of elector9_9
- Full residential address street numbernamecity9_9
- Postal code9_9
- Elector signature9_9
- Witness initials9_9
- Internal use only9_9
- Printed name of elector10_9
- Full residential address street numbernamecity10_9
- Postal code10_9
- Elector signature10_9
- Witness initials10_9
- Internal use only10_9
- Printed name of elector1_10
- Full residential address street numbernamecity1_10
- Postal code1_10
- Elector signature1_10
- Witness initials1_10
- Internal use only1_10
- Printed name of elector2_10
- Full residential address street numbernamecity2_10
- Postal code2_10
- Elector signature2_10
- Witness initials2_10
- Internal use only2_10
- Printed name of elector3_10
- Full residential address street numbernamecity3_10
- Postal code3_10
- Elector signature3_10
- Witness initials3_10
- Internal use only3_10
- Printed name of elector4_10
- Full residential address street numbernamecity4_10
- Postal code4_10
- Elector signature4_10
- Witness initials4_10
- Internal use only4_10
- Printed name of elector5_10
- Full residential address street numbernamecity5_10
- Postal code5_10
- Elector signature5_10
- Witness initials5_10
- Internal use only5_10
- Printed name of elector6_10
- Full residential address street numbernamecity6_10
- Postal code6_10
- Elector signature6_10
- Witness initials6_10
- Internal use only6_10
- Printed name of elector7_10
- Full residential address street numbernamecity7_10
- Postal code7_10
- Elector signature7_10
- Witness initials7_10
- Internal use only7_10
- Printed name of elector8_10
- Full residential address street numbernamecity8_10
- Postal code8_10
- Elector signature8_10
- Witness initials8_10
- Internal use only8_10
- Printed name of elector9_10
- Full residential address street numbernamecity9_10
- Postal code9_10
- Elector signature9_10
- Witness initials9_10
- Internal use only9_10
- Printed name of elector10_10
- Full residential address street numbernamecity10_10
- Postal code10_10
- Elector signature10_10
- Witness initials10_10
- Internal use only10_10
- Printed name of elector1_11
- Full residential address street numbernamecity1_11
- Postal code1_11
- Elector signature1_11
- Witness initials1_11
- Internal use only1_11
- Printed name of elector2_11
- Full residential address street numbernamecity2_11
- Postal code2_11
- Elector signature2_11
- Witness initials2_11
- Internal use only2_11
- Printed name of elector3_11
- Full residential address street numbernamecity3_11
- Postal code3_11
- Elector signature3_11
- Witness initials3_11
- Internal use only3_11
- Printed name of elector4_11
- Full residential address street numbernamecity4_11
- Postal code4_11
- Elector signature4_11
- Witness initials4_11
- Internal use only4_11
- Printed name of elector5_11
- Full residential address street numbernamecity5_11
- Postal code5_11
- Elector signature5_11
- Witness initials5_11
- Internal use only5_11
- Printed name of elector6_11
- Full residential address street numbernamecity6_11
- Postal code6_11
- Elector signature6_11
- Witness initials6_11
- Internal use only6_11
- Printed name of elector7_11
- Full residential address street numbernamecity7_11
- Postal code7_11
- Elector signature7_11
- Witness initials7_11
- Internal use only7_11
- Printed name of elector8_11
- Full residential address street numbernamecity8_11
- Postal code8_11
- Elector signature8_11
- Witness initials8_11
- Internal use only8_11
- Printed name of elector9_11
- Full residential address street numbernamecity9_11
- Postal code9_11
- Elector signature9_11
- Witness initials9_11
- Internal use only9_11
- Printed name of elector10_11
- Full residential address street numbernamecity10_11
- Postal code10_11
- Elector signature10_11
- Witness initials10_11
- Internal use only10_11
- Printed name of elector1_12
- Full residential address street numbernamecity1_12
- Postal code1_12
- Elector signature1_12
- Witness initials1_12
- Internal use only1_12
- Printed name of elector2_12
- Full residential address street numbernamecity2_12
- Postal code2_12
- Elector signature2_12
- Witness initials2_12
- Internal use only2_12
- Printed name of elector3_12
- Full residential address street numbernamecity3_12
- Postal code3_12
- Elector signature3_12
- Witness initials3_12
- Internal use only3_12
- Printed name of elector4_12
- Full residential address street numbernamecity4_12
- Postal code4_12
- Elector signature4_12
- Witness initials4_12
- Internal use only4_12
- Printed name of elector5_12
- Full residential address street numbernamecity5_12
- Postal code5_12
- Elector signature5_12
- Witness initials5_12
- Internal use only5_12
- Printed name of elector6_12
- Full residential address street numbernamecity6_12
- Postal code6_12
- Elector signature6_12
- Witness initials6_12
- Internal use only6_12
- Printed name of elector7_12
- Full residential address street numbernamecity7_12
- Postal code7_12
- Elector signature7_12
- Witness initials7_12
- Internal use only7_12
- Printed name of elector8_12
- Full residential address street numbernamecity8_12
- Postal code8_12
- Elector signature8_12
- Witness initials8_12
- Internal use only8_12
- Printed name of elector9_12
- Full residential address street numbernamecity9_12
- Postal code9_12
- Elector signature9_12
- Witness initials9_12
- Internal use only9_12
- Printed name of elector10_12
- Full residential address street numbernamecity10_12
- Postal code10_12
- Elector signature10_12
- Witness initials10_12
- Internal use only10_12
- Printed name of elector1_13
- Full residential address street numbernamecity1_13
- Postal code1_13
- Elector signature1_13
- Witness initials1_13
- Internal use only1_13
- Printed name of elector2_13
- Full residential address street numbernamecity2_13
- Postal code2_13
- Elector signature2_13
- Witness initials2_13
- Internal use only2_13
- Printed name of elector3_13
- Full residential address street numbernamecity3_13
- Postal code3_13
- Elector signature3_13
- Witness initials3_13
- Internal use only3_13
- Printed name of elector4_13
- Full residential address street numbernamecity4_13
- Postal code4_13
- Elector signature4_13
- Witness initials4_13
- Internal use only4_13
- Printed name of elector5_13
- Full residential address street numbernamecity5_13
- Postal code5_13
- Elector signature5_13
- Witness initials5_13
- Internal use only5_13
- Printed name of elector6_13
- Full residential address street numbernamecity6_13
- Postal code6_13
- Elector signature6_13
- Witness initials6_13
- Internal use only6_13
- Printed name of elector7_13
- Full residential address street numbernamecity7_13
- Postal code7_13
- Elector signature7_13
- Witness initials7_13
- Internal use only7_13
- Printed name of elector8_13
- Full residential address street numbernamecity8_13
- Postal code8_13
- Elector signature8_13
- Witness initials8_13
- Internal use only8_13
- Printed name of elector9_13
- Full residential address street numbernamecity9_13
- Postal code9_13
- Elector signature9_13
- Witness initials9_13
- Internal use only9_13
- Printed name of elector10_13
- Full residential address street numbernamecity10_13
- Postal code10_13
- Elector signature10_13
- Witness initials10_13
- Internal use only10_13
- Printed name of elector1_14
- Full residential address street numbernamecity1_14
- Postal code1_14
- Elector signature1_14
- Witness initials1_14
- Internal use only1_14
- Printed name of elector2_14
- Full residential address street numbernamecity2_14
- Postal code2_14
- Elector signature2_14
- Witness initials2_14
- Internal use only2_14
- Printed name of elector3_14
- Full residential address street numbernamecity3_14
- Postal code3_14
- Elector signature3_14
- Witness initials3_14
- Internal use only3_14
- Printed name of elector4_14
- Full residential address street numbernamecity4_14
- Postal code4_14
- Elector signature4_14
- Witness initials4_14
- Internal use only4_14
- Printed name of elector5_14
- Full residential address street numbernamecity5_14
- Postal code5_14
- Elector signature5_14
- Witness initials5_14
- Internal use only5_14
- Printed name of elector6_14
- Full residential address street numbernamecity6_14
- Postal code6_14
- Elector signature6_14
- Witness initials6_14
- Internal use only6_14
- Printed name of elector7_14
- Full residential address street numbernamecity7_14
- Postal code7_14
- Elector signature7_14
- Witness initials7_14
- Internal use only7_14
- Printed name of elector8_14
- Full residential address street numbernamecity8_14
- Postal code8_14
- Elector signature8_14
- Witness initials8_14
- Internal use only8_14
- Printed name of elector9_14
- Full residential address street numbernamecity9_14
- Postal code9_14
- Elector signature9_14
- Witness initials9_14
- Internal use only9_14
- Printed name of elector10_14
- Full residential address street numbernamecity10_14
- Postal code10_14
- Elector signature10_14
- Witness initials10_14
- Internal use only10_14
- Printed name of elector1_15
- Full residential address street numbernamecity1_15
- Postal code1_15
- Elector signature1_15
- Witness initials1_15
- Internal use only1_15
- Printed name of elector2_15
- Full residential address street numbernamecity2_15
- Postal code2_15
- Elector signature2_15
- Witness initials2_15
- Internal use only2_15
- Printed name of elector3_15
- Full residential address street numbernamecity3_15
- Postal code3_15
- Elector signature3_15
- Witness initials3_15
- Internal use only3_15
- Printed name of elector4_15
- Full residential address street numbernamecity4_15
- Postal code4_15
- Elector signature4_15
- Witness initials4_15
- Internal use only4_15
- Printed name of elector5_15
- Full residential address street numbernamecity5_15
- Postal code5_15
- Elector signature5_15
- Witness initials5_15
- Internal use only5_15
- Printed name of elector6_15
- Full residential address street numbernamecity6_15
- Postal code6_15
- Elector signature6_15
- Witness initials6_15
- Internal use only6_15
- Printed name of elector7_15
- Full residential address street numbernamecity7_15
- Postal code7_15
- Elector signature7_15
- Witness initials7_15
- Internal use only7_15
- Printed name of elector8_15
- Full residential address street numbernamecity8_15
- Postal code8_15
- Elector signature8_15
- Witness initials8_15
- Internal use only8_15
- Printed name of elector9_15
- Full residential address street numbernamecity9_15
- Postal code9_15
- Elector signature9_15
- Witness initials9_15
- Internal use only9_15
- Printed name of elector10_15
- Full residential address street numbernamecity10_15
- Postal code10_15
- Elector signature10_15
- Witness initials10_15
- Internal use only10_15
- Printed name of elector1_16
- Full residential address street numbernamecity1_16
- Postal code1_16
- Elector signature1_16
- Witness initials1_16
- Internal use only1_16
- Printed name of elector2_16
- Full residential address street numbernamecity2_16
- Postal code2_16
- Elector signature2_16
- Witness initials2_16
- Internal use only2_16
- Printed name of elector3_16
- Full residential address street numbernamecity3_16
- Postal code3_16
- Elector signature3_16
- Witness initials3_16
- Internal use only3_16
- Printed name of elector4_16
- Full residential address street numbernamecity4_16
- Postal code4_16
- Elector signature4_16
- Witness initials4_16
- Internal use only4_16
- Printed name of elector5_16
- Full residential address street numbernamecity5_16
- Postal code5_16
- Elector signature5_16
- Witness initials5_16
- Internal use only5_16
- Printed name of elector6_16
- Full residential address street numbernamecity6_16
- Postal code6_16
- Elector signature6_16
- Witness initials6_16
- Internal use only6_16
- Printed name of elector7_16
- Full residential address street numbernamecity7_16
- Postal code7_16
- Elector signature7_16
- Witness initials7_16
- Internal use only7_16
- Printed name of elector8_16
- Full residential address street numbernamecity8_16
- Postal code8_16
- Elector signature8_16
- Witness initials8_16
- Internal use only8_16
- Printed name of elector9_16
- Full residential address street numbernamecity9_16
- Postal code9_16
- Elector signature9_16
- Witness initials9_16
- Internal use only9_16
- Printed name of elector10_16
- Full residential address street numbernamecity10_16
- Postal code10_16
- Elector signature10_16
- Witness initials10_16
- Internal use only10_16
- Have you completed the Nomination Paper EC 20010 Off
- Do you have authorized proof of identify Off
- Are you endorsed by a political party Off
- Have you made a nomination appointment Off
- Last name - Candidate Name
- First name - Candidate Name
- Name of electoral district- Candidate Information
- First name - Candidate Information
- Last name - Candidate Information
- Ballot Name Off
- Ballot First name(s)
- Ballot Last name(s)
- Gender -Candidate information
- Date of birth (YYY-MM-DD) - Gender -Candidate information
- language of correspondence - Candidate information Off
- Email -Contact information
- Primary phone number - Contact information
- Ext - Primary phone number
- Alternate phone number - Contact information
- Ext - Alternate phone number
- Fax number- Alternate phone number
- Unit -Residential address
- Street -Residential address
- Street name -Residential address
- City -Residential address
- ProvinceTerritory -Residential address
- Postal code - -Residential address
- Mailing address - same as residential address Off
- Occupation- Candidate occupation
- Sharing of information with the Conflict of Interest and Ethics Commissioner and the House of Commons including the Library of Parliament Off
- where applicable if the returning officer is unable to verify that I have been endorsed by the political party identified in section A of this Nomination Paper I wish to Off
- Date of Signature (YYYY-MM-DD) - Candidate signature
- Date of Signature (YYYY-MM-DD) -Signature of person receiving the solemn declaration
- Campaign delegate information
- First name - Campaign delegate information
- Last name - Campaign delegate information
- Language of correspondence - Campaign delegate information Off
- Email - Contact information -Campaign Delegate
- Primary phone number - Contact information -Campaign Delegate
- Primary phone number EXT - Contact information -Campaign Delegate
- Alternate phone number - Contact information -Campaign Delegate
- Alternate phone number EXT - Contact information -Campaign Delegate
- Fax nmuber- Contact information -Campaign Delegate
- Street - Residential address -Campaign delegate
- Street name - Residential address -Campaign delegate
- City - Residential address -Campaign delegate
- ProvinceTerritory - Residential address -Campaign delegate
- Postal Code - Residential address -Campaign delegate
- Campaign delegate - Mailing address ndash Same as residential address Off
- Unit - Residential address -Campaign delegate
- Date (YYYY-MM-DD) - Candidate authorization Signature
- Date (YYYY-MM-DD) - Candidate campaign Signature
- First name - Official agent information
- Last name - Official agent information
- Language of correspondence - Official agent information Off
- Email - Official agent information
- Primary phone number - Official agent information
- Primary phone number EXT - Official agent information
- Alternate phone number EXT - Official agent information
- Alternate phone number - Official agent information
- Fax number - Official agent information
- Unit -Residential address - Official Agent
- Street name -Residential address - Official Agent
- City -Residential address - Official Agent
- Street -Residential address - Official Agent
- ProvinceTerritory -Residential address - Official Agent
- Postal code-Residential address - Official Agent
- Mailing address ndash Same as residential address- Official Agent Off
- Date (YYYY-MM-DD) - Official agent signature
- First name - Auditor information
- Last name - Auditor information
- Language of correspondence - Auditor information Off
- Email - Auditor information
- Primary phone number - Auditor information
- Primary phone number EXT- Auditor information
- Alternate phone number - Auditor information
- Alternate phone number EXT- Auditor information
- Fax number - Auditor information
- Name of firm- Auditor organizational information
- Occupation of auditor - Auditor organizational information
- Professional designation - Auditor organizational information Off
- Designation registration number
- Make cheque payable to
- Unit - Address (where cheque is sent)
- Street - Address (where cheque is sent)
- Street name - Address (where cheque is sent)
- City - Address (where cheque is sent)
- ProvinceTerritory - Address (where cheque is sent)
- Postal code - Address (where cheque is sent)
- Date (YYY-MM-DD) - Auditor signature
- Unit - Campaign office address (optional)
- Street - Campaign office address (optional)
- Street name - Campaign office address (optional)
- City - Campaign office address (optional)
- ProvinceTerritory- Campaign office address (optional)
- Postal code - Campaign office address (optional)
- Name of witness
- Full address of witness
- Name of candidate
- Electoral district
- Year
- Name of candidate2
- Electoral district2
- Year2
- Name of witness2
- Full address of witness2
- Name of candidate3
- Electoral district3
- Year3
- Full address of witness3
- Name of witness3
- Name of candidate 4
- Electoral district4
- Year4
- Full address of witness 4
- Name of witness 4
- Name of candidate5
- Electoral district5
- Year5
- Full address of witness5
- Name of witness5
- Name of candidate6
- Electoral district6
- Year6
- Name of witness6
- Full address of witness6
- Name of candidate7
- Electoral district7
- Year7
- Full address of witness7
- Name of witness7
- Name of candidate8
- Electoral district8
- Year8
- Full address of witness8
- Name of witness8
- Name of candidate9
- Electoral district9
- Year9
- Full address of witness 9
- Name of witness 9
- Name of candidate10
- Electoral district10
- Year10
- Full address of witness10
- Name of witness10
- Name of candidate11
- Electoral district11
- Year11
- Full address of witness11
- Name of witness11
- Name of candidate12
- Electoral district12
- Year12
- Full address of witness12
- Name of witness12
- Name of candidate13
- Electoral district13
- Year13
- Full address of witness13
- Name of witness13
- Name of candidate14
- Electoral district14
- Year14
- Name of witness14
- Full address of witness14
- Name of candidate1
- Electoral district1
- Year1
- Name of witness1
- Full address of witness1
- Name of candidate15
- Electoral district15
- Year15
- Name of witness15
- Full address of witness15
- unit -Mailing address
- Street -Mailing address
- Street name -Mailing address
- City -Mailing address
- ProvinceTerritory -Mailing address
- Postal code -Mailing address
- Unit - Mailing address -Campaign delegate
- Street - Mailing address -Campaign delegate
- Street name - Mailing address -Campaign delegate
- City - Mailing address -Campaign delegate
- ProvinceTerritory- Mailing address -Campaign delegate
- Postal code- Mailing address -Campaign delegate
- Unit -Mailing address - Official Agent
- Street -Mailing address - Official Agent
- Street name -Mailing address - Official Agent
- city -Mailing address - Official Agent
- ProvinceTerritory-Mailing address - Official Agent
- Postal code-Mailing address - Official Agent
EC 20010 (052019)
1BGeneral Information
Collecting Signatures of Electors Consenting to Candidacy You must supply the names addresses and signatures of at least 100 qualified electors (Canadian citizens at least 18 years old on election day) who ordinarily reside in the electoral district where you intend to run as a candidate Elections Canada recommends that you collect 150 or more signatures to ensure that you meet this requirement Note In the larger or remote electoral districts listed in Schedule 3 of the CEA the required minimum number of signatures is 50 Note For the next general election the previously prescribed pages for collecting signatures (Part 7 of the Nomination Paper) will be accepted
Deadline to Submit Nomination Paper The completed Nomination Paper and all associated supporting documents must be submitted to the returning officer Nominations may be submitted by either you or your campaign delegate In accordance with the CEA the Nomination Paper must be filed between the day the returning officer publishes the Notice of Election and the close of nominations 21 days before election day at 200 pm local time The returning office contact information will be available on the Elections Canada website once the writ of election is issued We suggest making an appointment with the returning officer early during the nomination period so there is sufficient time if required to correct the Nomination Paper before the close of nominations
Offence It is an offence under section 89 and paragraph 486(3)(a) of the CEA to consent to be a candidate when you are not eligible It is also an offence under paragraph 499(2)(a) and subsection 549(3) of the CEA to falsely take an oath that is provided for by the CEA
Public Inspection Any person may examine the completed Nomination Paper at the office of the returning officer during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document The Nomination Paper may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
For More Information If you require additional information visit the How to become a candidate page on the Elections Canada website or contact the Political Entities Support Network directly
Telephone 1-800-486-6563TTY 1-800-361-8935Email CSEP-PESCelectionscaMail Elections Canada
30 Victoria StreetGatineau QuebecK1A 0M6
3
EC 20010 (052019)
SECTION A ndash 2BCandidate Information (Mandatory)
All fields marked with are mandatory
Electoral district
Print the name of the electoral district you are running in You may run in only one electoral district at a time You do not need to reside in the district
Name of electoral district
Candidate name
Print your first name and last name The name must not include any title degree or other prefix or suffix When you file the Nomination Paper you must provide the returning officer with proof of identity that matches the first and last name as identified below CEA 66(2) 67(2)(a)(b)
First name(s) Last name
Name on ballot
You may request an alternative name to appear on the ballot however you must provide the returning officer with sufficient documentation that you are commonly known by that name For more information on authorized proof see the How to become a candidate webpage at electionsca CEA 67(5)
Ballot name
Option 1 Use first and last name as provided above (leave fields below blank)
Option 2 Use other name (complete fields below)
Ballot first name(s) Ballot last name
Political affiliation
State your political affiliation (name of the registered or eligible political party or ldquoIndependentrdquo) In the absence of a stated political affiliation a series of black dashes will appear under your name on the ballot Note In order to have a political party affiliation on the ballot the party must file an endorsement with Elections Canada It is strongly recommended you confirm with your political party and local returning officer to better ensure that your name has been submitted
Political affiliation
4
ndash
EC 20010 (052019)
25BSECTION A ndash Candidate Information (Mandatory)
All fields marked with are mandatory
Candidate information
Gender Date of birth (YYYY-MM-DD) Language of correspondence
English French
Contact information
Upon confirmation of the nomination Elections Canada will send to the email address listed below an invitation to the Political Entities Service Centre (PESC) online portal
Primary phone number Ext Alternate phone number Ext Fax number
Residential address
Unit Street Street name
City ProvinceTerritory Postal code
Mailing address Same as residential address
Unit Street Street name
City ProvinceTerritory Postal code
5
EC 20010 (052019)
26BSECTION A ndash Candidate Information (Mandatory)
All fields marked with are mandatory
Candidate occupation
State the occupation you are commonly known by in your place of ordinary residence Please note that the term ldquoMember of Parliamentrdquo is not an occupation but a title and will not be accepted The term ldquoparliamentarianrdquo however is acceptable CEA 66(3)
Occupation
Sharing of information with the Conflict of Interest and Ethics Commissioner and the House of Commons including the Library of Parliament
To help new members of Parliament Elections Canada will share the name gender residential address telephone number email address occupation preferred language of correspondence electoral district and political party affiliation of candidates who authorize Elections Canada to share their information with the Conflict of Interest and Ethics Commissioner and the House of Commons which includes the Library of Parliament
Do you authorize Elections Canada to share your personal information with the Conflict of Interest and Ethics Commissioner and the House of Commons including the Library of Parliament
Yes No
Privacy notice
Personal information in this Nomination Paper and all associated supporting documents are collected to determine your eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
Any person at the returning office may examine the completed Nomination Paper during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
Subject to consent your contact information may be shared with the House of Commons Conflict of Interest and Ethics Commissioner and Library of Parliament for orientation and communication purposes for new Members of Parliament If you provide a URL it may be posted on Elections Canadarsquos website to increase electorsrsquo accessibility to the electoral framework and democratic process
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information
Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB may be found on the Elections Canada website
6
a
b
c
EC 20010 (052019)
SECTION A ndash Candidate Declaration and Signature (Mandatory)
All fields marked with are mandatory
Candidatersquos declaration
I the undersigned do hereby solemnly declare that
1 my name (including any alternative name I wish to have appear on the ballot) my addressand occupation are as stated in section A of this Nomination Paper
2 I designate the permanent residential address in this Nomination Paper as the address forservice of process and papers under the Canada Elections Act
3 the name and address of my official agent and the name address and occupation of myauditor (if applicable) are as stated in sections C and D of this Nomination Paper
4 the information regarding my political affiliation is as stated in section A of this NominationPaper and
5 where applicable if the returning officer is unable to verify that I have been endorsed by thepolitical party identified in section A of this Nomination Paper I wish to
Have the word ldquoindependentrdquo appear under my name on the ballot
have no designation of political affiliation (meaning that a series of black dashes will appear under my name on the ballot) or
withdraw my Nomination paper
I further state that
1 I consent to the nomination
2 I am a Canadian citizen at least 18 years of age on election day
3 as per section 65 of the Canada Elections Act I am not ineligible to be a candidate
4 I consent to allowing my official agent and candidate campaign delegate (if applicable) toaccess on my behalf electoral materials online or at the local Elections Canada officeincluding the lists of electors distributed by Elections Canada and
5 I am aware of my obligations under the Canada Elections Act
Candidate signature Date (YYYY-MM-DD)
Signature of person receiving the solemn declaration
As per subsection 549(1) of the Canada Elections Act the solemn declaration must be witnessed by a judge an election officer a unit election officer as defined in section 177 a notary public a provincial court judge a justice of the peace or a commissioner for taking oaths in the province
Signature of person receiving the solemn declaration Date (YYYY-MM-DD)
7
ndash
EC 20010 (052019)
SECTION B ndash 3BCampaign Delegate (Optional)
If appointing a campaign delegate all fields marked with are mandatory
Campaign delegate information
A candidate may authorize another individual (referred to in the Nomination Paper as the campaign delegate) to act on their behalf during the election The campaign delegate can submit the Nomination Paper and all associated supporting documents CEA 67(7) Note The campaign delegate does not have access to the candidatersquos financial returns
First name Last name Language of correspondence
English French
Contact information
Upon confirmation of the nomination Elections Canada will send to the email address listed below an invitation to the Political Entities Service Centre (PESC) online portal
Primary phone number Ext Alternate phone number Ext Fax number
Residential address
Unit Street Street name
City ProvinceTerritory Postal code
Mailing address Same as residential address
Unit Street Street name
City ProvinceTerritory Postal code
8
EC 20010 (052019)
SECTION B ndash Campaign Delegate ndash Privacy Notice and Declaration (Optional)
If appointing a campaign delegate all fields marked with are mandatory
Privacy notice
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA) Any person at the returning office may examine the completed Nomination Paper during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
Candidate authorization of the campaign delegate
As per subsection 66(1)(h) of the Canada Elections Act I authorize the individual identified in this section to act as my campaign delegate
Candidate signature Date (YYYY-MM-DD)
Candidate campaign delegate signature
I the undersigned candidate campaign delegate for the candidate named in this Nomination Paper state that
1 I hereby agree to act as the authorized person for the candidate named herein for the purposes of theCanada Elections Act
2 I am fully aware of the duties and responsibilities imposed on me by the Canada Elections Act
Campaign delegate signature Date (YYYY-MM-DD)
9
ndash
EC 20010 (052019)
SECTION C ndash 4BOfficial Agent (Mandatory)
All fields marked with are mandatory
Official agent information
The official agent is responsible for administering the campaignrsquos financial transactions and reporting those transactions to Elections Canada as required by the CEA For more information consult the Political Financing Handbook for Candidates and Official Agents Note The candidate official agent and auditor must all be different people
First name Last name Language of correspondence
English French
Contact information
Upon confirmation of the nomination Elections Canada will send to the email address listed below an invitation to the Political Entities Service Centre (PESC) online portal
Primary phone number Ext Alternate phone number Ext Fax number
Residential address Unit Street Street name
City ProvinceTerritory Postal code
Mailing address Same as residential address
Unit Street Street name
City ProvinceTerritory Postal code
10
EC 20010 (052019)
24BSECTION C ndash Official Agent ndash Privacy Notice and Declaration (Mandatory)
All fields marked with are mandatory
Privacy notice
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA) Any person at the returning office may examine the completed Nomination Paper during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
Official agent signature
I the undersigned official agent for the candidate named in this Nomination Paper hereby agree to act as official agent for the candidate named herein for the purposes of the Canada Elections Act I further state that
1 I am fully aware of the duties and responsibilities imposed on me by the Canada Elections Act
2 I am capable of entering into contracts in the provinceterritory in which this electoral district is located
3 I am eligible to act as official agent pursuant to section 4772 of the Canada Elections Act
Section 4772 of the Canada Elections Act states The following persons are ineligible to be an official agenta candidate an election officer or a member of the staff of a returning office an undischarged bankrupt anauditor appointed as required by this Act a person who is not qualified as an elector and a person who doesnot have the capacity to enter into contracts in the province in which they ordinarily reside
Official agent signature Date (YYYY-MM-DD)
11
EC 20010 (052019)
SECTION D ndash 5B Auditor (Optional)
If appointing an auditor all fields marked with are mandatory
Auditor information An auditor must be appointed if bull the candidatersquos campaign accepts contributions of $10000 or more bull the candidatersquos campaign incurs expenses of $10000 or more or bull the candidate receives 10 or more of votes cast in the electoral district If at the time of filing the Nomination Paper none of the above applies you do not need to appoint an auditor though you may still choose to do so If the above requirements are later met you must appoint an auditor without delay A person or partnership who wants to act as a candidatersquos auditor must be or have every partner be recognized as a professional accountant under provincial or territorial legislation CEA 4773(1) For more information consult the Political Financing Handbook for Candidates and Official Agents
First name Last name Language of correspondence
English French
Contact information Upon confirmation of the nomination Elections Canada will send to the email address listed below an invitation to the Political Entities Service Centre (PESC) online portal
Primary phone number Ext Alternate phone number Ext Fax number
Auditor organizational information Name of firm Occupation of auditor Professional designation
CPA FCPA
Designation registration number Make cheque payable to
Address (where cheque is sent) Unit Street Street name
City ProvinceTerritory Postal code
12
EC 20010 (052019)
SECTION D ndash Auditor ndash Privacy Notice and Declaration (Optional)
If appointing an auditor all fields marked with are mandatory
Privacy notice
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA) Any person at the returning office may examine the completed Nomination Paper during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information
Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
Auditor signature
I the undersigned hereby agree to act as the auditor for the candidate named in this Nomination Paper I further state that I am aware of the duties and responsibilities of this position under the Canada Elections Act and I am qualified to act as auditor under subsection 4773(1) and (2) of the Canada Elections Act
Auditor signature Date (YYYY-MM-DD)
13
EC 20010 (052019)
SECTION E ndash 6BCampaign Office (Optional)
Contact information to be made available on the Elections Canada website (optional)
Please note You may provide a telephone number andor a link to your website or social media platform of choice when filing your Nomination Paper with Elections Canada You do not have to provide this information but it is intended to help electors access campaign information Elections Canada may provide this information as part of the Voter Information Service Please include the full website address including prefix (http https)
Telephone number to be posted on electionsca
Website to be posted on electionsca (including prefix http https)
Campaign office address (optional)
Unit Street Street name
City ProvinceTerritory Postal code
14
SECTION F ndash 7BElectors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
15
8BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
16
9BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
17
10BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
18
11BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
19
12BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
20
13BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
21
14BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
22
15BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
23
16BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
24
17BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
25
18BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
26
19BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
27
20BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
28
21BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
29
22BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
30
EC 20010 (022019)
SECTION G ndash 23B Are You Ready to Submit Your Nomination
Have you completed the Nomination Paper (EC 20010)
bull Are all mandatory fields in sections AndashE complete
bull Have you collected the required number of signatures from qualified electors in section F
o For most electoral districts 100 electors must consent to your candidacy
o For electoral districts identified in Schedule 3 only 50 electors are required
o To ensure a smooth nomination process Elections Canada recommends collecting signatures from at least 150 electors
Do you have authorized proof of identify
bull For a list of authorized identification visit the Elections Canada website
bull If a campaign delegate is submitting on your behalf they must bring a copy of your identification documents signed by you
bull If you want an alternative name to appear on the ballot additional documentation is required visit electionsca for details
Are you endorsed by a political party
bull Make sure your party has submitted the required documentation to Elections Canada attesting your designated political affiliation
Have you made a nomination appointment
bull To facilitate the nomination process make an appointment with the returning officer to finalize the filing of the complete nomination package
bull The nomination period closes 21 days before election day at 200 pm local time
31
- Nomination Paperof a Candidate at a Federal General Election or By-election
- Table of Contents
- General Information
- SECTION A ndash Candidate Information (Mandatory)
- SECTION B ndash Campaign Delegate (Optional)
- SECTION C ndash Official Agent (Mandatory)
- SECTION D ndash Auditor (Optional)
- SECTION E ndash Campaign Office (Optional)
- SECTION F ndash Electors Consenting to Candidacy (Mandatory)
-
- Name of electoral district
- Political affiliation
- Telephone number to be posted on electionsca
- Website to be posted on electionsca including prefix http https
- Printed name of elector1
- Full residential address street numbernamecity1
- Postal code1
- Elector signature1
- Witness initials1
- Internal use only1
- Printed name of elector2
- Full residential address street numbernamecity2
- Postal code2
- Elector signature2
- Witness initials2
- Internal use only2
- Printed name of elector3
- Full residential address street numbernamecity3
- Postal code3
- Elector signature3
- Witness initials3
- Internal use only3
- Printed name of elector4
- Full residential address street numbernamecity4
- Postal code4
- Elector signature4
- Witness initials4
- Internal use only4
- Printed name of elector5
- Full residential address street numbernamecity5
- Postal code5
- Elector signature5
- Witness initials5
- Internal use only5
- Printed name of elector6
- Full residential address street numbernamecity6
- Postal code6
- Elector signature6
- Witness initials6
- Internal use only6
- Printed name of elector7
- Full residential address street numbernamecity7
- Postal code7
- Elector signature7
- Witness initials7
- Internal use only7
- Printed name of elector8
- Full residential address street numbernamecity8
- Postal code8
- Elector signature8
- Witness initials8
- Internal use only8
- Printed name of elector9
- Full residential address street numbernamecity9
- Postal code9
- Elector signature9
- Witness initials9
- Internal use only9
- Printed name of elector10
- Full residential address street numbernamecity10
- Postal code10
- Elector signature10
- Witness initials10
- Internal use only10
- Printed name of elector1_2
- Full residential address street numbernamecity1_2
- Postal code1_2
- Elector signature1_2
- Witness initials1_2
- Internal use only1_2
- Printed name of elector2_2
- Full residential address street numbernamecity2_2
- Postal code2_2
- Elector signature2_2
- Witness initials2_2
- Internal use only2_2
- Printed name of elector3_2
- Full residential address street numbernamecity3_2
- Postal code3_2
- Elector signature3_2
- Witness initials3_2
- Internal use only3_2
- Printed name of elector4_2
- Full residential address street numbernamecity4_2
- Postal code4_2
- Elector signature4_2
- Witness initials4_2
- Internal use only4_2
- Printed name of elector5_2
- Full residential address street numbernamecity5_2
- Postal code5_2
- Elector signature5_2
- Witness initials5_2
- Internal use only5_2
- Printed name of elector6_2
- Full residential address street numbernamecity6_2
- Postal code6_2
- Elector signature6_2
- Witness initials6_2
- Internal use only6_2
- Printed name of elector7_2
- Full residential address street numbernamecity7_2
- Postal code7_2
- Elector signature7_2
- Witness initials7_2
- Internal use only7_2
- Printed name of elector8_2
- Full residential address street numbernamecity8_2
- Postal code8_2
- Elector signature8_2
- Witness initials8_2
- Internal use only8_2
- Printed name of elector9_2
- Full residential address street numbernamecity9_2
- Postal code9_2
- Elector signature9_2
- Witness initials9_2
- Internal use only9_2
- Printed name of elector10_2
- Full residential address street numbernamecity10_2
- Postal code10_2
- Elector signature10_2
- Witness initials10_2
- Internal use only10_2
- Printed name of elector1_3
- Full residential address street numbernamecity1_3
- Postal code1_3
- Elector signature1_3
- Witness initials1_3
- Internal use only1_3
- Printed name of elector2_3
- Full residential address street numbernamecity2_3
- Postal code2_3
- Elector signature2_3
- Witness initials2_3
- Internal use only2_3
- Printed name of elector3_3
- Full residential address street numbernamecity3_3
- Postal code3_3
- Elector signature3_3
- Witness initials3_3
- Internal use only3_3
- Printed name of elector4_3
- Full residential address street numbernamecity4_3
- Postal code4_3
- Elector signature4_3
- Witness initials4_3
- Internal use only4_3
- Printed name of elector5_3
- Full residential address street numbernamecity5_3
- Postal code5_3
- Elector signature5_3
- Witness initials5_3
- Internal use only5_3
- Printed name of elector6_3
- Full residential address street numbernamecity6_3
- Postal code6_3
- Elector signature6_3
- Witness initials6_3
- Internal use only6_3
- Printed name of elector7_3
- Full residential address street numbernamecity7_3
- Postal code7_3
- Elector signature7_3
- Witness initials7_3
- Internal use only7_3
- Printed name of elector8_3
- Full residential address street numbernamecity8_3
- Postal code8_3
- Elector signature8_3
- Witness initials8_3
- Internal use only8_3
- Printed name of elector9_3
- Full residential address street numbernamecity9_3
- Postal code9_3
- Elector signature9_3
- Witness initials9_3
- Internal use only9_3
- Printed name of elector10_3
- Full residential address street numbernamecity10_3
- Postal code10_3
- Elector signature10_3
- Witness initials10_3
- Internal use only10_3
- Printed name of elector1_4
- Full residential address street numbernamecity1_4
- Postal code1_4
- Elector signature1_4
- Witness initials1_4
- Internal use only1_4
- Printed name of elector2_4
- Full residential address street numbernamecity2_4
- Postal code2_4
- Elector signature2_4
- Witness initials2_4
- Internal use only2_4
- Printed name of elector3_4
- Full residential address street numbernamecity3_4
- Postal code3_4
- Elector signature3_4
- Witness initials3_4
- Internal use only3_4
- Printed name of elector4_4
- Full residential address street numbernamecity4_4
- Postal code4_4
- Elector signature4_4
- Witness initials4_4
- Internal use only4_4
- Printed name of elector5_4
- Full residential address street numbernamecity5_4
- Postal code5_4
- Elector signature5_4
- Witness initials5_4
- Internal use only5_4
- Printed name of elector6_4
- Full residential address street numbernamecity6_4
- Postal code6_4
- Elector signature6_4
- Witness initials6_4
- Internal use only6_4
- Printed name of elector7_4
- Full residential address street numbernamecity7_4
- Postal code7_4
- Elector signature7_4
- Witness initials7_4
- Internal use only7_4
- Printed name of elector8_4
- Full residential address street numbernamecity8_4
- Postal code8_4
- Elector signature8_4
- Witness initials8_4
- Internal use only8_4
- Printed name of elector9_4
- Full residential address street numbernamecity9_4
- Postal code9_4
- Elector signature9_4
- Witness initials9_4
- Internal use only9_4
- Printed name of elector10_4
- Full residential address street numbernamecity10_4
- Postal code10_4
- Elector signature10_4
- Witness initials10_4
- Internal use only10_4
- Printed name of elector1_5
- Full residential address street numbernamecity1_5
- Postal code1_5
- Elector signature1_5
- Witness initials1_5
- Internal use only1_5
- Printed name of elector2_5
- Full residential address street numbernamecity2_5
- Postal code2_5
- Elector signature2_5
- Witness initials2_5
- Internal use only2_5
- Printed name of elector3_5
- Full residential address street numbernamecity3_5
- Postal code3_5
- Elector signature3_5
- Witness initials3_5
- Internal use only3_5
- Printed name of elector4_5
- Full residential address street numbernamecity4_5
- Postal code4_5
- Elector signature4_5
- Witness initials4_5
- Internal use only4_5
- Printed name of elector5_5
- Full residential address street numbernamecity5_5
- Postal code5_5
- Elector signature5_5
- Witness initials5_5
- Internal use only5_5
- Printed name of elector6_5
- Full residential address street numbernamecity6_5
- Postal code6_5
- Elector signature6_5
- Witness initials6_5
- Internal use only6_5
- Printed name of elector7_5
- Full residential address street numbernamecity7_5
- Postal code7_5
- Elector signature7_5
- Witness initials7_5
- Internal use only7_5
- Printed name of elector8_5
- Full residential address street numbernamecity8_5
- Postal code8_5
- Elector signature8_5
- Witness initials8_5
- Internal use only8_5
- Printed name of elector9_5
- Full residential address street numbernamecity9_5
- Postal code9_5
- Elector signature9_5
- Witness initials9_5
- Internal use only9_5
- Printed name of elector10_5
- Full residential address street numbernamecity10_5
- Postal code10_5
- Elector signature10_5
- Witness initials10_5
- Internal use only10_5
- Printed name of elector1_6
- Full residential address street numbernamecity1_6
- Postal code1_6
- Elector signature1_6
- Witness initials1_6
- Internal use only1_6
- Printed name of elector2_6
- Full residential address street numbernamecity2_6
- Postal code2_6
- Elector signature2_6
- Witness initials2_6
- Internal use only2_6
- Printed name of elector3_6
- Full residential address street numbernamecity3_6
- Postal code3_6
- Elector signature3_6
- Witness initials3_6
- Internal use only3_6
- Printed name of elector4_6
- Full residential address street numbernamecity4_6
- Postal code4_6
- Elector signature4_6
- Witness initials4_6
- Internal use only4_6
- Printed name of elector5_6
- Full residential address street numbernamecity5_6
- Postal code5_6
- Elector signature5_6
- Witness initials5_6
- Internal use only5_6
- Printed name of elector6_6
- Full residential address street numbernamecity6_6
- Postal code6_6
- Elector signature6_6
- Witness initials6_6
- Internal use only6_6
- Printed name of elector7_6
- Full residential address street numbernamecity7_6
- Postal code7_6
- Elector signature7_6
- Witness initials7_6
- Internal use only7_6
- Printed name of elector8_6
- Full residential address street numbernamecity8_6
- Postal code8_6
- Elector signature8_6
- Witness initials8_6
- Internal use only8_6
- Printed name of elector9_6
- Full residential address street numbernamecity9_6
- Postal code9_6
- Elector signature9_6
- Witness initials9_6
- Internal use only9_6
- Printed name of elector10_6
- Full residential address street numbernamecity10_6
- Postal code10_6
- Elector signature10_6
- Witness initials10_6
- Internal use only10_6
- Printed name of elector1_7
- Full residential address street numbernamecity1_7
- Postal code1_7
- Elector signature1_7
- Witness initials1_7
- Internal use only1_7
- Printed name of elector2_7
- Full residential address street numbernamecity2_7
- Postal code2_7
- Elector signature2_7
- Witness initials2_7
- Internal use only2_7
- Printed name of elector3_7
- Full residential address street numbernamecity3_7
- Postal code3_7
- Elector signature3_7
- Witness initials3_7
- Internal use only3_7
- Printed name of elector4_7
- Full residential address street numbernamecity4_7
- Postal code4_7
- Elector signature4_7
- Witness initials4_7
- Internal use only4_7
- Printed name of elector5_7
- Full residential address street numbernamecity5_7
- Postal code5_7
- Elector signature5_7
- Witness initials5_7
- Internal use only5_7
- Printed name of elector6_7
- Full residential address street numbernamecity6_7
- Postal code6_7
- Elector signature6_7
- Witness initials6_7
- Internal use only6_7
- Printed name of elector7_7
- Full residential address street numbernamecity7_7
- Postal code7_7
- Elector signature7_7
- Witness initials7_7
- Internal use only7_7
- Printed name of elector8_7
- Full residential address street numbernamecity8_7
- Postal code8_7
- Elector signature8_7
- Witness initials8_7
- Internal use only8_7
- Printed name of elector9_7
- Full residential address street numbernamecity9_7
- Postal code9_7
- Elector signature9_7
- Witness initials9_7
- Internal use only9_7
- Printed name of elector10_7
- Full residential address street numbernamecity10_7
- Postal code10_7
- Elector signature10_7
- Witness initials10_7
- Internal use only10_7
- Printed name of elector1_8
- Full residential address street numbernamecity1_8
- Postal code1_8
- Elector signature1_8
- Witness initials1_8
- Internal use only1_8
- Printed name of elector2_8
- Full residential address street numbernamecity2_8
- Postal code2_8
- Elector signature2_8
- Witness initials2_8
- Internal use only2_8
- Printed name of elector3_8
- Full residential address street numbernamecity3_8
- Postal code3_8
- Elector signature3_8
- Witness initials3_8
- Internal use only3_8
- Printed name of elector4_8
- Full residential address street numbernamecity4_8
- Postal code4_8
- Elector signature4_8
- Witness initials4_8
- Internal use only4_8
- Printed name of elector5_8
- Full residential address street numbernamecity5_8
- Postal code5_8
- Elector signature5_8
- Witness initials5_8
- Internal use only5_8
- Printed name of elector6_8
- Full residential address street numbernamecity6_8
- Postal code6_8
- Elector signature6_8
- Witness initials6_8
- Internal use only6_8
- Printed name of elector7_8
- Full residential address street numbernamecity7_8
- Postal code7_8
- Elector signature7_8
- Witness initials7_8
- Internal use only7_8
- Printed name of elector8_8
- Full residential address street numbernamecity8_8
- Postal code8_8
- Elector signature8_8
- Witness initials8_8
- Internal use only8_8
- Printed name of elector9_8
- Full residential address street numbernamecity9_8
- Postal code9_8
- Elector signature9_8
- Witness initials9_8
- Internal use only9_8
- Printed name of elector10_8
- Full residential address street numbernamecity10_8
- Postal code10_8
- Elector signature10_8
- Witness initials10_8
- Internal use only10_8
- Printed name of elector1_9
- Full residential address street numbernamecity1_9
- Postal code1_9
- Elector signature1_9
- Witness initials1_9
- Internal use only1_9
- Printed name of elector2_9
- Full residential address street numbernamecity2_9
- Postal code2_9
- Elector signature2_9
- Witness initials2_9
- Internal use only2_9
- Printed name of elector3_9
- Full residential address street numbernamecity3_9
- Postal code3_9
- Elector signature3_9
- Witness initials3_9
- Internal use only3_9
- Printed name of elector4_9
- Full residential address street numbernamecity4_9
- Postal code4_9
- Elector signature4_9
- Witness initials4_9
- Internal use only4_9
- Printed name of elector5_9
- Full residential address street numbernamecity5_9
- Postal code5_9
- Elector signature5_9
- Witness initials5_9
- Internal use only5_9
- Printed name of elector6_9
- Full residential address street numbernamecity6_9
- Postal code6_9
- Elector signature6_9
- Witness initials6_9
- Internal use only6_9
- Printed name of elector7_9
- Full residential address street numbernamecity7_9
- Postal code7_9
- Elector signature7_9
- Witness initials7_9
- Internal use only7_9
- Printed name of elector8_9
- Full residential address street numbernamecity8_9
- Postal code8_9
- Elector signature8_9
- Witness initials8_9
- Internal use only8_9
- Printed name of elector9_9
- Full residential address street numbernamecity9_9
- Postal code9_9
- Elector signature9_9
- Witness initials9_9
- Internal use only9_9
- Printed name of elector10_9
- Full residential address street numbernamecity10_9
- Postal code10_9
- Elector signature10_9
- Witness initials10_9
- Internal use only10_9
- Printed name of elector1_10
- Full residential address street numbernamecity1_10
- Postal code1_10
- Elector signature1_10
- Witness initials1_10
- Internal use only1_10
- Printed name of elector2_10
- Full residential address street numbernamecity2_10
- Postal code2_10
- Elector signature2_10
- Witness initials2_10
- Internal use only2_10
- Printed name of elector3_10
- Full residential address street numbernamecity3_10
- Postal code3_10
- Elector signature3_10
- Witness initials3_10
- Internal use only3_10
- Printed name of elector4_10
- Full residential address street numbernamecity4_10
- Postal code4_10
- Elector signature4_10
- Witness initials4_10
- Internal use only4_10
- Printed name of elector5_10
- Full residential address street numbernamecity5_10
- Postal code5_10
- Elector signature5_10
- Witness initials5_10
- Internal use only5_10
- Printed name of elector6_10
- Full residential address street numbernamecity6_10
- Postal code6_10
- Elector signature6_10
- Witness initials6_10
- Internal use only6_10
- Printed name of elector7_10
- Full residential address street numbernamecity7_10
- Postal code7_10
- Elector signature7_10
- Witness initials7_10
- Internal use only7_10
- Printed name of elector8_10
- Full residential address street numbernamecity8_10
- Postal code8_10
- Elector signature8_10
- Witness initials8_10
- Internal use only8_10
- Printed name of elector9_10
- Full residential address street numbernamecity9_10
- Postal code9_10
- Elector signature9_10
- Witness initials9_10
- Internal use only9_10
- Printed name of elector10_10
- Full residential address street numbernamecity10_10
- Postal code10_10
- Elector signature10_10
- Witness initials10_10
- Internal use only10_10
- Printed name of elector1_11
- Full residential address street numbernamecity1_11
- Postal code1_11
- Elector signature1_11
- Witness initials1_11
- Internal use only1_11
- Printed name of elector2_11
- Full residential address street numbernamecity2_11
- Postal code2_11
- Elector signature2_11
- Witness initials2_11
- Internal use only2_11
- Printed name of elector3_11
- Full residential address street numbernamecity3_11
- Postal code3_11
- Elector signature3_11
- Witness initials3_11
- Internal use only3_11
- Printed name of elector4_11
- Full residential address street numbernamecity4_11
- Postal code4_11
- Elector signature4_11
- Witness initials4_11
- Internal use only4_11
- Printed name of elector5_11
- Full residential address street numbernamecity5_11
- Postal code5_11
- Elector signature5_11
- Witness initials5_11
- Internal use only5_11
- Printed name of elector6_11
- Full residential address street numbernamecity6_11
- Postal code6_11
- Elector signature6_11
- Witness initials6_11
- Internal use only6_11
- Printed name of elector7_11
- Full residential address street numbernamecity7_11
- Postal code7_11
- Elector signature7_11
- Witness initials7_11
- Internal use only7_11
- Printed name of elector8_11
- Full residential address street numbernamecity8_11
- Postal code8_11
- Elector signature8_11
- Witness initials8_11
- Internal use only8_11
- Printed name of elector9_11
- Full residential address street numbernamecity9_11
- Postal code9_11
- Elector signature9_11
- Witness initials9_11
- Internal use only9_11
- Printed name of elector10_11
- Full residential address street numbernamecity10_11
- Postal code10_11
- Elector signature10_11
- Witness initials10_11
- Internal use only10_11
- Printed name of elector1_12
- Full residential address street numbernamecity1_12
- Postal code1_12
- Elector signature1_12
- Witness initials1_12
- Internal use only1_12
- Printed name of elector2_12
- Full residential address street numbernamecity2_12
- Postal code2_12
- Elector signature2_12
- Witness initials2_12
- Internal use only2_12
- Printed name of elector3_12
- Full residential address street numbernamecity3_12
- Postal code3_12
- Elector signature3_12
- Witness initials3_12
- Internal use only3_12
- Printed name of elector4_12
- Full residential address street numbernamecity4_12
- Postal code4_12
- Elector signature4_12
- Witness initials4_12
- Internal use only4_12
- Printed name of elector5_12
- Full residential address street numbernamecity5_12
- Postal code5_12
- Elector signature5_12
- Witness initials5_12
- Internal use only5_12
- Printed name of elector6_12
- Full residential address street numbernamecity6_12
- Postal code6_12
- Elector signature6_12
- Witness initials6_12
- Internal use only6_12
- Printed name of elector7_12
- Full residential address street numbernamecity7_12
- Postal code7_12
- Elector signature7_12
- Witness initials7_12
- Internal use only7_12
- Printed name of elector8_12
- Full residential address street numbernamecity8_12
- Postal code8_12
- Elector signature8_12
- Witness initials8_12
- Internal use only8_12
- Printed name of elector9_12
- Full residential address street numbernamecity9_12
- Postal code9_12
- Elector signature9_12
- Witness initials9_12
- Internal use only9_12
- Printed name of elector10_12
- Full residential address street numbernamecity10_12
- Postal code10_12
- Elector signature10_12
- Witness initials10_12
- Internal use only10_12
- Printed name of elector1_13
- Full residential address street numbernamecity1_13
- Postal code1_13
- Elector signature1_13
- Witness initials1_13
- Internal use only1_13
- Printed name of elector2_13
- Full residential address street numbernamecity2_13
- Postal code2_13
- Elector signature2_13
- Witness initials2_13
- Internal use only2_13
- Printed name of elector3_13
- Full residential address street numbernamecity3_13
- Postal code3_13
- Elector signature3_13
- Witness initials3_13
- Internal use only3_13
- Printed name of elector4_13
- Full residential address street numbernamecity4_13
- Postal code4_13
- Elector signature4_13
- Witness initials4_13
- Internal use only4_13
- Printed name of elector5_13
- Full residential address street numbernamecity5_13
- Postal code5_13
- Elector signature5_13
- Witness initials5_13
- Internal use only5_13
- Printed name of elector6_13
- Full residential address street numbernamecity6_13
- Postal code6_13
- Elector signature6_13
- Witness initials6_13
- Internal use only6_13
- Printed name of elector7_13
- Full residential address street numbernamecity7_13
- Postal code7_13
- Elector signature7_13
- Witness initials7_13
- Internal use only7_13
- Printed name of elector8_13
- Full residential address street numbernamecity8_13
- Postal code8_13
- Elector signature8_13
- Witness initials8_13
- Internal use only8_13
- Printed name of elector9_13
- Full residential address street numbernamecity9_13
- Postal code9_13
- Elector signature9_13
- Witness initials9_13
- Internal use only9_13
- Printed name of elector10_13
- Full residential address street numbernamecity10_13
- Postal code10_13
- Elector signature10_13
- Witness initials10_13
- Internal use only10_13
- Printed name of elector1_14
- Full residential address street numbernamecity1_14
- Postal code1_14
- Elector signature1_14
- Witness initials1_14
- Internal use only1_14
- Printed name of elector2_14
- Full residential address street numbernamecity2_14
- Postal code2_14
- Elector signature2_14
- Witness initials2_14
- Internal use only2_14
- Printed name of elector3_14
- Full residential address street numbernamecity3_14
- Postal code3_14
- Elector signature3_14
- Witness initials3_14
- Internal use only3_14
- Printed name of elector4_14
- Full residential address street numbernamecity4_14
- Postal code4_14
- Elector signature4_14
- Witness initials4_14
- Internal use only4_14
- Printed name of elector5_14
- Full residential address street numbernamecity5_14
- Postal code5_14
- Elector signature5_14
- Witness initials5_14
- Internal use only5_14
- Printed name of elector6_14
- Full residential address street numbernamecity6_14
- Postal code6_14
- Elector signature6_14
- Witness initials6_14
- Internal use only6_14
- Printed name of elector7_14
- Full residential address street numbernamecity7_14
- Postal code7_14
- Elector signature7_14
- Witness initials7_14
- Internal use only7_14
- Printed name of elector8_14
- Full residential address street numbernamecity8_14
- Postal code8_14
- Elector signature8_14
- Witness initials8_14
- Internal use only8_14
- Printed name of elector9_14
- Full residential address street numbernamecity9_14
- Postal code9_14
- Elector signature9_14
- Witness initials9_14
- Internal use only9_14
- Printed name of elector10_14
- Full residential address street numbernamecity10_14
- Postal code10_14
- Elector signature10_14
- Witness initials10_14
- Internal use only10_14
- Printed name of elector1_15
- Full residential address street numbernamecity1_15
- Postal code1_15
- Elector signature1_15
- Witness initials1_15
- Internal use only1_15
- Printed name of elector2_15
- Full residential address street numbernamecity2_15
- Postal code2_15
- Elector signature2_15
- Witness initials2_15
- Internal use only2_15
- Printed name of elector3_15
- Full residential address street numbernamecity3_15
- Postal code3_15
- Elector signature3_15
- Witness initials3_15
- Internal use only3_15
- Printed name of elector4_15
- Full residential address street numbernamecity4_15
- Postal code4_15
- Elector signature4_15
- Witness initials4_15
- Internal use only4_15
- Printed name of elector5_15
- Full residential address street numbernamecity5_15
- Postal code5_15
- Elector signature5_15
- Witness initials5_15
- Internal use only5_15
- Printed name of elector6_15
- Full residential address street numbernamecity6_15
- Postal code6_15
- Elector signature6_15
- Witness initials6_15
- Internal use only6_15
- Printed name of elector7_15
- Full residential address street numbernamecity7_15
- Postal code7_15
- Elector signature7_15
- Witness initials7_15
- Internal use only7_15
- Printed name of elector8_15
- Full residential address street numbernamecity8_15
- Postal code8_15
- Elector signature8_15
- Witness initials8_15
- Internal use only8_15
- Printed name of elector9_15
- Full residential address street numbernamecity9_15
- Postal code9_15
- Elector signature9_15
- Witness initials9_15
- Internal use only9_15
- Printed name of elector10_15
- Full residential address street numbernamecity10_15
- Postal code10_15
- Elector signature10_15
- Witness initials10_15
- Internal use only10_15
- Printed name of elector1_16
- Full residential address street numbernamecity1_16
- Postal code1_16
- Elector signature1_16
- Witness initials1_16
- Internal use only1_16
- Printed name of elector2_16
- Full residential address street numbernamecity2_16
- Postal code2_16
- Elector signature2_16
- Witness initials2_16
- Internal use only2_16
- Printed name of elector3_16
- Full residential address street numbernamecity3_16
- Postal code3_16
- Elector signature3_16
- Witness initials3_16
- Internal use only3_16
- Printed name of elector4_16
- Full residential address street numbernamecity4_16
- Postal code4_16
- Elector signature4_16
- Witness initials4_16
- Internal use only4_16
- Printed name of elector5_16
- Full residential address street numbernamecity5_16
- Postal code5_16
- Elector signature5_16
- Witness initials5_16
- Internal use only5_16
- Printed name of elector6_16
- Full residential address street numbernamecity6_16
- Postal code6_16
- Elector signature6_16
- Witness initials6_16
- Internal use only6_16
- Printed name of elector7_16
- Full residential address street numbernamecity7_16
- Postal code7_16
- Elector signature7_16
- Witness initials7_16
- Internal use only7_16
- Printed name of elector8_16
- Full residential address street numbernamecity8_16
- Postal code8_16
- Elector signature8_16
- Witness initials8_16
- Internal use only8_16
- Printed name of elector9_16
- Full residential address street numbernamecity9_16
- Postal code9_16
- Elector signature9_16
- Witness initials9_16
- Internal use only9_16
- Printed name of elector10_16
- Full residential address street numbernamecity10_16
- Postal code10_16
- Elector signature10_16
- Witness initials10_16
- Internal use only10_16
- Have you completed the Nomination Paper EC 20010 Off
- Do you have authorized proof of identify Off
- Are you endorsed by a political party Off
- Have you made a nomination appointment Off
- Last name - Candidate Name
- First name - Candidate Name
- Name of electoral district- Candidate Information
- First name - Candidate Information
- Last name - Candidate Information
- Ballot Name Off
- Ballot First name(s)
- Ballot Last name(s)
- Gender -Candidate information
- Date of birth (YYY-MM-DD) - Gender -Candidate information
- language of correspondence - Candidate information Off
- Email -Contact information
- Primary phone number - Contact information
- Ext - Primary phone number
- Alternate phone number - Contact information
- Ext - Alternate phone number
- Fax number- Alternate phone number
- Unit -Residential address
- Street -Residential address
- Street name -Residential address
- City -Residential address
- ProvinceTerritory -Residential address
- Postal code - -Residential address
- Mailing address - same as residential address Off
- Occupation- Candidate occupation
- Sharing of information with the Conflict of Interest and Ethics Commissioner and the House of Commons including the Library of Parliament Off
- where applicable if the returning officer is unable to verify that I have been endorsed by the political party identified in section A of this Nomination Paper I wish to Off
- Date of Signature (YYYY-MM-DD) - Candidate signature
- Date of Signature (YYYY-MM-DD) -Signature of person receiving the solemn declaration
- Campaign delegate information
- First name - Campaign delegate information
- Last name - Campaign delegate information
- Language of correspondence - Campaign delegate information Off
- Email - Contact information -Campaign Delegate
- Primary phone number - Contact information -Campaign Delegate
- Primary phone number EXT - Contact information -Campaign Delegate
- Alternate phone number - Contact information -Campaign Delegate
- Alternate phone number EXT - Contact information -Campaign Delegate
- Fax nmuber- Contact information -Campaign Delegate
- Street - Residential address -Campaign delegate
- Street name - Residential address -Campaign delegate
- City - Residential address -Campaign delegate
- ProvinceTerritory - Residential address -Campaign delegate
- Postal Code - Residential address -Campaign delegate
- Campaign delegate - Mailing address ndash Same as residential address Off
- Unit - Residential address -Campaign delegate
- Date (YYYY-MM-DD) - Candidate authorization Signature
- Date (YYYY-MM-DD) - Candidate campaign Signature
- First name - Official agent information
- Last name - Official agent information
- Language of correspondence - Official agent information Off
- Email - Official agent information
- Primary phone number - Official agent information
- Primary phone number EXT - Official agent information
- Alternate phone number EXT - Official agent information
- Alternate phone number - Official agent information
- Fax number - Official agent information
- Unit -Residential address - Official Agent
- Street name -Residential address - Official Agent
- City -Residential address - Official Agent
- Street -Residential address - Official Agent
- ProvinceTerritory -Residential address - Official Agent
- Postal code-Residential address - Official Agent
- Mailing address ndash Same as residential address- Official Agent Off
- Date (YYYY-MM-DD) - Official agent signature
- First name - Auditor information
- Last name - Auditor information
- Language of correspondence - Auditor information Off
- Email - Auditor information
- Primary phone number - Auditor information
- Primary phone number EXT- Auditor information
- Alternate phone number - Auditor information
- Alternate phone number EXT- Auditor information
- Fax number - Auditor information
- Name of firm- Auditor organizational information
- Occupation of auditor - Auditor organizational information
- Professional designation - Auditor organizational information Off
- Designation registration number
- Make cheque payable to
- Unit - Address (where cheque is sent)
- Street - Address (where cheque is sent)
- Street name - Address (where cheque is sent)
- City - Address (where cheque is sent)
- ProvinceTerritory - Address (where cheque is sent)
- Postal code - Address (where cheque is sent)
- Date (YYY-MM-DD) - Auditor signature
- Unit - Campaign office address (optional)
- Street - Campaign office address (optional)
- Street name - Campaign office address (optional)
- City - Campaign office address (optional)
- ProvinceTerritory- Campaign office address (optional)
- Postal code - Campaign office address (optional)
- Name of witness
- Full address of witness
- Name of candidate
- Electoral district
- Year
- Name of candidate2
- Electoral district2
- Year2
- Name of witness2
- Full address of witness2
- Name of candidate3
- Electoral district3
- Year3
- Full address of witness3
- Name of witness3
- Name of candidate 4
- Electoral district4
- Year4
- Full address of witness 4
- Name of witness 4
- Name of candidate5
- Electoral district5
- Year5
- Full address of witness5
- Name of witness5
- Name of candidate6
- Electoral district6
- Year6
- Name of witness6
- Full address of witness6
- Name of candidate7
- Electoral district7
- Year7
- Full address of witness7
- Name of witness7
- Name of candidate8
- Electoral district8
- Year8
- Full address of witness8
- Name of witness8
- Name of candidate9
- Electoral district9
- Year9
- Full address of witness 9
- Name of witness 9
- Name of candidate10
- Electoral district10
- Year10
- Full address of witness10
- Name of witness10
- Name of candidate11
- Electoral district11
- Year11
- Full address of witness11
- Name of witness11
- Name of candidate12
- Electoral district12
- Year12
- Full address of witness12
- Name of witness12
- Name of candidate13
- Electoral district13
- Year13
- Full address of witness13
- Name of witness13
- Name of candidate14
- Electoral district14
- Year14
- Name of witness14
- Full address of witness14
- Name of candidate1
- Electoral district1
- Year1
- Name of witness1
- Full address of witness1
- Name of candidate15
- Electoral district15
- Year15
- Name of witness15
- Full address of witness15
- unit -Mailing address
- Street -Mailing address
- Street name -Mailing address
- City -Mailing address
- ProvinceTerritory -Mailing address
- Postal code -Mailing address
- Unit - Mailing address -Campaign delegate
- Street - Mailing address -Campaign delegate
- Street name - Mailing address -Campaign delegate
- City - Mailing address -Campaign delegate
- ProvinceTerritory- Mailing address -Campaign delegate
- Postal code- Mailing address -Campaign delegate
- Unit -Mailing address - Official Agent
- Street -Mailing address - Official Agent
- Street name -Mailing address - Official Agent
- city -Mailing address - Official Agent
- ProvinceTerritory-Mailing address - Official Agent
- Postal code-Mailing address - Official Agent
EC 20010 (052019)
SECTION A ndash 2BCandidate Information (Mandatory)
All fields marked with are mandatory
Electoral district
Print the name of the electoral district you are running in You may run in only one electoral district at a time You do not need to reside in the district
Name of electoral district
Candidate name
Print your first name and last name The name must not include any title degree or other prefix or suffix When you file the Nomination Paper you must provide the returning officer with proof of identity that matches the first and last name as identified below CEA 66(2) 67(2)(a)(b)
First name(s) Last name
Name on ballot
You may request an alternative name to appear on the ballot however you must provide the returning officer with sufficient documentation that you are commonly known by that name For more information on authorized proof see the How to become a candidate webpage at electionsca CEA 67(5)
Ballot name
Option 1 Use first and last name as provided above (leave fields below blank)
Option 2 Use other name (complete fields below)
Ballot first name(s) Ballot last name
Political affiliation
State your political affiliation (name of the registered or eligible political party or ldquoIndependentrdquo) In the absence of a stated political affiliation a series of black dashes will appear under your name on the ballot Note In order to have a political party affiliation on the ballot the party must file an endorsement with Elections Canada It is strongly recommended you confirm with your political party and local returning officer to better ensure that your name has been submitted
Political affiliation
4
ndash
EC 20010 (052019)
25BSECTION A ndash Candidate Information (Mandatory)
All fields marked with are mandatory
Candidate information
Gender Date of birth (YYYY-MM-DD) Language of correspondence
English French
Contact information
Upon confirmation of the nomination Elections Canada will send to the email address listed below an invitation to the Political Entities Service Centre (PESC) online portal
Primary phone number Ext Alternate phone number Ext Fax number
Residential address
Unit Street Street name
City ProvinceTerritory Postal code
Mailing address Same as residential address
Unit Street Street name
City ProvinceTerritory Postal code
5
EC 20010 (052019)
26BSECTION A ndash Candidate Information (Mandatory)
All fields marked with are mandatory
Candidate occupation
State the occupation you are commonly known by in your place of ordinary residence Please note that the term ldquoMember of Parliamentrdquo is not an occupation but a title and will not be accepted The term ldquoparliamentarianrdquo however is acceptable CEA 66(3)
Occupation
Sharing of information with the Conflict of Interest and Ethics Commissioner and the House of Commons including the Library of Parliament
To help new members of Parliament Elections Canada will share the name gender residential address telephone number email address occupation preferred language of correspondence electoral district and political party affiliation of candidates who authorize Elections Canada to share their information with the Conflict of Interest and Ethics Commissioner and the House of Commons which includes the Library of Parliament
Do you authorize Elections Canada to share your personal information with the Conflict of Interest and Ethics Commissioner and the House of Commons including the Library of Parliament
Yes No
Privacy notice
Personal information in this Nomination Paper and all associated supporting documents are collected to determine your eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
Any person at the returning office may examine the completed Nomination Paper during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
Subject to consent your contact information may be shared with the House of Commons Conflict of Interest and Ethics Commissioner and Library of Parliament for orientation and communication purposes for new Members of Parliament If you provide a URL it may be posted on Elections Canadarsquos website to increase electorsrsquo accessibility to the electoral framework and democratic process
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information
Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB may be found on the Elections Canada website
6
a
b
c
EC 20010 (052019)
SECTION A ndash Candidate Declaration and Signature (Mandatory)
All fields marked with are mandatory
Candidatersquos declaration
I the undersigned do hereby solemnly declare that
1 my name (including any alternative name I wish to have appear on the ballot) my addressand occupation are as stated in section A of this Nomination Paper
2 I designate the permanent residential address in this Nomination Paper as the address forservice of process and papers under the Canada Elections Act
3 the name and address of my official agent and the name address and occupation of myauditor (if applicable) are as stated in sections C and D of this Nomination Paper
4 the information regarding my political affiliation is as stated in section A of this NominationPaper and
5 where applicable if the returning officer is unable to verify that I have been endorsed by thepolitical party identified in section A of this Nomination Paper I wish to
Have the word ldquoindependentrdquo appear under my name on the ballot
have no designation of political affiliation (meaning that a series of black dashes will appear under my name on the ballot) or
withdraw my Nomination paper
I further state that
1 I consent to the nomination
2 I am a Canadian citizen at least 18 years of age on election day
3 as per section 65 of the Canada Elections Act I am not ineligible to be a candidate
4 I consent to allowing my official agent and candidate campaign delegate (if applicable) toaccess on my behalf electoral materials online or at the local Elections Canada officeincluding the lists of electors distributed by Elections Canada and
5 I am aware of my obligations under the Canada Elections Act
Candidate signature Date (YYYY-MM-DD)
Signature of person receiving the solemn declaration
As per subsection 549(1) of the Canada Elections Act the solemn declaration must be witnessed by a judge an election officer a unit election officer as defined in section 177 a notary public a provincial court judge a justice of the peace or a commissioner for taking oaths in the province
Signature of person receiving the solemn declaration Date (YYYY-MM-DD)
7
ndash
EC 20010 (052019)
SECTION B ndash 3BCampaign Delegate (Optional)
If appointing a campaign delegate all fields marked with are mandatory
Campaign delegate information
A candidate may authorize another individual (referred to in the Nomination Paper as the campaign delegate) to act on their behalf during the election The campaign delegate can submit the Nomination Paper and all associated supporting documents CEA 67(7) Note The campaign delegate does not have access to the candidatersquos financial returns
First name Last name Language of correspondence
English French
Contact information
Upon confirmation of the nomination Elections Canada will send to the email address listed below an invitation to the Political Entities Service Centre (PESC) online portal
Primary phone number Ext Alternate phone number Ext Fax number
Residential address
Unit Street Street name
City ProvinceTerritory Postal code
Mailing address Same as residential address
Unit Street Street name
City ProvinceTerritory Postal code
8
EC 20010 (052019)
SECTION B ndash Campaign Delegate ndash Privacy Notice and Declaration (Optional)
If appointing a campaign delegate all fields marked with are mandatory
Privacy notice
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA) Any person at the returning office may examine the completed Nomination Paper during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
Candidate authorization of the campaign delegate
As per subsection 66(1)(h) of the Canada Elections Act I authorize the individual identified in this section to act as my campaign delegate
Candidate signature Date (YYYY-MM-DD)
Candidate campaign delegate signature
I the undersigned candidate campaign delegate for the candidate named in this Nomination Paper state that
1 I hereby agree to act as the authorized person for the candidate named herein for the purposes of theCanada Elections Act
2 I am fully aware of the duties and responsibilities imposed on me by the Canada Elections Act
Campaign delegate signature Date (YYYY-MM-DD)
9
ndash
EC 20010 (052019)
SECTION C ndash 4BOfficial Agent (Mandatory)
All fields marked with are mandatory
Official agent information
The official agent is responsible for administering the campaignrsquos financial transactions and reporting those transactions to Elections Canada as required by the CEA For more information consult the Political Financing Handbook for Candidates and Official Agents Note The candidate official agent and auditor must all be different people
First name Last name Language of correspondence
English French
Contact information
Upon confirmation of the nomination Elections Canada will send to the email address listed below an invitation to the Political Entities Service Centre (PESC) online portal
Primary phone number Ext Alternate phone number Ext Fax number
Residential address Unit Street Street name
City ProvinceTerritory Postal code
Mailing address Same as residential address
Unit Street Street name
City ProvinceTerritory Postal code
10
EC 20010 (052019)
24BSECTION C ndash Official Agent ndash Privacy Notice and Declaration (Mandatory)
All fields marked with are mandatory
Privacy notice
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA) Any person at the returning office may examine the completed Nomination Paper during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
Official agent signature
I the undersigned official agent for the candidate named in this Nomination Paper hereby agree to act as official agent for the candidate named herein for the purposes of the Canada Elections Act I further state that
1 I am fully aware of the duties and responsibilities imposed on me by the Canada Elections Act
2 I am capable of entering into contracts in the provinceterritory in which this electoral district is located
3 I am eligible to act as official agent pursuant to section 4772 of the Canada Elections Act
Section 4772 of the Canada Elections Act states The following persons are ineligible to be an official agenta candidate an election officer or a member of the staff of a returning office an undischarged bankrupt anauditor appointed as required by this Act a person who is not qualified as an elector and a person who doesnot have the capacity to enter into contracts in the province in which they ordinarily reside
Official agent signature Date (YYYY-MM-DD)
11
EC 20010 (052019)
SECTION D ndash 5B Auditor (Optional)
If appointing an auditor all fields marked with are mandatory
Auditor information An auditor must be appointed if bull the candidatersquos campaign accepts contributions of $10000 or more bull the candidatersquos campaign incurs expenses of $10000 or more or bull the candidate receives 10 or more of votes cast in the electoral district If at the time of filing the Nomination Paper none of the above applies you do not need to appoint an auditor though you may still choose to do so If the above requirements are later met you must appoint an auditor without delay A person or partnership who wants to act as a candidatersquos auditor must be or have every partner be recognized as a professional accountant under provincial or territorial legislation CEA 4773(1) For more information consult the Political Financing Handbook for Candidates and Official Agents
First name Last name Language of correspondence
English French
Contact information Upon confirmation of the nomination Elections Canada will send to the email address listed below an invitation to the Political Entities Service Centre (PESC) online portal
Primary phone number Ext Alternate phone number Ext Fax number
Auditor organizational information Name of firm Occupation of auditor Professional designation
CPA FCPA
Designation registration number Make cheque payable to
Address (where cheque is sent) Unit Street Street name
City ProvinceTerritory Postal code
12
EC 20010 (052019)
SECTION D ndash Auditor ndash Privacy Notice and Declaration (Optional)
If appointing an auditor all fields marked with are mandatory
Privacy notice
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA) Any person at the returning office may examine the completed Nomination Paper during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information
Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
Auditor signature
I the undersigned hereby agree to act as the auditor for the candidate named in this Nomination Paper I further state that I am aware of the duties and responsibilities of this position under the Canada Elections Act and I am qualified to act as auditor under subsection 4773(1) and (2) of the Canada Elections Act
Auditor signature Date (YYYY-MM-DD)
13
EC 20010 (052019)
SECTION E ndash 6BCampaign Office (Optional)
Contact information to be made available on the Elections Canada website (optional)
Please note You may provide a telephone number andor a link to your website or social media platform of choice when filing your Nomination Paper with Elections Canada You do not have to provide this information but it is intended to help electors access campaign information Elections Canada may provide this information as part of the Voter Information Service Please include the full website address including prefix (http https)
Telephone number to be posted on electionsca
Website to be posted on electionsca (including prefix http https)
Campaign office address (optional)
Unit Street Street name
City ProvinceTerritory Postal code
14
SECTION F ndash 7BElectors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
15
8BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
16
9BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
17
10BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
18
11BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
19
12BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
20
13BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
21
14BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
22
15BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
23
16BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
24
17BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
25
18BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
26
19BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
27
20BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
28
21BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
29
22BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
30
EC 20010 (022019)
SECTION G ndash 23B Are You Ready to Submit Your Nomination
Have you completed the Nomination Paper (EC 20010)
bull Are all mandatory fields in sections AndashE complete
bull Have you collected the required number of signatures from qualified electors in section F
o For most electoral districts 100 electors must consent to your candidacy
o For electoral districts identified in Schedule 3 only 50 electors are required
o To ensure a smooth nomination process Elections Canada recommends collecting signatures from at least 150 electors
Do you have authorized proof of identify
bull For a list of authorized identification visit the Elections Canada website
bull If a campaign delegate is submitting on your behalf they must bring a copy of your identification documents signed by you
bull If you want an alternative name to appear on the ballot additional documentation is required visit electionsca for details
Are you endorsed by a political party
bull Make sure your party has submitted the required documentation to Elections Canada attesting your designated political affiliation
Have you made a nomination appointment
bull To facilitate the nomination process make an appointment with the returning officer to finalize the filing of the complete nomination package
bull The nomination period closes 21 days before election day at 200 pm local time
31
- Nomination Paperof a Candidate at a Federal General Election or By-election
- Table of Contents
- General Information
- SECTION A ndash Candidate Information (Mandatory)
- SECTION B ndash Campaign Delegate (Optional)
- SECTION C ndash Official Agent (Mandatory)
- SECTION D ndash Auditor (Optional)
- SECTION E ndash Campaign Office (Optional)
- SECTION F ndash Electors Consenting to Candidacy (Mandatory)
-
- Name of electoral district
- Political affiliation
- Telephone number to be posted on electionsca
- Website to be posted on electionsca including prefix http https
- Printed name of elector1
- Full residential address street numbernamecity1
- Postal code1
- Elector signature1
- Witness initials1
- Internal use only1
- Printed name of elector2
- Full residential address street numbernamecity2
- Postal code2
- Elector signature2
- Witness initials2
- Internal use only2
- Printed name of elector3
- Full residential address street numbernamecity3
- Postal code3
- Elector signature3
- Witness initials3
- Internal use only3
- Printed name of elector4
- Full residential address street numbernamecity4
- Postal code4
- Elector signature4
- Witness initials4
- Internal use only4
- Printed name of elector5
- Full residential address street numbernamecity5
- Postal code5
- Elector signature5
- Witness initials5
- Internal use only5
- Printed name of elector6
- Full residential address street numbernamecity6
- Postal code6
- Elector signature6
- Witness initials6
- Internal use only6
- Printed name of elector7
- Full residential address street numbernamecity7
- Postal code7
- Elector signature7
- Witness initials7
- Internal use only7
- Printed name of elector8
- Full residential address street numbernamecity8
- Postal code8
- Elector signature8
- Witness initials8
- Internal use only8
- Printed name of elector9
- Full residential address street numbernamecity9
- Postal code9
- Elector signature9
- Witness initials9
- Internal use only9
- Printed name of elector10
- Full residential address street numbernamecity10
- Postal code10
- Elector signature10
- Witness initials10
- Internal use only10
- Printed name of elector1_2
- Full residential address street numbernamecity1_2
- Postal code1_2
- Elector signature1_2
- Witness initials1_2
- Internal use only1_2
- Printed name of elector2_2
- Full residential address street numbernamecity2_2
- Postal code2_2
- Elector signature2_2
- Witness initials2_2
- Internal use only2_2
- Printed name of elector3_2
- Full residential address street numbernamecity3_2
- Postal code3_2
- Elector signature3_2
- Witness initials3_2
- Internal use only3_2
- Printed name of elector4_2
- Full residential address street numbernamecity4_2
- Postal code4_2
- Elector signature4_2
- Witness initials4_2
- Internal use only4_2
- Printed name of elector5_2
- Full residential address street numbernamecity5_2
- Postal code5_2
- Elector signature5_2
- Witness initials5_2
- Internal use only5_2
- Printed name of elector6_2
- Full residential address street numbernamecity6_2
- Postal code6_2
- Elector signature6_2
- Witness initials6_2
- Internal use only6_2
- Printed name of elector7_2
- Full residential address street numbernamecity7_2
- Postal code7_2
- Elector signature7_2
- Witness initials7_2
- Internal use only7_2
- Printed name of elector8_2
- Full residential address street numbernamecity8_2
- Postal code8_2
- Elector signature8_2
- Witness initials8_2
- Internal use only8_2
- Printed name of elector9_2
- Full residential address street numbernamecity9_2
- Postal code9_2
- Elector signature9_2
- Witness initials9_2
- Internal use only9_2
- Printed name of elector10_2
- Full residential address street numbernamecity10_2
- Postal code10_2
- Elector signature10_2
- Witness initials10_2
- Internal use only10_2
- Printed name of elector1_3
- Full residential address street numbernamecity1_3
- Postal code1_3
- Elector signature1_3
- Witness initials1_3
- Internal use only1_3
- Printed name of elector2_3
- Full residential address street numbernamecity2_3
- Postal code2_3
- Elector signature2_3
- Witness initials2_3
- Internal use only2_3
- Printed name of elector3_3
- Full residential address street numbernamecity3_3
- Postal code3_3
- Elector signature3_3
- Witness initials3_3
- Internal use only3_3
- Printed name of elector4_3
- Full residential address street numbernamecity4_3
- Postal code4_3
- Elector signature4_3
- Witness initials4_3
- Internal use only4_3
- Printed name of elector5_3
- Full residential address street numbernamecity5_3
- Postal code5_3
- Elector signature5_3
- Witness initials5_3
- Internal use only5_3
- Printed name of elector6_3
- Full residential address street numbernamecity6_3
- Postal code6_3
- Elector signature6_3
- Witness initials6_3
- Internal use only6_3
- Printed name of elector7_3
- Full residential address street numbernamecity7_3
- Postal code7_3
- Elector signature7_3
- Witness initials7_3
- Internal use only7_3
- Printed name of elector8_3
- Full residential address street numbernamecity8_3
- Postal code8_3
- Elector signature8_3
- Witness initials8_3
- Internal use only8_3
- Printed name of elector9_3
- Full residential address street numbernamecity9_3
- Postal code9_3
- Elector signature9_3
- Witness initials9_3
- Internal use only9_3
- Printed name of elector10_3
- Full residential address street numbernamecity10_3
- Postal code10_3
- Elector signature10_3
- Witness initials10_3
- Internal use only10_3
- Printed name of elector1_4
- Full residential address street numbernamecity1_4
- Postal code1_4
- Elector signature1_4
- Witness initials1_4
- Internal use only1_4
- Printed name of elector2_4
- Full residential address street numbernamecity2_4
- Postal code2_4
- Elector signature2_4
- Witness initials2_4
- Internal use only2_4
- Printed name of elector3_4
- Full residential address street numbernamecity3_4
- Postal code3_4
- Elector signature3_4
- Witness initials3_4
- Internal use only3_4
- Printed name of elector4_4
- Full residential address street numbernamecity4_4
- Postal code4_4
- Elector signature4_4
- Witness initials4_4
- Internal use only4_4
- Printed name of elector5_4
- Full residential address street numbernamecity5_4
- Postal code5_4
- Elector signature5_4
- Witness initials5_4
- Internal use only5_4
- Printed name of elector6_4
- Full residential address street numbernamecity6_4
- Postal code6_4
- Elector signature6_4
- Witness initials6_4
- Internal use only6_4
- Printed name of elector7_4
- Full residential address street numbernamecity7_4
- Postal code7_4
- Elector signature7_4
- Witness initials7_4
- Internal use only7_4
- Printed name of elector8_4
- Full residential address street numbernamecity8_4
- Postal code8_4
- Elector signature8_4
- Witness initials8_4
- Internal use only8_4
- Printed name of elector9_4
- Full residential address street numbernamecity9_4
- Postal code9_4
- Elector signature9_4
- Witness initials9_4
- Internal use only9_4
- Printed name of elector10_4
- Full residential address street numbernamecity10_4
- Postal code10_4
- Elector signature10_4
- Witness initials10_4
- Internal use only10_4
- Printed name of elector1_5
- Full residential address street numbernamecity1_5
- Postal code1_5
- Elector signature1_5
- Witness initials1_5
- Internal use only1_5
- Printed name of elector2_5
- Full residential address street numbernamecity2_5
- Postal code2_5
- Elector signature2_5
- Witness initials2_5
- Internal use only2_5
- Printed name of elector3_5
- Full residential address street numbernamecity3_5
- Postal code3_5
- Elector signature3_5
- Witness initials3_5
- Internal use only3_5
- Printed name of elector4_5
- Full residential address street numbernamecity4_5
- Postal code4_5
- Elector signature4_5
- Witness initials4_5
- Internal use only4_5
- Printed name of elector5_5
- Full residential address street numbernamecity5_5
- Postal code5_5
- Elector signature5_5
- Witness initials5_5
- Internal use only5_5
- Printed name of elector6_5
- Full residential address street numbernamecity6_5
- Postal code6_5
- Elector signature6_5
- Witness initials6_5
- Internal use only6_5
- Printed name of elector7_5
- Full residential address street numbernamecity7_5
- Postal code7_5
- Elector signature7_5
- Witness initials7_5
- Internal use only7_5
- Printed name of elector8_5
- Full residential address street numbernamecity8_5
- Postal code8_5
- Elector signature8_5
- Witness initials8_5
- Internal use only8_5
- Printed name of elector9_5
- Full residential address street numbernamecity9_5
- Postal code9_5
- Elector signature9_5
- Witness initials9_5
- Internal use only9_5
- Printed name of elector10_5
- Full residential address street numbernamecity10_5
- Postal code10_5
- Elector signature10_5
- Witness initials10_5
- Internal use only10_5
- Printed name of elector1_6
- Full residential address street numbernamecity1_6
- Postal code1_6
- Elector signature1_6
- Witness initials1_6
- Internal use only1_6
- Printed name of elector2_6
- Full residential address street numbernamecity2_6
- Postal code2_6
- Elector signature2_6
- Witness initials2_6
- Internal use only2_6
- Printed name of elector3_6
- Full residential address street numbernamecity3_6
- Postal code3_6
- Elector signature3_6
- Witness initials3_6
- Internal use only3_6
- Printed name of elector4_6
- Full residential address street numbernamecity4_6
- Postal code4_6
- Elector signature4_6
- Witness initials4_6
- Internal use only4_6
- Printed name of elector5_6
- Full residential address street numbernamecity5_6
- Postal code5_6
- Elector signature5_6
- Witness initials5_6
- Internal use only5_6
- Printed name of elector6_6
- Full residential address street numbernamecity6_6
- Postal code6_6
- Elector signature6_6
- Witness initials6_6
- Internal use only6_6
- Printed name of elector7_6
- Full residential address street numbernamecity7_6
- Postal code7_6
- Elector signature7_6
- Witness initials7_6
- Internal use only7_6
- Printed name of elector8_6
- Full residential address street numbernamecity8_6
- Postal code8_6
- Elector signature8_6
- Witness initials8_6
- Internal use only8_6
- Printed name of elector9_6
- Full residential address street numbernamecity9_6
- Postal code9_6
- Elector signature9_6
- Witness initials9_6
- Internal use only9_6
- Printed name of elector10_6
- Full residential address street numbernamecity10_6
- Postal code10_6
- Elector signature10_6
- Witness initials10_6
- Internal use only10_6
- Printed name of elector1_7
- Full residential address street numbernamecity1_7
- Postal code1_7
- Elector signature1_7
- Witness initials1_7
- Internal use only1_7
- Printed name of elector2_7
- Full residential address street numbernamecity2_7
- Postal code2_7
- Elector signature2_7
- Witness initials2_7
- Internal use only2_7
- Printed name of elector3_7
- Full residential address street numbernamecity3_7
- Postal code3_7
- Elector signature3_7
- Witness initials3_7
- Internal use only3_7
- Printed name of elector4_7
- Full residential address street numbernamecity4_7
- Postal code4_7
- Elector signature4_7
- Witness initials4_7
- Internal use only4_7
- Printed name of elector5_7
- Full residential address street numbernamecity5_7
- Postal code5_7
- Elector signature5_7
- Witness initials5_7
- Internal use only5_7
- Printed name of elector6_7
- Full residential address street numbernamecity6_7
- Postal code6_7
- Elector signature6_7
- Witness initials6_7
- Internal use only6_7
- Printed name of elector7_7
- Full residential address street numbernamecity7_7
- Postal code7_7
- Elector signature7_7
- Witness initials7_7
- Internal use only7_7
- Printed name of elector8_7
- Full residential address street numbernamecity8_7
- Postal code8_7
- Elector signature8_7
- Witness initials8_7
- Internal use only8_7
- Printed name of elector9_7
- Full residential address street numbernamecity9_7
- Postal code9_7
- Elector signature9_7
- Witness initials9_7
- Internal use only9_7
- Printed name of elector10_7
- Full residential address street numbernamecity10_7
- Postal code10_7
- Elector signature10_7
- Witness initials10_7
- Internal use only10_7
- Printed name of elector1_8
- Full residential address street numbernamecity1_8
- Postal code1_8
- Elector signature1_8
- Witness initials1_8
- Internal use only1_8
- Printed name of elector2_8
- Full residential address street numbernamecity2_8
- Postal code2_8
- Elector signature2_8
- Witness initials2_8
- Internal use only2_8
- Printed name of elector3_8
- Full residential address street numbernamecity3_8
- Postal code3_8
- Elector signature3_8
- Witness initials3_8
- Internal use only3_8
- Printed name of elector4_8
- Full residential address street numbernamecity4_8
- Postal code4_8
- Elector signature4_8
- Witness initials4_8
- Internal use only4_8
- Printed name of elector5_8
- Full residential address street numbernamecity5_8
- Postal code5_8
- Elector signature5_8
- Witness initials5_8
- Internal use only5_8
- Printed name of elector6_8
- Full residential address street numbernamecity6_8
- Postal code6_8
- Elector signature6_8
- Witness initials6_8
- Internal use only6_8
- Printed name of elector7_8
- Full residential address street numbernamecity7_8
- Postal code7_8
- Elector signature7_8
- Witness initials7_8
- Internal use only7_8
- Printed name of elector8_8
- Full residential address street numbernamecity8_8
- Postal code8_8
- Elector signature8_8
- Witness initials8_8
- Internal use only8_8
- Printed name of elector9_8
- Full residential address street numbernamecity9_8
- Postal code9_8
- Elector signature9_8
- Witness initials9_8
- Internal use only9_8
- Printed name of elector10_8
- Full residential address street numbernamecity10_8
- Postal code10_8
- Elector signature10_8
- Witness initials10_8
- Internal use only10_8
- Printed name of elector1_9
- Full residential address street numbernamecity1_9
- Postal code1_9
- Elector signature1_9
- Witness initials1_9
- Internal use only1_9
- Printed name of elector2_9
- Full residential address street numbernamecity2_9
- Postal code2_9
- Elector signature2_9
- Witness initials2_9
- Internal use only2_9
- Printed name of elector3_9
- Full residential address street numbernamecity3_9
- Postal code3_9
- Elector signature3_9
- Witness initials3_9
- Internal use only3_9
- Printed name of elector4_9
- Full residential address street numbernamecity4_9
- Postal code4_9
- Elector signature4_9
- Witness initials4_9
- Internal use only4_9
- Printed name of elector5_9
- Full residential address street numbernamecity5_9
- Postal code5_9
- Elector signature5_9
- Witness initials5_9
- Internal use only5_9
- Printed name of elector6_9
- Full residential address street numbernamecity6_9
- Postal code6_9
- Elector signature6_9
- Witness initials6_9
- Internal use only6_9
- Printed name of elector7_9
- Full residential address street numbernamecity7_9
- Postal code7_9
- Elector signature7_9
- Witness initials7_9
- Internal use only7_9
- Printed name of elector8_9
- Full residential address street numbernamecity8_9
- Postal code8_9
- Elector signature8_9
- Witness initials8_9
- Internal use only8_9
- Printed name of elector9_9
- Full residential address street numbernamecity9_9
- Postal code9_9
- Elector signature9_9
- Witness initials9_9
- Internal use only9_9
- Printed name of elector10_9
- Full residential address street numbernamecity10_9
- Postal code10_9
- Elector signature10_9
- Witness initials10_9
- Internal use only10_9
- Printed name of elector1_10
- Full residential address street numbernamecity1_10
- Postal code1_10
- Elector signature1_10
- Witness initials1_10
- Internal use only1_10
- Printed name of elector2_10
- Full residential address street numbernamecity2_10
- Postal code2_10
- Elector signature2_10
- Witness initials2_10
- Internal use only2_10
- Printed name of elector3_10
- Full residential address street numbernamecity3_10
- Postal code3_10
- Elector signature3_10
- Witness initials3_10
- Internal use only3_10
- Printed name of elector4_10
- Full residential address street numbernamecity4_10
- Postal code4_10
- Elector signature4_10
- Witness initials4_10
- Internal use only4_10
- Printed name of elector5_10
- Full residential address street numbernamecity5_10
- Postal code5_10
- Elector signature5_10
- Witness initials5_10
- Internal use only5_10
- Printed name of elector6_10
- Full residential address street numbernamecity6_10
- Postal code6_10
- Elector signature6_10
- Witness initials6_10
- Internal use only6_10
- Printed name of elector7_10
- Full residential address street numbernamecity7_10
- Postal code7_10
- Elector signature7_10
- Witness initials7_10
- Internal use only7_10
- Printed name of elector8_10
- Full residential address street numbernamecity8_10
- Postal code8_10
- Elector signature8_10
- Witness initials8_10
- Internal use only8_10
- Printed name of elector9_10
- Full residential address street numbernamecity9_10
- Postal code9_10
- Elector signature9_10
- Witness initials9_10
- Internal use only9_10
- Printed name of elector10_10
- Full residential address street numbernamecity10_10
- Postal code10_10
- Elector signature10_10
- Witness initials10_10
- Internal use only10_10
- Printed name of elector1_11
- Full residential address street numbernamecity1_11
- Postal code1_11
- Elector signature1_11
- Witness initials1_11
- Internal use only1_11
- Printed name of elector2_11
- Full residential address street numbernamecity2_11
- Postal code2_11
- Elector signature2_11
- Witness initials2_11
- Internal use only2_11
- Printed name of elector3_11
- Full residential address street numbernamecity3_11
- Postal code3_11
- Elector signature3_11
- Witness initials3_11
- Internal use only3_11
- Printed name of elector4_11
- Full residential address street numbernamecity4_11
- Postal code4_11
- Elector signature4_11
- Witness initials4_11
- Internal use only4_11
- Printed name of elector5_11
- Full residential address street numbernamecity5_11
- Postal code5_11
- Elector signature5_11
- Witness initials5_11
- Internal use only5_11
- Printed name of elector6_11
- Full residential address street numbernamecity6_11
- Postal code6_11
- Elector signature6_11
- Witness initials6_11
- Internal use only6_11
- Printed name of elector7_11
- Full residential address street numbernamecity7_11
- Postal code7_11
- Elector signature7_11
- Witness initials7_11
- Internal use only7_11
- Printed name of elector8_11
- Full residential address street numbernamecity8_11
- Postal code8_11
- Elector signature8_11
- Witness initials8_11
- Internal use only8_11
- Printed name of elector9_11
- Full residential address street numbernamecity9_11
- Postal code9_11
- Elector signature9_11
- Witness initials9_11
- Internal use only9_11
- Printed name of elector10_11
- Full residential address street numbernamecity10_11
- Postal code10_11
- Elector signature10_11
- Witness initials10_11
- Internal use only10_11
- Printed name of elector1_12
- Full residential address street numbernamecity1_12
- Postal code1_12
- Elector signature1_12
- Witness initials1_12
- Internal use only1_12
- Printed name of elector2_12
- Full residential address street numbernamecity2_12
- Postal code2_12
- Elector signature2_12
- Witness initials2_12
- Internal use only2_12
- Printed name of elector3_12
- Full residential address street numbernamecity3_12
- Postal code3_12
- Elector signature3_12
- Witness initials3_12
- Internal use only3_12
- Printed name of elector4_12
- Full residential address street numbernamecity4_12
- Postal code4_12
- Elector signature4_12
- Witness initials4_12
- Internal use only4_12
- Printed name of elector5_12
- Full residential address street numbernamecity5_12
- Postal code5_12
- Elector signature5_12
- Witness initials5_12
- Internal use only5_12
- Printed name of elector6_12
- Full residential address street numbernamecity6_12
- Postal code6_12
- Elector signature6_12
- Witness initials6_12
- Internal use only6_12
- Printed name of elector7_12
- Full residential address street numbernamecity7_12
- Postal code7_12
- Elector signature7_12
- Witness initials7_12
- Internal use only7_12
- Printed name of elector8_12
- Full residential address street numbernamecity8_12
- Postal code8_12
- Elector signature8_12
- Witness initials8_12
- Internal use only8_12
- Printed name of elector9_12
- Full residential address street numbernamecity9_12
- Postal code9_12
- Elector signature9_12
- Witness initials9_12
- Internal use only9_12
- Printed name of elector10_12
- Full residential address street numbernamecity10_12
- Postal code10_12
- Elector signature10_12
- Witness initials10_12
- Internal use only10_12
- Printed name of elector1_13
- Full residential address street numbernamecity1_13
- Postal code1_13
- Elector signature1_13
- Witness initials1_13
- Internal use only1_13
- Printed name of elector2_13
- Full residential address street numbernamecity2_13
- Postal code2_13
- Elector signature2_13
- Witness initials2_13
- Internal use only2_13
- Printed name of elector3_13
- Full residential address street numbernamecity3_13
- Postal code3_13
- Elector signature3_13
- Witness initials3_13
- Internal use only3_13
- Printed name of elector4_13
- Full residential address street numbernamecity4_13
- Postal code4_13
- Elector signature4_13
- Witness initials4_13
- Internal use only4_13
- Printed name of elector5_13
- Full residential address street numbernamecity5_13
- Postal code5_13
- Elector signature5_13
- Witness initials5_13
- Internal use only5_13
- Printed name of elector6_13
- Full residential address street numbernamecity6_13
- Postal code6_13
- Elector signature6_13
- Witness initials6_13
- Internal use only6_13
- Printed name of elector7_13
- Full residential address street numbernamecity7_13
- Postal code7_13
- Elector signature7_13
- Witness initials7_13
- Internal use only7_13
- Printed name of elector8_13
- Full residential address street numbernamecity8_13
- Postal code8_13
- Elector signature8_13
- Witness initials8_13
- Internal use only8_13
- Printed name of elector9_13
- Full residential address street numbernamecity9_13
- Postal code9_13
- Elector signature9_13
- Witness initials9_13
- Internal use only9_13
- Printed name of elector10_13
- Full residential address street numbernamecity10_13
- Postal code10_13
- Elector signature10_13
- Witness initials10_13
- Internal use only10_13
- Printed name of elector1_14
- Full residential address street numbernamecity1_14
- Postal code1_14
- Elector signature1_14
- Witness initials1_14
- Internal use only1_14
- Printed name of elector2_14
- Full residential address street numbernamecity2_14
- Postal code2_14
- Elector signature2_14
- Witness initials2_14
- Internal use only2_14
- Printed name of elector3_14
- Full residential address street numbernamecity3_14
- Postal code3_14
- Elector signature3_14
- Witness initials3_14
- Internal use only3_14
- Printed name of elector4_14
- Full residential address street numbernamecity4_14
- Postal code4_14
- Elector signature4_14
- Witness initials4_14
- Internal use only4_14
- Printed name of elector5_14
- Full residential address street numbernamecity5_14
- Postal code5_14
- Elector signature5_14
- Witness initials5_14
- Internal use only5_14
- Printed name of elector6_14
- Full residential address street numbernamecity6_14
- Postal code6_14
- Elector signature6_14
- Witness initials6_14
- Internal use only6_14
- Printed name of elector7_14
- Full residential address street numbernamecity7_14
- Postal code7_14
- Elector signature7_14
- Witness initials7_14
- Internal use only7_14
- Printed name of elector8_14
- Full residential address street numbernamecity8_14
- Postal code8_14
- Elector signature8_14
- Witness initials8_14
- Internal use only8_14
- Printed name of elector9_14
- Full residential address street numbernamecity9_14
- Postal code9_14
- Elector signature9_14
- Witness initials9_14
- Internal use only9_14
- Printed name of elector10_14
- Full residential address street numbernamecity10_14
- Postal code10_14
- Elector signature10_14
- Witness initials10_14
- Internal use only10_14
- Printed name of elector1_15
- Full residential address street numbernamecity1_15
- Postal code1_15
- Elector signature1_15
- Witness initials1_15
- Internal use only1_15
- Printed name of elector2_15
- Full residential address street numbernamecity2_15
- Postal code2_15
- Elector signature2_15
- Witness initials2_15
- Internal use only2_15
- Printed name of elector3_15
- Full residential address street numbernamecity3_15
- Postal code3_15
- Elector signature3_15
- Witness initials3_15
- Internal use only3_15
- Printed name of elector4_15
- Full residential address street numbernamecity4_15
- Postal code4_15
- Elector signature4_15
- Witness initials4_15
- Internal use only4_15
- Printed name of elector5_15
- Full residential address street numbernamecity5_15
- Postal code5_15
- Elector signature5_15
- Witness initials5_15
- Internal use only5_15
- Printed name of elector6_15
- Full residential address street numbernamecity6_15
- Postal code6_15
- Elector signature6_15
- Witness initials6_15
- Internal use only6_15
- Printed name of elector7_15
- Full residential address street numbernamecity7_15
- Postal code7_15
- Elector signature7_15
- Witness initials7_15
- Internal use only7_15
- Printed name of elector8_15
- Full residential address street numbernamecity8_15
- Postal code8_15
- Elector signature8_15
- Witness initials8_15
- Internal use only8_15
- Printed name of elector9_15
- Full residential address street numbernamecity9_15
- Postal code9_15
- Elector signature9_15
- Witness initials9_15
- Internal use only9_15
- Printed name of elector10_15
- Full residential address street numbernamecity10_15
- Postal code10_15
- Elector signature10_15
- Witness initials10_15
- Internal use only10_15
- Printed name of elector1_16
- Full residential address street numbernamecity1_16
- Postal code1_16
- Elector signature1_16
- Witness initials1_16
- Internal use only1_16
- Printed name of elector2_16
- Full residential address street numbernamecity2_16
- Postal code2_16
- Elector signature2_16
- Witness initials2_16
- Internal use only2_16
- Printed name of elector3_16
- Full residential address street numbernamecity3_16
- Postal code3_16
- Elector signature3_16
- Witness initials3_16
- Internal use only3_16
- Printed name of elector4_16
- Full residential address street numbernamecity4_16
- Postal code4_16
- Elector signature4_16
- Witness initials4_16
- Internal use only4_16
- Printed name of elector5_16
- Full residential address street numbernamecity5_16
- Postal code5_16
- Elector signature5_16
- Witness initials5_16
- Internal use only5_16
- Printed name of elector6_16
- Full residential address street numbernamecity6_16
- Postal code6_16
- Elector signature6_16
- Witness initials6_16
- Internal use only6_16
- Printed name of elector7_16
- Full residential address street numbernamecity7_16
- Postal code7_16
- Elector signature7_16
- Witness initials7_16
- Internal use only7_16
- Printed name of elector8_16
- Full residential address street numbernamecity8_16
- Postal code8_16
- Elector signature8_16
- Witness initials8_16
- Internal use only8_16
- Printed name of elector9_16
- Full residential address street numbernamecity9_16
- Postal code9_16
- Elector signature9_16
- Witness initials9_16
- Internal use only9_16
- Printed name of elector10_16
- Full residential address street numbernamecity10_16
- Postal code10_16
- Elector signature10_16
- Witness initials10_16
- Internal use only10_16
- Have you completed the Nomination Paper EC 20010 Off
- Do you have authorized proof of identify Off
- Are you endorsed by a political party Off
- Have you made a nomination appointment Off
- Last name - Candidate Name
- First name - Candidate Name
- Name of electoral district- Candidate Information
- First name - Candidate Information
- Last name - Candidate Information
- Ballot Name Off
- Ballot First name(s)
- Ballot Last name(s)
- Gender -Candidate information
- Date of birth (YYY-MM-DD) - Gender -Candidate information
- language of correspondence - Candidate information Off
- Email -Contact information
- Primary phone number - Contact information
- Ext - Primary phone number
- Alternate phone number - Contact information
- Ext - Alternate phone number
- Fax number- Alternate phone number
- Unit -Residential address
- Street -Residential address
- Street name -Residential address
- City -Residential address
- ProvinceTerritory -Residential address
- Postal code - -Residential address
- Mailing address - same as residential address Off
- Occupation- Candidate occupation
- Sharing of information with the Conflict of Interest and Ethics Commissioner and the House of Commons including the Library of Parliament Off
- where applicable if the returning officer is unable to verify that I have been endorsed by the political party identified in section A of this Nomination Paper I wish to Off
- Date of Signature (YYYY-MM-DD) - Candidate signature
- Date of Signature (YYYY-MM-DD) -Signature of person receiving the solemn declaration
- Campaign delegate information
- First name - Campaign delegate information
- Last name - Campaign delegate information
- Language of correspondence - Campaign delegate information Off
- Email - Contact information -Campaign Delegate
- Primary phone number - Contact information -Campaign Delegate
- Primary phone number EXT - Contact information -Campaign Delegate
- Alternate phone number - Contact information -Campaign Delegate
- Alternate phone number EXT - Contact information -Campaign Delegate
- Fax nmuber- Contact information -Campaign Delegate
- Street - Residential address -Campaign delegate
- Street name - Residential address -Campaign delegate
- City - Residential address -Campaign delegate
- ProvinceTerritory - Residential address -Campaign delegate
- Postal Code - Residential address -Campaign delegate
- Campaign delegate - Mailing address ndash Same as residential address Off
- Unit - Residential address -Campaign delegate
- Date (YYYY-MM-DD) - Candidate authorization Signature
- Date (YYYY-MM-DD) - Candidate campaign Signature
- First name - Official agent information
- Last name - Official agent information
- Language of correspondence - Official agent information Off
- Email - Official agent information
- Primary phone number - Official agent information
- Primary phone number EXT - Official agent information
- Alternate phone number EXT - Official agent information
- Alternate phone number - Official agent information
- Fax number - Official agent information
- Unit -Residential address - Official Agent
- Street name -Residential address - Official Agent
- City -Residential address - Official Agent
- Street -Residential address - Official Agent
- ProvinceTerritory -Residential address - Official Agent
- Postal code-Residential address - Official Agent
- Mailing address ndash Same as residential address- Official Agent Off
- Date (YYYY-MM-DD) - Official agent signature
- First name - Auditor information
- Last name - Auditor information
- Language of correspondence - Auditor information Off
- Email - Auditor information
- Primary phone number - Auditor information
- Primary phone number EXT- Auditor information
- Alternate phone number - Auditor information
- Alternate phone number EXT- Auditor information
- Fax number - Auditor information
- Name of firm- Auditor organizational information
- Occupation of auditor - Auditor organizational information
- Professional designation - Auditor organizational information Off
- Designation registration number
- Make cheque payable to
- Unit - Address (where cheque is sent)
- Street - Address (where cheque is sent)
- Street name - Address (where cheque is sent)
- City - Address (where cheque is sent)
- ProvinceTerritory - Address (where cheque is sent)
- Postal code - Address (where cheque is sent)
- Date (YYY-MM-DD) - Auditor signature
- Unit - Campaign office address (optional)
- Street - Campaign office address (optional)
- Street name - Campaign office address (optional)
- City - Campaign office address (optional)
- ProvinceTerritory- Campaign office address (optional)
- Postal code - Campaign office address (optional)
- Name of witness
- Full address of witness
- Name of candidate
- Electoral district
- Year
- Name of candidate2
- Electoral district2
- Year2
- Name of witness2
- Full address of witness2
- Name of candidate3
- Electoral district3
- Year3
- Full address of witness3
- Name of witness3
- Name of candidate 4
- Electoral district4
- Year4
- Full address of witness 4
- Name of witness 4
- Name of candidate5
- Electoral district5
- Year5
- Full address of witness5
- Name of witness5
- Name of candidate6
- Electoral district6
- Year6
- Name of witness6
- Full address of witness6
- Name of candidate7
- Electoral district7
- Year7
- Full address of witness7
- Name of witness7
- Name of candidate8
- Electoral district8
- Year8
- Full address of witness8
- Name of witness8
- Name of candidate9
- Electoral district9
- Year9
- Full address of witness 9
- Name of witness 9
- Name of candidate10
- Electoral district10
- Year10
- Full address of witness10
- Name of witness10
- Name of candidate11
- Electoral district11
- Year11
- Full address of witness11
- Name of witness11
- Name of candidate12
- Electoral district12
- Year12
- Full address of witness12
- Name of witness12
- Name of candidate13
- Electoral district13
- Year13
- Full address of witness13
- Name of witness13
- Name of candidate14
- Electoral district14
- Year14
- Name of witness14
- Full address of witness14
- Name of candidate1
- Electoral district1
- Year1
- Name of witness1
- Full address of witness1
- Name of candidate15
- Electoral district15
- Year15
- Name of witness15
- Full address of witness15
- unit -Mailing address
- Street -Mailing address
- Street name -Mailing address
- City -Mailing address
- ProvinceTerritory -Mailing address
- Postal code -Mailing address
- Unit - Mailing address -Campaign delegate
- Street - Mailing address -Campaign delegate
- Street name - Mailing address -Campaign delegate
- City - Mailing address -Campaign delegate
- ProvinceTerritory- Mailing address -Campaign delegate
- Postal code- Mailing address -Campaign delegate
- Unit -Mailing address - Official Agent
- Street -Mailing address - Official Agent
- Street name -Mailing address - Official Agent
- city -Mailing address - Official Agent
- ProvinceTerritory-Mailing address - Official Agent
- Postal code-Mailing address - Official Agent
ndash
EC 20010 (052019)
25BSECTION A ndash Candidate Information (Mandatory)
All fields marked with are mandatory
Candidate information
Gender Date of birth (YYYY-MM-DD) Language of correspondence
English French
Contact information
Upon confirmation of the nomination Elections Canada will send to the email address listed below an invitation to the Political Entities Service Centre (PESC) online portal
Primary phone number Ext Alternate phone number Ext Fax number
Residential address
Unit Street Street name
City ProvinceTerritory Postal code
Mailing address Same as residential address
Unit Street Street name
City ProvinceTerritory Postal code
5
EC 20010 (052019)
26BSECTION A ndash Candidate Information (Mandatory)
All fields marked with are mandatory
Candidate occupation
State the occupation you are commonly known by in your place of ordinary residence Please note that the term ldquoMember of Parliamentrdquo is not an occupation but a title and will not be accepted The term ldquoparliamentarianrdquo however is acceptable CEA 66(3)
Occupation
Sharing of information with the Conflict of Interest and Ethics Commissioner and the House of Commons including the Library of Parliament
To help new members of Parliament Elections Canada will share the name gender residential address telephone number email address occupation preferred language of correspondence electoral district and political party affiliation of candidates who authorize Elections Canada to share their information with the Conflict of Interest and Ethics Commissioner and the House of Commons which includes the Library of Parliament
Do you authorize Elections Canada to share your personal information with the Conflict of Interest and Ethics Commissioner and the House of Commons including the Library of Parliament
Yes No
Privacy notice
Personal information in this Nomination Paper and all associated supporting documents are collected to determine your eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
Any person at the returning office may examine the completed Nomination Paper during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
Subject to consent your contact information may be shared with the House of Commons Conflict of Interest and Ethics Commissioner and Library of Parliament for orientation and communication purposes for new Members of Parliament If you provide a URL it may be posted on Elections Canadarsquos website to increase electorsrsquo accessibility to the electoral framework and democratic process
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information
Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB may be found on the Elections Canada website
6
a
b
c
EC 20010 (052019)
SECTION A ndash Candidate Declaration and Signature (Mandatory)
All fields marked with are mandatory
Candidatersquos declaration
I the undersigned do hereby solemnly declare that
1 my name (including any alternative name I wish to have appear on the ballot) my addressand occupation are as stated in section A of this Nomination Paper
2 I designate the permanent residential address in this Nomination Paper as the address forservice of process and papers under the Canada Elections Act
3 the name and address of my official agent and the name address and occupation of myauditor (if applicable) are as stated in sections C and D of this Nomination Paper
4 the information regarding my political affiliation is as stated in section A of this NominationPaper and
5 where applicable if the returning officer is unable to verify that I have been endorsed by thepolitical party identified in section A of this Nomination Paper I wish to
Have the word ldquoindependentrdquo appear under my name on the ballot
have no designation of political affiliation (meaning that a series of black dashes will appear under my name on the ballot) or
withdraw my Nomination paper
I further state that
1 I consent to the nomination
2 I am a Canadian citizen at least 18 years of age on election day
3 as per section 65 of the Canada Elections Act I am not ineligible to be a candidate
4 I consent to allowing my official agent and candidate campaign delegate (if applicable) toaccess on my behalf electoral materials online or at the local Elections Canada officeincluding the lists of electors distributed by Elections Canada and
5 I am aware of my obligations under the Canada Elections Act
Candidate signature Date (YYYY-MM-DD)
Signature of person receiving the solemn declaration
As per subsection 549(1) of the Canada Elections Act the solemn declaration must be witnessed by a judge an election officer a unit election officer as defined in section 177 a notary public a provincial court judge a justice of the peace or a commissioner for taking oaths in the province
Signature of person receiving the solemn declaration Date (YYYY-MM-DD)
7
ndash
EC 20010 (052019)
SECTION B ndash 3BCampaign Delegate (Optional)
If appointing a campaign delegate all fields marked with are mandatory
Campaign delegate information
A candidate may authorize another individual (referred to in the Nomination Paper as the campaign delegate) to act on their behalf during the election The campaign delegate can submit the Nomination Paper and all associated supporting documents CEA 67(7) Note The campaign delegate does not have access to the candidatersquos financial returns
First name Last name Language of correspondence
English French
Contact information
Upon confirmation of the nomination Elections Canada will send to the email address listed below an invitation to the Political Entities Service Centre (PESC) online portal
Primary phone number Ext Alternate phone number Ext Fax number
Residential address
Unit Street Street name
City ProvinceTerritory Postal code
Mailing address Same as residential address
Unit Street Street name
City ProvinceTerritory Postal code
8
EC 20010 (052019)
SECTION B ndash Campaign Delegate ndash Privacy Notice and Declaration (Optional)
If appointing a campaign delegate all fields marked with are mandatory
Privacy notice
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA) Any person at the returning office may examine the completed Nomination Paper during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
Candidate authorization of the campaign delegate
As per subsection 66(1)(h) of the Canada Elections Act I authorize the individual identified in this section to act as my campaign delegate
Candidate signature Date (YYYY-MM-DD)
Candidate campaign delegate signature
I the undersigned candidate campaign delegate for the candidate named in this Nomination Paper state that
1 I hereby agree to act as the authorized person for the candidate named herein for the purposes of theCanada Elections Act
2 I am fully aware of the duties and responsibilities imposed on me by the Canada Elections Act
Campaign delegate signature Date (YYYY-MM-DD)
9
ndash
EC 20010 (052019)
SECTION C ndash 4BOfficial Agent (Mandatory)
All fields marked with are mandatory
Official agent information
The official agent is responsible for administering the campaignrsquos financial transactions and reporting those transactions to Elections Canada as required by the CEA For more information consult the Political Financing Handbook for Candidates and Official Agents Note The candidate official agent and auditor must all be different people
First name Last name Language of correspondence
English French
Contact information
Upon confirmation of the nomination Elections Canada will send to the email address listed below an invitation to the Political Entities Service Centre (PESC) online portal
Primary phone number Ext Alternate phone number Ext Fax number
Residential address Unit Street Street name
City ProvinceTerritory Postal code
Mailing address Same as residential address
Unit Street Street name
City ProvinceTerritory Postal code
10
EC 20010 (052019)
24BSECTION C ndash Official Agent ndash Privacy Notice and Declaration (Mandatory)
All fields marked with are mandatory
Privacy notice
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA) Any person at the returning office may examine the completed Nomination Paper during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
Official agent signature
I the undersigned official agent for the candidate named in this Nomination Paper hereby agree to act as official agent for the candidate named herein for the purposes of the Canada Elections Act I further state that
1 I am fully aware of the duties and responsibilities imposed on me by the Canada Elections Act
2 I am capable of entering into contracts in the provinceterritory in which this electoral district is located
3 I am eligible to act as official agent pursuant to section 4772 of the Canada Elections Act
Section 4772 of the Canada Elections Act states The following persons are ineligible to be an official agenta candidate an election officer or a member of the staff of a returning office an undischarged bankrupt anauditor appointed as required by this Act a person who is not qualified as an elector and a person who doesnot have the capacity to enter into contracts in the province in which they ordinarily reside
Official agent signature Date (YYYY-MM-DD)
11
EC 20010 (052019)
SECTION D ndash 5B Auditor (Optional)
If appointing an auditor all fields marked with are mandatory
Auditor information An auditor must be appointed if bull the candidatersquos campaign accepts contributions of $10000 or more bull the candidatersquos campaign incurs expenses of $10000 or more or bull the candidate receives 10 or more of votes cast in the electoral district If at the time of filing the Nomination Paper none of the above applies you do not need to appoint an auditor though you may still choose to do so If the above requirements are later met you must appoint an auditor without delay A person or partnership who wants to act as a candidatersquos auditor must be or have every partner be recognized as a professional accountant under provincial or territorial legislation CEA 4773(1) For more information consult the Political Financing Handbook for Candidates and Official Agents
First name Last name Language of correspondence
English French
Contact information Upon confirmation of the nomination Elections Canada will send to the email address listed below an invitation to the Political Entities Service Centre (PESC) online portal
Primary phone number Ext Alternate phone number Ext Fax number
Auditor organizational information Name of firm Occupation of auditor Professional designation
CPA FCPA
Designation registration number Make cheque payable to
Address (where cheque is sent) Unit Street Street name
City ProvinceTerritory Postal code
12
EC 20010 (052019)
SECTION D ndash Auditor ndash Privacy Notice and Declaration (Optional)
If appointing an auditor all fields marked with are mandatory
Privacy notice
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA) Any person at the returning office may examine the completed Nomination Paper during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information
Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
Auditor signature
I the undersigned hereby agree to act as the auditor for the candidate named in this Nomination Paper I further state that I am aware of the duties and responsibilities of this position under the Canada Elections Act and I am qualified to act as auditor under subsection 4773(1) and (2) of the Canada Elections Act
Auditor signature Date (YYYY-MM-DD)
13
EC 20010 (052019)
SECTION E ndash 6BCampaign Office (Optional)
Contact information to be made available on the Elections Canada website (optional)
Please note You may provide a telephone number andor a link to your website or social media platform of choice when filing your Nomination Paper with Elections Canada You do not have to provide this information but it is intended to help electors access campaign information Elections Canada may provide this information as part of the Voter Information Service Please include the full website address including prefix (http https)
Telephone number to be posted on electionsca
Website to be posted on electionsca (including prefix http https)
Campaign office address (optional)
Unit Street Street name
City ProvinceTerritory Postal code
14
SECTION F ndash 7BElectors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
15
8BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
16
9BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
17
10BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
18
11BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
19
12BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
20
13BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
21
14BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
22
15BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
23
16BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
24
17BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
25
18BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
26
19BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
27
20BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
28
21BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
29
22BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
30
EC 20010 (022019)
SECTION G ndash 23B Are You Ready to Submit Your Nomination
Have you completed the Nomination Paper (EC 20010)
bull Are all mandatory fields in sections AndashE complete
bull Have you collected the required number of signatures from qualified electors in section F
o For most electoral districts 100 electors must consent to your candidacy
o For electoral districts identified in Schedule 3 only 50 electors are required
o To ensure a smooth nomination process Elections Canada recommends collecting signatures from at least 150 electors
Do you have authorized proof of identify
bull For a list of authorized identification visit the Elections Canada website
bull If a campaign delegate is submitting on your behalf they must bring a copy of your identification documents signed by you
bull If you want an alternative name to appear on the ballot additional documentation is required visit electionsca for details
Are you endorsed by a political party
bull Make sure your party has submitted the required documentation to Elections Canada attesting your designated political affiliation
Have you made a nomination appointment
bull To facilitate the nomination process make an appointment with the returning officer to finalize the filing of the complete nomination package
bull The nomination period closes 21 days before election day at 200 pm local time
31
- Nomination Paperof a Candidate at a Federal General Election or By-election
- Table of Contents
- General Information
- SECTION A ndash Candidate Information (Mandatory)
- SECTION B ndash Campaign Delegate (Optional)
- SECTION C ndash Official Agent (Mandatory)
- SECTION D ndash Auditor (Optional)
- SECTION E ndash Campaign Office (Optional)
- SECTION F ndash Electors Consenting to Candidacy (Mandatory)
-
- Name of electoral district
- Political affiliation
- Telephone number to be posted on electionsca
- Website to be posted on electionsca including prefix http https
- Printed name of elector1
- Full residential address street numbernamecity1
- Postal code1
- Elector signature1
- Witness initials1
- Internal use only1
- Printed name of elector2
- Full residential address street numbernamecity2
- Postal code2
- Elector signature2
- Witness initials2
- Internal use only2
- Printed name of elector3
- Full residential address street numbernamecity3
- Postal code3
- Elector signature3
- Witness initials3
- Internal use only3
- Printed name of elector4
- Full residential address street numbernamecity4
- Postal code4
- Elector signature4
- Witness initials4
- Internal use only4
- Printed name of elector5
- Full residential address street numbernamecity5
- Postal code5
- Elector signature5
- Witness initials5
- Internal use only5
- Printed name of elector6
- Full residential address street numbernamecity6
- Postal code6
- Elector signature6
- Witness initials6
- Internal use only6
- Printed name of elector7
- Full residential address street numbernamecity7
- Postal code7
- Elector signature7
- Witness initials7
- Internal use only7
- Printed name of elector8
- Full residential address street numbernamecity8
- Postal code8
- Elector signature8
- Witness initials8
- Internal use only8
- Printed name of elector9
- Full residential address street numbernamecity9
- Postal code9
- Elector signature9
- Witness initials9
- Internal use only9
- Printed name of elector10
- Full residential address street numbernamecity10
- Postal code10
- Elector signature10
- Witness initials10
- Internal use only10
- Printed name of elector1_2
- Full residential address street numbernamecity1_2
- Postal code1_2
- Elector signature1_2
- Witness initials1_2
- Internal use only1_2
- Printed name of elector2_2
- Full residential address street numbernamecity2_2
- Postal code2_2
- Elector signature2_2
- Witness initials2_2
- Internal use only2_2
- Printed name of elector3_2
- Full residential address street numbernamecity3_2
- Postal code3_2
- Elector signature3_2
- Witness initials3_2
- Internal use only3_2
- Printed name of elector4_2
- Full residential address street numbernamecity4_2
- Postal code4_2
- Elector signature4_2
- Witness initials4_2
- Internal use only4_2
- Printed name of elector5_2
- Full residential address street numbernamecity5_2
- Postal code5_2
- Elector signature5_2
- Witness initials5_2
- Internal use only5_2
- Printed name of elector6_2
- Full residential address street numbernamecity6_2
- Postal code6_2
- Elector signature6_2
- Witness initials6_2
- Internal use only6_2
- Printed name of elector7_2
- Full residential address street numbernamecity7_2
- Postal code7_2
- Elector signature7_2
- Witness initials7_2
- Internal use only7_2
- Printed name of elector8_2
- Full residential address street numbernamecity8_2
- Postal code8_2
- Elector signature8_2
- Witness initials8_2
- Internal use only8_2
- Printed name of elector9_2
- Full residential address street numbernamecity9_2
- Postal code9_2
- Elector signature9_2
- Witness initials9_2
- Internal use only9_2
- Printed name of elector10_2
- Full residential address street numbernamecity10_2
- Postal code10_2
- Elector signature10_2
- Witness initials10_2
- Internal use only10_2
- Printed name of elector1_3
- Full residential address street numbernamecity1_3
- Postal code1_3
- Elector signature1_3
- Witness initials1_3
- Internal use only1_3
- Printed name of elector2_3
- Full residential address street numbernamecity2_3
- Postal code2_3
- Elector signature2_3
- Witness initials2_3
- Internal use only2_3
- Printed name of elector3_3
- Full residential address street numbernamecity3_3
- Postal code3_3
- Elector signature3_3
- Witness initials3_3
- Internal use only3_3
- Printed name of elector4_3
- Full residential address street numbernamecity4_3
- Postal code4_3
- Elector signature4_3
- Witness initials4_3
- Internal use only4_3
- Printed name of elector5_3
- Full residential address street numbernamecity5_3
- Postal code5_3
- Elector signature5_3
- Witness initials5_3
- Internal use only5_3
- Printed name of elector6_3
- Full residential address street numbernamecity6_3
- Postal code6_3
- Elector signature6_3
- Witness initials6_3
- Internal use only6_3
- Printed name of elector7_3
- Full residential address street numbernamecity7_3
- Postal code7_3
- Elector signature7_3
- Witness initials7_3
- Internal use only7_3
- Printed name of elector8_3
- Full residential address street numbernamecity8_3
- Postal code8_3
- Elector signature8_3
- Witness initials8_3
- Internal use only8_3
- Printed name of elector9_3
- Full residential address street numbernamecity9_3
- Postal code9_3
- Elector signature9_3
- Witness initials9_3
- Internal use only9_3
- Printed name of elector10_3
- Full residential address street numbernamecity10_3
- Postal code10_3
- Elector signature10_3
- Witness initials10_3
- Internal use only10_3
- Printed name of elector1_4
- Full residential address street numbernamecity1_4
- Postal code1_4
- Elector signature1_4
- Witness initials1_4
- Internal use only1_4
- Printed name of elector2_4
- Full residential address street numbernamecity2_4
- Postal code2_4
- Elector signature2_4
- Witness initials2_4
- Internal use only2_4
- Printed name of elector3_4
- Full residential address street numbernamecity3_4
- Postal code3_4
- Elector signature3_4
- Witness initials3_4
- Internal use only3_4
- Printed name of elector4_4
- Full residential address street numbernamecity4_4
- Postal code4_4
- Elector signature4_4
- Witness initials4_4
- Internal use only4_4
- Printed name of elector5_4
- Full residential address street numbernamecity5_4
- Postal code5_4
- Elector signature5_4
- Witness initials5_4
- Internal use only5_4
- Printed name of elector6_4
- Full residential address street numbernamecity6_4
- Postal code6_4
- Elector signature6_4
- Witness initials6_4
- Internal use only6_4
- Printed name of elector7_4
- Full residential address street numbernamecity7_4
- Postal code7_4
- Elector signature7_4
- Witness initials7_4
- Internal use only7_4
- Printed name of elector8_4
- Full residential address street numbernamecity8_4
- Postal code8_4
- Elector signature8_4
- Witness initials8_4
- Internal use only8_4
- Printed name of elector9_4
- Full residential address street numbernamecity9_4
- Postal code9_4
- Elector signature9_4
- Witness initials9_4
- Internal use only9_4
- Printed name of elector10_4
- Full residential address street numbernamecity10_4
- Postal code10_4
- Elector signature10_4
- Witness initials10_4
- Internal use only10_4
- Printed name of elector1_5
- Full residential address street numbernamecity1_5
- Postal code1_5
- Elector signature1_5
- Witness initials1_5
- Internal use only1_5
- Printed name of elector2_5
- Full residential address street numbernamecity2_5
- Postal code2_5
- Elector signature2_5
- Witness initials2_5
- Internal use only2_5
- Printed name of elector3_5
- Full residential address street numbernamecity3_5
- Postal code3_5
- Elector signature3_5
- Witness initials3_5
- Internal use only3_5
- Printed name of elector4_5
- Full residential address street numbernamecity4_5
- Postal code4_5
- Elector signature4_5
- Witness initials4_5
- Internal use only4_5
- Printed name of elector5_5
- Full residential address street numbernamecity5_5
- Postal code5_5
- Elector signature5_5
- Witness initials5_5
- Internal use only5_5
- Printed name of elector6_5
- Full residential address street numbernamecity6_5
- Postal code6_5
- Elector signature6_5
- Witness initials6_5
- Internal use only6_5
- Printed name of elector7_5
- Full residential address street numbernamecity7_5
- Postal code7_5
- Elector signature7_5
- Witness initials7_5
- Internal use only7_5
- Printed name of elector8_5
- Full residential address street numbernamecity8_5
- Postal code8_5
- Elector signature8_5
- Witness initials8_5
- Internal use only8_5
- Printed name of elector9_5
- Full residential address street numbernamecity9_5
- Postal code9_5
- Elector signature9_5
- Witness initials9_5
- Internal use only9_5
- Printed name of elector10_5
- Full residential address street numbernamecity10_5
- Postal code10_5
- Elector signature10_5
- Witness initials10_5
- Internal use only10_5
- Printed name of elector1_6
- Full residential address street numbernamecity1_6
- Postal code1_6
- Elector signature1_6
- Witness initials1_6
- Internal use only1_6
- Printed name of elector2_6
- Full residential address street numbernamecity2_6
- Postal code2_6
- Elector signature2_6
- Witness initials2_6
- Internal use only2_6
- Printed name of elector3_6
- Full residential address street numbernamecity3_6
- Postal code3_6
- Elector signature3_6
- Witness initials3_6
- Internal use only3_6
- Printed name of elector4_6
- Full residential address street numbernamecity4_6
- Postal code4_6
- Elector signature4_6
- Witness initials4_6
- Internal use only4_6
- Printed name of elector5_6
- Full residential address street numbernamecity5_6
- Postal code5_6
- Elector signature5_6
- Witness initials5_6
- Internal use only5_6
- Printed name of elector6_6
- Full residential address street numbernamecity6_6
- Postal code6_6
- Elector signature6_6
- Witness initials6_6
- Internal use only6_6
- Printed name of elector7_6
- Full residential address street numbernamecity7_6
- Postal code7_6
- Elector signature7_6
- Witness initials7_6
- Internal use only7_6
- Printed name of elector8_6
- Full residential address street numbernamecity8_6
- Postal code8_6
- Elector signature8_6
- Witness initials8_6
- Internal use only8_6
- Printed name of elector9_6
- Full residential address street numbernamecity9_6
- Postal code9_6
- Elector signature9_6
- Witness initials9_6
- Internal use only9_6
- Printed name of elector10_6
- Full residential address street numbernamecity10_6
- Postal code10_6
- Elector signature10_6
- Witness initials10_6
- Internal use only10_6
- Printed name of elector1_7
- Full residential address street numbernamecity1_7
- Postal code1_7
- Elector signature1_7
- Witness initials1_7
- Internal use only1_7
- Printed name of elector2_7
- Full residential address street numbernamecity2_7
- Postal code2_7
- Elector signature2_7
- Witness initials2_7
- Internal use only2_7
- Printed name of elector3_7
- Full residential address street numbernamecity3_7
- Postal code3_7
- Elector signature3_7
- Witness initials3_7
- Internal use only3_7
- Printed name of elector4_7
- Full residential address street numbernamecity4_7
- Postal code4_7
- Elector signature4_7
- Witness initials4_7
- Internal use only4_7
- Printed name of elector5_7
- Full residential address street numbernamecity5_7
- Postal code5_7
- Elector signature5_7
- Witness initials5_7
- Internal use only5_7
- Printed name of elector6_7
- Full residential address street numbernamecity6_7
- Postal code6_7
- Elector signature6_7
- Witness initials6_7
- Internal use only6_7
- Printed name of elector7_7
- Full residential address street numbernamecity7_7
- Postal code7_7
- Elector signature7_7
- Witness initials7_7
- Internal use only7_7
- Printed name of elector8_7
- Full residential address street numbernamecity8_7
- Postal code8_7
- Elector signature8_7
- Witness initials8_7
- Internal use only8_7
- Printed name of elector9_7
- Full residential address street numbernamecity9_7
- Postal code9_7
- Elector signature9_7
- Witness initials9_7
- Internal use only9_7
- Printed name of elector10_7
- Full residential address street numbernamecity10_7
- Postal code10_7
- Elector signature10_7
- Witness initials10_7
- Internal use only10_7
- Printed name of elector1_8
- Full residential address street numbernamecity1_8
- Postal code1_8
- Elector signature1_8
- Witness initials1_8
- Internal use only1_8
- Printed name of elector2_8
- Full residential address street numbernamecity2_8
- Postal code2_8
- Elector signature2_8
- Witness initials2_8
- Internal use only2_8
- Printed name of elector3_8
- Full residential address street numbernamecity3_8
- Postal code3_8
- Elector signature3_8
- Witness initials3_8
- Internal use only3_8
- Printed name of elector4_8
- Full residential address street numbernamecity4_8
- Postal code4_8
- Elector signature4_8
- Witness initials4_8
- Internal use only4_8
- Printed name of elector5_8
- Full residential address street numbernamecity5_8
- Postal code5_8
- Elector signature5_8
- Witness initials5_8
- Internal use only5_8
- Printed name of elector6_8
- Full residential address street numbernamecity6_8
- Postal code6_8
- Elector signature6_8
- Witness initials6_8
- Internal use only6_8
- Printed name of elector7_8
- Full residential address street numbernamecity7_8
- Postal code7_8
- Elector signature7_8
- Witness initials7_8
- Internal use only7_8
- Printed name of elector8_8
- Full residential address street numbernamecity8_8
- Postal code8_8
- Elector signature8_8
- Witness initials8_8
- Internal use only8_8
- Printed name of elector9_8
- Full residential address street numbernamecity9_8
- Postal code9_8
- Elector signature9_8
- Witness initials9_8
- Internal use only9_8
- Printed name of elector10_8
- Full residential address street numbernamecity10_8
- Postal code10_8
- Elector signature10_8
- Witness initials10_8
- Internal use only10_8
- Printed name of elector1_9
- Full residential address street numbernamecity1_9
- Postal code1_9
- Elector signature1_9
- Witness initials1_9
- Internal use only1_9
- Printed name of elector2_9
- Full residential address street numbernamecity2_9
- Postal code2_9
- Elector signature2_9
- Witness initials2_9
- Internal use only2_9
- Printed name of elector3_9
- Full residential address street numbernamecity3_9
- Postal code3_9
- Elector signature3_9
- Witness initials3_9
- Internal use only3_9
- Printed name of elector4_9
- Full residential address street numbernamecity4_9
- Postal code4_9
- Elector signature4_9
- Witness initials4_9
- Internal use only4_9
- Printed name of elector5_9
- Full residential address street numbernamecity5_9
- Postal code5_9
- Elector signature5_9
- Witness initials5_9
- Internal use only5_9
- Printed name of elector6_9
- Full residential address street numbernamecity6_9
- Postal code6_9
- Elector signature6_9
- Witness initials6_9
- Internal use only6_9
- Printed name of elector7_9
- Full residential address street numbernamecity7_9
- Postal code7_9
- Elector signature7_9
- Witness initials7_9
- Internal use only7_9
- Printed name of elector8_9
- Full residential address street numbernamecity8_9
- Postal code8_9
- Elector signature8_9
- Witness initials8_9
- Internal use only8_9
- Printed name of elector9_9
- Full residential address street numbernamecity9_9
- Postal code9_9
- Elector signature9_9
- Witness initials9_9
- Internal use only9_9
- Printed name of elector10_9
- Full residential address street numbernamecity10_9
- Postal code10_9
- Elector signature10_9
- Witness initials10_9
- Internal use only10_9
- Printed name of elector1_10
- Full residential address street numbernamecity1_10
- Postal code1_10
- Elector signature1_10
- Witness initials1_10
- Internal use only1_10
- Printed name of elector2_10
- Full residential address street numbernamecity2_10
- Postal code2_10
- Elector signature2_10
- Witness initials2_10
- Internal use only2_10
- Printed name of elector3_10
- Full residential address street numbernamecity3_10
- Postal code3_10
- Elector signature3_10
- Witness initials3_10
- Internal use only3_10
- Printed name of elector4_10
- Full residential address street numbernamecity4_10
- Postal code4_10
- Elector signature4_10
- Witness initials4_10
- Internal use only4_10
- Printed name of elector5_10
- Full residential address street numbernamecity5_10
- Postal code5_10
- Elector signature5_10
- Witness initials5_10
- Internal use only5_10
- Printed name of elector6_10
- Full residential address street numbernamecity6_10
- Postal code6_10
- Elector signature6_10
- Witness initials6_10
- Internal use only6_10
- Printed name of elector7_10
- Full residential address street numbernamecity7_10
- Postal code7_10
- Elector signature7_10
- Witness initials7_10
- Internal use only7_10
- Printed name of elector8_10
- Full residential address street numbernamecity8_10
- Postal code8_10
- Elector signature8_10
- Witness initials8_10
- Internal use only8_10
- Printed name of elector9_10
- Full residential address street numbernamecity9_10
- Postal code9_10
- Elector signature9_10
- Witness initials9_10
- Internal use only9_10
- Printed name of elector10_10
- Full residential address street numbernamecity10_10
- Postal code10_10
- Elector signature10_10
- Witness initials10_10
- Internal use only10_10
- Printed name of elector1_11
- Full residential address street numbernamecity1_11
- Postal code1_11
- Elector signature1_11
- Witness initials1_11
- Internal use only1_11
- Printed name of elector2_11
- Full residential address street numbernamecity2_11
- Postal code2_11
- Elector signature2_11
- Witness initials2_11
- Internal use only2_11
- Printed name of elector3_11
- Full residential address street numbernamecity3_11
- Postal code3_11
- Elector signature3_11
- Witness initials3_11
- Internal use only3_11
- Printed name of elector4_11
- Full residential address street numbernamecity4_11
- Postal code4_11
- Elector signature4_11
- Witness initials4_11
- Internal use only4_11
- Printed name of elector5_11
- Full residential address street numbernamecity5_11
- Postal code5_11
- Elector signature5_11
- Witness initials5_11
- Internal use only5_11
- Printed name of elector6_11
- Full residential address street numbernamecity6_11
- Postal code6_11
- Elector signature6_11
- Witness initials6_11
- Internal use only6_11
- Printed name of elector7_11
- Full residential address street numbernamecity7_11
- Postal code7_11
- Elector signature7_11
- Witness initials7_11
- Internal use only7_11
- Printed name of elector8_11
- Full residential address street numbernamecity8_11
- Postal code8_11
- Elector signature8_11
- Witness initials8_11
- Internal use only8_11
- Printed name of elector9_11
- Full residential address street numbernamecity9_11
- Postal code9_11
- Elector signature9_11
- Witness initials9_11
- Internal use only9_11
- Printed name of elector10_11
- Full residential address street numbernamecity10_11
- Postal code10_11
- Elector signature10_11
- Witness initials10_11
- Internal use only10_11
- Printed name of elector1_12
- Full residential address street numbernamecity1_12
- Postal code1_12
- Elector signature1_12
- Witness initials1_12
- Internal use only1_12
- Printed name of elector2_12
- Full residential address street numbernamecity2_12
- Postal code2_12
- Elector signature2_12
- Witness initials2_12
- Internal use only2_12
- Printed name of elector3_12
- Full residential address street numbernamecity3_12
- Postal code3_12
- Elector signature3_12
- Witness initials3_12
- Internal use only3_12
- Printed name of elector4_12
- Full residential address street numbernamecity4_12
- Postal code4_12
- Elector signature4_12
- Witness initials4_12
- Internal use only4_12
- Printed name of elector5_12
- Full residential address street numbernamecity5_12
- Postal code5_12
- Elector signature5_12
- Witness initials5_12
- Internal use only5_12
- Printed name of elector6_12
- Full residential address street numbernamecity6_12
- Postal code6_12
- Elector signature6_12
- Witness initials6_12
- Internal use only6_12
- Printed name of elector7_12
- Full residential address street numbernamecity7_12
- Postal code7_12
- Elector signature7_12
- Witness initials7_12
- Internal use only7_12
- Printed name of elector8_12
- Full residential address street numbernamecity8_12
- Postal code8_12
- Elector signature8_12
- Witness initials8_12
- Internal use only8_12
- Printed name of elector9_12
- Full residential address street numbernamecity9_12
- Postal code9_12
- Elector signature9_12
- Witness initials9_12
- Internal use only9_12
- Printed name of elector10_12
- Full residential address street numbernamecity10_12
- Postal code10_12
- Elector signature10_12
- Witness initials10_12
- Internal use only10_12
- Printed name of elector1_13
- Full residential address street numbernamecity1_13
- Postal code1_13
- Elector signature1_13
- Witness initials1_13
- Internal use only1_13
- Printed name of elector2_13
- Full residential address street numbernamecity2_13
- Postal code2_13
- Elector signature2_13
- Witness initials2_13
- Internal use only2_13
- Printed name of elector3_13
- Full residential address street numbernamecity3_13
- Postal code3_13
- Elector signature3_13
- Witness initials3_13
- Internal use only3_13
- Printed name of elector4_13
- Full residential address street numbernamecity4_13
- Postal code4_13
- Elector signature4_13
- Witness initials4_13
- Internal use only4_13
- Printed name of elector5_13
- Full residential address street numbernamecity5_13
- Postal code5_13
- Elector signature5_13
- Witness initials5_13
- Internal use only5_13
- Printed name of elector6_13
- Full residential address street numbernamecity6_13
- Postal code6_13
- Elector signature6_13
- Witness initials6_13
- Internal use only6_13
- Printed name of elector7_13
- Full residential address street numbernamecity7_13
- Postal code7_13
- Elector signature7_13
- Witness initials7_13
- Internal use only7_13
- Printed name of elector8_13
- Full residential address street numbernamecity8_13
- Postal code8_13
- Elector signature8_13
- Witness initials8_13
- Internal use only8_13
- Printed name of elector9_13
- Full residential address street numbernamecity9_13
- Postal code9_13
- Elector signature9_13
- Witness initials9_13
- Internal use only9_13
- Printed name of elector10_13
- Full residential address street numbernamecity10_13
- Postal code10_13
- Elector signature10_13
- Witness initials10_13
- Internal use only10_13
- Printed name of elector1_14
- Full residential address street numbernamecity1_14
- Postal code1_14
- Elector signature1_14
- Witness initials1_14
- Internal use only1_14
- Printed name of elector2_14
- Full residential address street numbernamecity2_14
- Postal code2_14
- Elector signature2_14
- Witness initials2_14
- Internal use only2_14
- Printed name of elector3_14
- Full residential address street numbernamecity3_14
- Postal code3_14
- Elector signature3_14
- Witness initials3_14
- Internal use only3_14
- Printed name of elector4_14
- Full residential address street numbernamecity4_14
- Postal code4_14
- Elector signature4_14
- Witness initials4_14
- Internal use only4_14
- Printed name of elector5_14
- Full residential address street numbernamecity5_14
- Postal code5_14
- Elector signature5_14
- Witness initials5_14
- Internal use only5_14
- Printed name of elector6_14
- Full residential address street numbernamecity6_14
- Postal code6_14
- Elector signature6_14
- Witness initials6_14
- Internal use only6_14
- Printed name of elector7_14
- Full residential address street numbernamecity7_14
- Postal code7_14
- Elector signature7_14
- Witness initials7_14
- Internal use only7_14
- Printed name of elector8_14
- Full residential address street numbernamecity8_14
- Postal code8_14
- Elector signature8_14
- Witness initials8_14
- Internal use only8_14
- Printed name of elector9_14
- Full residential address street numbernamecity9_14
- Postal code9_14
- Elector signature9_14
- Witness initials9_14
- Internal use only9_14
- Printed name of elector10_14
- Full residential address street numbernamecity10_14
- Postal code10_14
- Elector signature10_14
- Witness initials10_14
- Internal use only10_14
- Printed name of elector1_15
- Full residential address street numbernamecity1_15
- Postal code1_15
- Elector signature1_15
- Witness initials1_15
- Internal use only1_15
- Printed name of elector2_15
- Full residential address street numbernamecity2_15
- Postal code2_15
- Elector signature2_15
- Witness initials2_15
- Internal use only2_15
- Printed name of elector3_15
- Full residential address street numbernamecity3_15
- Postal code3_15
- Elector signature3_15
- Witness initials3_15
- Internal use only3_15
- Printed name of elector4_15
- Full residential address street numbernamecity4_15
- Postal code4_15
- Elector signature4_15
- Witness initials4_15
- Internal use only4_15
- Printed name of elector5_15
- Full residential address street numbernamecity5_15
- Postal code5_15
- Elector signature5_15
- Witness initials5_15
- Internal use only5_15
- Printed name of elector6_15
- Full residential address street numbernamecity6_15
- Postal code6_15
- Elector signature6_15
- Witness initials6_15
- Internal use only6_15
- Printed name of elector7_15
- Full residential address street numbernamecity7_15
- Postal code7_15
- Elector signature7_15
- Witness initials7_15
- Internal use only7_15
- Printed name of elector8_15
- Full residential address street numbernamecity8_15
- Postal code8_15
- Elector signature8_15
- Witness initials8_15
- Internal use only8_15
- Printed name of elector9_15
- Full residential address street numbernamecity9_15
- Postal code9_15
- Elector signature9_15
- Witness initials9_15
- Internal use only9_15
- Printed name of elector10_15
- Full residential address street numbernamecity10_15
- Postal code10_15
- Elector signature10_15
- Witness initials10_15
- Internal use only10_15
- Printed name of elector1_16
- Full residential address street numbernamecity1_16
- Postal code1_16
- Elector signature1_16
- Witness initials1_16
- Internal use only1_16
- Printed name of elector2_16
- Full residential address street numbernamecity2_16
- Postal code2_16
- Elector signature2_16
- Witness initials2_16
- Internal use only2_16
- Printed name of elector3_16
- Full residential address street numbernamecity3_16
- Postal code3_16
- Elector signature3_16
- Witness initials3_16
- Internal use only3_16
- Printed name of elector4_16
- Full residential address street numbernamecity4_16
- Postal code4_16
- Elector signature4_16
- Witness initials4_16
- Internal use only4_16
- Printed name of elector5_16
- Full residential address street numbernamecity5_16
- Postal code5_16
- Elector signature5_16
- Witness initials5_16
- Internal use only5_16
- Printed name of elector6_16
- Full residential address street numbernamecity6_16
- Postal code6_16
- Elector signature6_16
- Witness initials6_16
- Internal use only6_16
- Printed name of elector7_16
- Full residential address street numbernamecity7_16
- Postal code7_16
- Elector signature7_16
- Witness initials7_16
- Internal use only7_16
- Printed name of elector8_16
- Full residential address street numbernamecity8_16
- Postal code8_16
- Elector signature8_16
- Witness initials8_16
- Internal use only8_16
- Printed name of elector9_16
- Full residential address street numbernamecity9_16
- Postal code9_16
- Elector signature9_16
- Witness initials9_16
- Internal use only9_16
- Printed name of elector10_16
- Full residential address street numbernamecity10_16
- Postal code10_16
- Elector signature10_16
- Witness initials10_16
- Internal use only10_16
- Have you completed the Nomination Paper EC 20010 Off
- Do you have authorized proof of identify Off
- Are you endorsed by a political party Off
- Have you made a nomination appointment Off
- Last name - Candidate Name
- First name - Candidate Name
- Name of electoral district- Candidate Information
- First name - Candidate Information
- Last name - Candidate Information
- Ballot Name Off
- Ballot First name(s)
- Ballot Last name(s)
- Gender -Candidate information
- Date of birth (YYY-MM-DD) - Gender -Candidate information
- language of correspondence - Candidate information Off
- Email -Contact information
- Primary phone number - Contact information
- Ext - Primary phone number
- Alternate phone number - Contact information
- Ext - Alternate phone number
- Fax number- Alternate phone number
- Unit -Residential address
- Street -Residential address
- Street name -Residential address
- City -Residential address
- ProvinceTerritory -Residential address
- Postal code - -Residential address
- Mailing address - same as residential address Off
- Occupation- Candidate occupation
- Sharing of information with the Conflict of Interest and Ethics Commissioner and the House of Commons including the Library of Parliament Off
- where applicable if the returning officer is unable to verify that I have been endorsed by the political party identified in section A of this Nomination Paper I wish to Off
- Date of Signature (YYYY-MM-DD) - Candidate signature
- Date of Signature (YYYY-MM-DD) -Signature of person receiving the solemn declaration
- Campaign delegate information
- First name - Campaign delegate information
- Last name - Campaign delegate information
- Language of correspondence - Campaign delegate information Off
- Email - Contact information -Campaign Delegate
- Primary phone number - Contact information -Campaign Delegate
- Primary phone number EXT - Contact information -Campaign Delegate
- Alternate phone number - Contact information -Campaign Delegate
- Alternate phone number EXT - Contact information -Campaign Delegate
- Fax nmuber- Contact information -Campaign Delegate
- Street - Residential address -Campaign delegate
- Street name - Residential address -Campaign delegate
- City - Residential address -Campaign delegate
- ProvinceTerritory - Residential address -Campaign delegate
- Postal Code - Residential address -Campaign delegate
- Campaign delegate - Mailing address ndash Same as residential address Off
- Unit - Residential address -Campaign delegate
- Date (YYYY-MM-DD) - Candidate authorization Signature
- Date (YYYY-MM-DD) - Candidate campaign Signature
- First name - Official agent information
- Last name - Official agent information
- Language of correspondence - Official agent information Off
- Email - Official agent information
- Primary phone number - Official agent information
- Primary phone number EXT - Official agent information
- Alternate phone number EXT - Official agent information
- Alternate phone number - Official agent information
- Fax number - Official agent information
- Unit -Residential address - Official Agent
- Street name -Residential address - Official Agent
- City -Residential address - Official Agent
- Street -Residential address - Official Agent
- ProvinceTerritory -Residential address - Official Agent
- Postal code-Residential address - Official Agent
- Mailing address ndash Same as residential address- Official Agent Off
- Date (YYYY-MM-DD) - Official agent signature
- First name - Auditor information
- Last name - Auditor information
- Language of correspondence - Auditor information Off
- Email - Auditor information
- Primary phone number - Auditor information
- Primary phone number EXT- Auditor information
- Alternate phone number - Auditor information
- Alternate phone number EXT- Auditor information
- Fax number - Auditor information
- Name of firm- Auditor organizational information
- Occupation of auditor - Auditor organizational information
- Professional designation - Auditor organizational information Off
- Designation registration number
- Make cheque payable to
- Unit - Address (where cheque is sent)
- Street - Address (where cheque is sent)
- Street name - Address (where cheque is sent)
- City - Address (where cheque is sent)
- ProvinceTerritory - Address (where cheque is sent)
- Postal code - Address (where cheque is sent)
- Date (YYY-MM-DD) - Auditor signature
- Unit - Campaign office address (optional)
- Street - Campaign office address (optional)
- Street name - Campaign office address (optional)
- City - Campaign office address (optional)
- ProvinceTerritory- Campaign office address (optional)
- Postal code - Campaign office address (optional)
- Name of witness
- Full address of witness
- Name of candidate
- Electoral district
- Year
- Name of candidate2
- Electoral district2
- Year2
- Name of witness2
- Full address of witness2
- Name of candidate3
- Electoral district3
- Year3
- Full address of witness3
- Name of witness3
- Name of candidate 4
- Electoral district4
- Year4
- Full address of witness 4
- Name of witness 4
- Name of candidate5
- Electoral district5
- Year5
- Full address of witness5
- Name of witness5
- Name of candidate6
- Electoral district6
- Year6
- Name of witness6
- Full address of witness6
- Name of candidate7
- Electoral district7
- Year7
- Full address of witness7
- Name of witness7
- Name of candidate8
- Electoral district8
- Year8
- Full address of witness8
- Name of witness8
- Name of candidate9
- Electoral district9
- Year9
- Full address of witness 9
- Name of witness 9
- Name of candidate10
- Electoral district10
- Year10
- Full address of witness10
- Name of witness10
- Name of candidate11
- Electoral district11
- Year11
- Full address of witness11
- Name of witness11
- Name of candidate12
- Electoral district12
- Year12
- Full address of witness12
- Name of witness12
- Name of candidate13
- Electoral district13
- Year13
- Full address of witness13
- Name of witness13
- Name of candidate14
- Electoral district14
- Year14
- Name of witness14
- Full address of witness14
- Name of candidate1
- Electoral district1
- Year1
- Name of witness1
- Full address of witness1
- Name of candidate15
- Electoral district15
- Year15
- Name of witness15
- Full address of witness15
- unit -Mailing address
- Street -Mailing address
- Street name -Mailing address
- City -Mailing address
- ProvinceTerritory -Mailing address
- Postal code -Mailing address
- Unit - Mailing address -Campaign delegate
- Street - Mailing address -Campaign delegate
- Street name - Mailing address -Campaign delegate
- City - Mailing address -Campaign delegate
- ProvinceTerritory- Mailing address -Campaign delegate
- Postal code- Mailing address -Campaign delegate
- Unit -Mailing address - Official Agent
- Street -Mailing address - Official Agent
- Street name -Mailing address - Official Agent
- city -Mailing address - Official Agent
- ProvinceTerritory-Mailing address - Official Agent
- Postal code-Mailing address - Official Agent
EC 20010 (052019)
26BSECTION A ndash Candidate Information (Mandatory)
All fields marked with are mandatory
Candidate occupation
State the occupation you are commonly known by in your place of ordinary residence Please note that the term ldquoMember of Parliamentrdquo is not an occupation but a title and will not be accepted The term ldquoparliamentarianrdquo however is acceptable CEA 66(3)
Occupation
Sharing of information with the Conflict of Interest and Ethics Commissioner and the House of Commons including the Library of Parliament
To help new members of Parliament Elections Canada will share the name gender residential address telephone number email address occupation preferred language of correspondence electoral district and political party affiliation of candidates who authorize Elections Canada to share their information with the Conflict of Interest and Ethics Commissioner and the House of Commons which includes the Library of Parliament
Do you authorize Elections Canada to share your personal information with the Conflict of Interest and Ethics Commissioner and the House of Commons including the Library of Parliament
Yes No
Privacy notice
Personal information in this Nomination Paper and all associated supporting documents are collected to determine your eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
Any person at the returning office may examine the completed Nomination Paper during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
Subject to consent your contact information may be shared with the House of Commons Conflict of Interest and Ethics Commissioner and Library of Parliament for orientation and communication purposes for new Members of Parliament If you provide a URL it may be posted on Elections Canadarsquos website to increase electorsrsquo accessibility to the electoral framework and democratic process
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information
Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB may be found on the Elections Canada website
6
a
b
c
EC 20010 (052019)
SECTION A ndash Candidate Declaration and Signature (Mandatory)
All fields marked with are mandatory
Candidatersquos declaration
I the undersigned do hereby solemnly declare that
1 my name (including any alternative name I wish to have appear on the ballot) my addressand occupation are as stated in section A of this Nomination Paper
2 I designate the permanent residential address in this Nomination Paper as the address forservice of process and papers under the Canada Elections Act
3 the name and address of my official agent and the name address and occupation of myauditor (if applicable) are as stated in sections C and D of this Nomination Paper
4 the information regarding my political affiliation is as stated in section A of this NominationPaper and
5 where applicable if the returning officer is unable to verify that I have been endorsed by thepolitical party identified in section A of this Nomination Paper I wish to
Have the word ldquoindependentrdquo appear under my name on the ballot
have no designation of political affiliation (meaning that a series of black dashes will appear under my name on the ballot) or
withdraw my Nomination paper
I further state that
1 I consent to the nomination
2 I am a Canadian citizen at least 18 years of age on election day
3 as per section 65 of the Canada Elections Act I am not ineligible to be a candidate
4 I consent to allowing my official agent and candidate campaign delegate (if applicable) toaccess on my behalf electoral materials online or at the local Elections Canada officeincluding the lists of electors distributed by Elections Canada and
5 I am aware of my obligations under the Canada Elections Act
Candidate signature Date (YYYY-MM-DD)
Signature of person receiving the solemn declaration
As per subsection 549(1) of the Canada Elections Act the solemn declaration must be witnessed by a judge an election officer a unit election officer as defined in section 177 a notary public a provincial court judge a justice of the peace or a commissioner for taking oaths in the province
Signature of person receiving the solemn declaration Date (YYYY-MM-DD)
7
ndash
EC 20010 (052019)
SECTION B ndash 3BCampaign Delegate (Optional)
If appointing a campaign delegate all fields marked with are mandatory
Campaign delegate information
A candidate may authorize another individual (referred to in the Nomination Paper as the campaign delegate) to act on their behalf during the election The campaign delegate can submit the Nomination Paper and all associated supporting documents CEA 67(7) Note The campaign delegate does not have access to the candidatersquos financial returns
First name Last name Language of correspondence
English French
Contact information
Upon confirmation of the nomination Elections Canada will send to the email address listed below an invitation to the Political Entities Service Centre (PESC) online portal
Primary phone number Ext Alternate phone number Ext Fax number
Residential address
Unit Street Street name
City ProvinceTerritory Postal code
Mailing address Same as residential address
Unit Street Street name
City ProvinceTerritory Postal code
8
EC 20010 (052019)
SECTION B ndash Campaign Delegate ndash Privacy Notice and Declaration (Optional)
If appointing a campaign delegate all fields marked with are mandatory
Privacy notice
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA) Any person at the returning office may examine the completed Nomination Paper during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
Candidate authorization of the campaign delegate
As per subsection 66(1)(h) of the Canada Elections Act I authorize the individual identified in this section to act as my campaign delegate
Candidate signature Date (YYYY-MM-DD)
Candidate campaign delegate signature
I the undersigned candidate campaign delegate for the candidate named in this Nomination Paper state that
1 I hereby agree to act as the authorized person for the candidate named herein for the purposes of theCanada Elections Act
2 I am fully aware of the duties and responsibilities imposed on me by the Canada Elections Act
Campaign delegate signature Date (YYYY-MM-DD)
9
ndash
EC 20010 (052019)
SECTION C ndash 4BOfficial Agent (Mandatory)
All fields marked with are mandatory
Official agent information
The official agent is responsible for administering the campaignrsquos financial transactions and reporting those transactions to Elections Canada as required by the CEA For more information consult the Political Financing Handbook for Candidates and Official Agents Note The candidate official agent and auditor must all be different people
First name Last name Language of correspondence
English French
Contact information
Upon confirmation of the nomination Elections Canada will send to the email address listed below an invitation to the Political Entities Service Centre (PESC) online portal
Primary phone number Ext Alternate phone number Ext Fax number
Residential address Unit Street Street name
City ProvinceTerritory Postal code
Mailing address Same as residential address
Unit Street Street name
City ProvinceTerritory Postal code
10
EC 20010 (052019)
24BSECTION C ndash Official Agent ndash Privacy Notice and Declaration (Mandatory)
All fields marked with are mandatory
Privacy notice
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA) Any person at the returning office may examine the completed Nomination Paper during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
Official agent signature
I the undersigned official agent for the candidate named in this Nomination Paper hereby agree to act as official agent for the candidate named herein for the purposes of the Canada Elections Act I further state that
1 I am fully aware of the duties and responsibilities imposed on me by the Canada Elections Act
2 I am capable of entering into contracts in the provinceterritory in which this electoral district is located
3 I am eligible to act as official agent pursuant to section 4772 of the Canada Elections Act
Section 4772 of the Canada Elections Act states The following persons are ineligible to be an official agenta candidate an election officer or a member of the staff of a returning office an undischarged bankrupt anauditor appointed as required by this Act a person who is not qualified as an elector and a person who doesnot have the capacity to enter into contracts in the province in which they ordinarily reside
Official agent signature Date (YYYY-MM-DD)
11
EC 20010 (052019)
SECTION D ndash 5B Auditor (Optional)
If appointing an auditor all fields marked with are mandatory
Auditor information An auditor must be appointed if bull the candidatersquos campaign accepts contributions of $10000 or more bull the candidatersquos campaign incurs expenses of $10000 or more or bull the candidate receives 10 or more of votes cast in the electoral district If at the time of filing the Nomination Paper none of the above applies you do not need to appoint an auditor though you may still choose to do so If the above requirements are later met you must appoint an auditor without delay A person or partnership who wants to act as a candidatersquos auditor must be or have every partner be recognized as a professional accountant under provincial or territorial legislation CEA 4773(1) For more information consult the Political Financing Handbook for Candidates and Official Agents
First name Last name Language of correspondence
English French
Contact information Upon confirmation of the nomination Elections Canada will send to the email address listed below an invitation to the Political Entities Service Centre (PESC) online portal
Primary phone number Ext Alternate phone number Ext Fax number
Auditor organizational information Name of firm Occupation of auditor Professional designation
CPA FCPA
Designation registration number Make cheque payable to
Address (where cheque is sent) Unit Street Street name
City ProvinceTerritory Postal code
12
EC 20010 (052019)
SECTION D ndash Auditor ndash Privacy Notice and Declaration (Optional)
If appointing an auditor all fields marked with are mandatory
Privacy notice
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA) Any person at the returning office may examine the completed Nomination Paper during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information
Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
Auditor signature
I the undersigned hereby agree to act as the auditor for the candidate named in this Nomination Paper I further state that I am aware of the duties and responsibilities of this position under the Canada Elections Act and I am qualified to act as auditor under subsection 4773(1) and (2) of the Canada Elections Act
Auditor signature Date (YYYY-MM-DD)
13
EC 20010 (052019)
SECTION E ndash 6BCampaign Office (Optional)
Contact information to be made available on the Elections Canada website (optional)
Please note You may provide a telephone number andor a link to your website or social media platform of choice when filing your Nomination Paper with Elections Canada You do not have to provide this information but it is intended to help electors access campaign information Elections Canada may provide this information as part of the Voter Information Service Please include the full website address including prefix (http https)
Telephone number to be posted on electionsca
Website to be posted on electionsca (including prefix http https)
Campaign office address (optional)
Unit Street Street name
City ProvinceTerritory Postal code
14
SECTION F ndash 7BElectors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
15
8BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
16
9BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
17
10BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
18
11BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
19
12BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
20
13BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
21
14BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
22
15BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
23
16BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
24
17BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
25
18BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
26
19BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
27
20BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
28
21BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
29
22BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
30
EC 20010 (022019)
SECTION G ndash 23B Are You Ready to Submit Your Nomination
Have you completed the Nomination Paper (EC 20010)
bull Are all mandatory fields in sections AndashE complete
bull Have you collected the required number of signatures from qualified electors in section F
o For most electoral districts 100 electors must consent to your candidacy
o For electoral districts identified in Schedule 3 only 50 electors are required
o To ensure a smooth nomination process Elections Canada recommends collecting signatures from at least 150 electors
Do you have authorized proof of identify
bull For a list of authorized identification visit the Elections Canada website
bull If a campaign delegate is submitting on your behalf they must bring a copy of your identification documents signed by you
bull If you want an alternative name to appear on the ballot additional documentation is required visit electionsca for details
Are you endorsed by a political party
bull Make sure your party has submitted the required documentation to Elections Canada attesting your designated political affiliation
Have you made a nomination appointment
bull To facilitate the nomination process make an appointment with the returning officer to finalize the filing of the complete nomination package
bull The nomination period closes 21 days before election day at 200 pm local time
31
- Nomination Paperof a Candidate at a Federal General Election or By-election
- Table of Contents
- General Information
- SECTION A ndash Candidate Information (Mandatory)
- SECTION B ndash Campaign Delegate (Optional)
- SECTION C ndash Official Agent (Mandatory)
- SECTION D ndash Auditor (Optional)
- SECTION E ndash Campaign Office (Optional)
- SECTION F ndash Electors Consenting to Candidacy (Mandatory)
-
- Name of electoral district
- Political affiliation
- Telephone number to be posted on electionsca
- Website to be posted on electionsca including prefix http https
- Printed name of elector1
- Full residential address street numbernamecity1
- Postal code1
- Elector signature1
- Witness initials1
- Internal use only1
- Printed name of elector2
- Full residential address street numbernamecity2
- Postal code2
- Elector signature2
- Witness initials2
- Internal use only2
- Printed name of elector3
- Full residential address street numbernamecity3
- Postal code3
- Elector signature3
- Witness initials3
- Internal use only3
- Printed name of elector4
- Full residential address street numbernamecity4
- Postal code4
- Elector signature4
- Witness initials4
- Internal use only4
- Printed name of elector5
- Full residential address street numbernamecity5
- Postal code5
- Elector signature5
- Witness initials5
- Internal use only5
- Printed name of elector6
- Full residential address street numbernamecity6
- Postal code6
- Elector signature6
- Witness initials6
- Internal use only6
- Printed name of elector7
- Full residential address street numbernamecity7
- Postal code7
- Elector signature7
- Witness initials7
- Internal use only7
- Printed name of elector8
- Full residential address street numbernamecity8
- Postal code8
- Elector signature8
- Witness initials8
- Internal use only8
- Printed name of elector9
- Full residential address street numbernamecity9
- Postal code9
- Elector signature9
- Witness initials9
- Internal use only9
- Printed name of elector10
- Full residential address street numbernamecity10
- Postal code10
- Elector signature10
- Witness initials10
- Internal use only10
- Printed name of elector1_2
- Full residential address street numbernamecity1_2
- Postal code1_2
- Elector signature1_2
- Witness initials1_2
- Internal use only1_2
- Printed name of elector2_2
- Full residential address street numbernamecity2_2
- Postal code2_2
- Elector signature2_2
- Witness initials2_2
- Internal use only2_2
- Printed name of elector3_2
- Full residential address street numbernamecity3_2
- Postal code3_2
- Elector signature3_2
- Witness initials3_2
- Internal use only3_2
- Printed name of elector4_2
- Full residential address street numbernamecity4_2
- Postal code4_2
- Elector signature4_2
- Witness initials4_2
- Internal use only4_2
- Printed name of elector5_2
- Full residential address street numbernamecity5_2
- Postal code5_2
- Elector signature5_2
- Witness initials5_2
- Internal use only5_2
- Printed name of elector6_2
- Full residential address street numbernamecity6_2
- Postal code6_2
- Elector signature6_2
- Witness initials6_2
- Internal use only6_2
- Printed name of elector7_2
- Full residential address street numbernamecity7_2
- Postal code7_2
- Elector signature7_2
- Witness initials7_2
- Internal use only7_2
- Printed name of elector8_2
- Full residential address street numbernamecity8_2
- Postal code8_2
- Elector signature8_2
- Witness initials8_2
- Internal use only8_2
- Printed name of elector9_2
- Full residential address street numbernamecity9_2
- Postal code9_2
- Elector signature9_2
- Witness initials9_2
- Internal use only9_2
- Printed name of elector10_2
- Full residential address street numbernamecity10_2
- Postal code10_2
- Elector signature10_2
- Witness initials10_2
- Internal use only10_2
- Printed name of elector1_3
- Full residential address street numbernamecity1_3
- Postal code1_3
- Elector signature1_3
- Witness initials1_3
- Internal use only1_3
- Printed name of elector2_3
- Full residential address street numbernamecity2_3
- Postal code2_3
- Elector signature2_3
- Witness initials2_3
- Internal use only2_3
- Printed name of elector3_3
- Full residential address street numbernamecity3_3
- Postal code3_3
- Elector signature3_3
- Witness initials3_3
- Internal use only3_3
- Printed name of elector4_3
- Full residential address street numbernamecity4_3
- Postal code4_3
- Elector signature4_3
- Witness initials4_3
- Internal use only4_3
- Printed name of elector5_3
- Full residential address street numbernamecity5_3
- Postal code5_3
- Elector signature5_3
- Witness initials5_3
- Internal use only5_3
- Printed name of elector6_3
- Full residential address street numbernamecity6_3
- Postal code6_3
- Elector signature6_3
- Witness initials6_3
- Internal use only6_3
- Printed name of elector7_3
- Full residential address street numbernamecity7_3
- Postal code7_3
- Elector signature7_3
- Witness initials7_3
- Internal use only7_3
- Printed name of elector8_3
- Full residential address street numbernamecity8_3
- Postal code8_3
- Elector signature8_3
- Witness initials8_3
- Internal use only8_3
- Printed name of elector9_3
- Full residential address street numbernamecity9_3
- Postal code9_3
- Elector signature9_3
- Witness initials9_3
- Internal use only9_3
- Printed name of elector10_3
- Full residential address street numbernamecity10_3
- Postal code10_3
- Elector signature10_3
- Witness initials10_3
- Internal use only10_3
- Printed name of elector1_4
- Full residential address street numbernamecity1_4
- Postal code1_4
- Elector signature1_4
- Witness initials1_4
- Internal use only1_4
- Printed name of elector2_4
- Full residential address street numbernamecity2_4
- Postal code2_4
- Elector signature2_4
- Witness initials2_4
- Internal use only2_4
- Printed name of elector3_4
- Full residential address street numbernamecity3_4
- Postal code3_4
- Elector signature3_4
- Witness initials3_4
- Internal use only3_4
- Printed name of elector4_4
- Full residential address street numbernamecity4_4
- Postal code4_4
- Elector signature4_4
- Witness initials4_4
- Internal use only4_4
- Printed name of elector5_4
- Full residential address street numbernamecity5_4
- Postal code5_4
- Elector signature5_4
- Witness initials5_4
- Internal use only5_4
- Printed name of elector6_4
- Full residential address street numbernamecity6_4
- Postal code6_4
- Elector signature6_4
- Witness initials6_4
- Internal use only6_4
- Printed name of elector7_4
- Full residential address street numbernamecity7_4
- Postal code7_4
- Elector signature7_4
- Witness initials7_4
- Internal use only7_4
- Printed name of elector8_4
- Full residential address street numbernamecity8_4
- Postal code8_4
- Elector signature8_4
- Witness initials8_4
- Internal use only8_4
- Printed name of elector9_4
- Full residential address street numbernamecity9_4
- Postal code9_4
- Elector signature9_4
- Witness initials9_4
- Internal use only9_4
- Printed name of elector10_4
- Full residential address street numbernamecity10_4
- Postal code10_4
- Elector signature10_4
- Witness initials10_4
- Internal use only10_4
- Printed name of elector1_5
- Full residential address street numbernamecity1_5
- Postal code1_5
- Elector signature1_5
- Witness initials1_5
- Internal use only1_5
- Printed name of elector2_5
- Full residential address street numbernamecity2_5
- Postal code2_5
- Elector signature2_5
- Witness initials2_5
- Internal use only2_5
- Printed name of elector3_5
- Full residential address street numbernamecity3_5
- Postal code3_5
- Elector signature3_5
- Witness initials3_5
- Internal use only3_5
- Printed name of elector4_5
- Full residential address street numbernamecity4_5
- Postal code4_5
- Elector signature4_5
- Witness initials4_5
- Internal use only4_5
- Printed name of elector5_5
- Full residential address street numbernamecity5_5
- Postal code5_5
- Elector signature5_5
- Witness initials5_5
- Internal use only5_5
- Printed name of elector6_5
- Full residential address street numbernamecity6_5
- Postal code6_5
- Elector signature6_5
- Witness initials6_5
- Internal use only6_5
- Printed name of elector7_5
- Full residential address street numbernamecity7_5
- Postal code7_5
- Elector signature7_5
- Witness initials7_5
- Internal use only7_5
- Printed name of elector8_5
- Full residential address street numbernamecity8_5
- Postal code8_5
- Elector signature8_5
- Witness initials8_5
- Internal use only8_5
- Printed name of elector9_5
- Full residential address street numbernamecity9_5
- Postal code9_5
- Elector signature9_5
- Witness initials9_5
- Internal use only9_5
- Printed name of elector10_5
- Full residential address street numbernamecity10_5
- Postal code10_5
- Elector signature10_5
- Witness initials10_5
- Internal use only10_5
- Printed name of elector1_6
- Full residential address street numbernamecity1_6
- Postal code1_6
- Elector signature1_6
- Witness initials1_6
- Internal use only1_6
- Printed name of elector2_6
- Full residential address street numbernamecity2_6
- Postal code2_6
- Elector signature2_6
- Witness initials2_6
- Internal use only2_6
- Printed name of elector3_6
- Full residential address street numbernamecity3_6
- Postal code3_6
- Elector signature3_6
- Witness initials3_6
- Internal use only3_6
- Printed name of elector4_6
- Full residential address street numbernamecity4_6
- Postal code4_6
- Elector signature4_6
- Witness initials4_6
- Internal use only4_6
- Printed name of elector5_6
- Full residential address street numbernamecity5_6
- Postal code5_6
- Elector signature5_6
- Witness initials5_6
- Internal use only5_6
- Printed name of elector6_6
- Full residential address street numbernamecity6_6
- Postal code6_6
- Elector signature6_6
- Witness initials6_6
- Internal use only6_6
- Printed name of elector7_6
- Full residential address street numbernamecity7_6
- Postal code7_6
- Elector signature7_6
- Witness initials7_6
- Internal use only7_6
- Printed name of elector8_6
- Full residential address street numbernamecity8_6
- Postal code8_6
- Elector signature8_6
- Witness initials8_6
- Internal use only8_6
- Printed name of elector9_6
- Full residential address street numbernamecity9_6
- Postal code9_6
- Elector signature9_6
- Witness initials9_6
- Internal use only9_6
- Printed name of elector10_6
- Full residential address street numbernamecity10_6
- Postal code10_6
- Elector signature10_6
- Witness initials10_6
- Internal use only10_6
- Printed name of elector1_7
- Full residential address street numbernamecity1_7
- Postal code1_7
- Elector signature1_7
- Witness initials1_7
- Internal use only1_7
- Printed name of elector2_7
- Full residential address street numbernamecity2_7
- Postal code2_7
- Elector signature2_7
- Witness initials2_7
- Internal use only2_7
- Printed name of elector3_7
- Full residential address street numbernamecity3_7
- Postal code3_7
- Elector signature3_7
- Witness initials3_7
- Internal use only3_7
- Printed name of elector4_7
- Full residential address street numbernamecity4_7
- Postal code4_7
- Elector signature4_7
- Witness initials4_7
- Internal use only4_7
- Printed name of elector5_7
- Full residential address street numbernamecity5_7
- Postal code5_7
- Elector signature5_7
- Witness initials5_7
- Internal use only5_7
- Printed name of elector6_7
- Full residential address street numbernamecity6_7
- Postal code6_7
- Elector signature6_7
- Witness initials6_7
- Internal use only6_7
- Printed name of elector7_7
- Full residential address street numbernamecity7_7
- Postal code7_7
- Elector signature7_7
- Witness initials7_7
- Internal use only7_7
- Printed name of elector8_7
- Full residential address street numbernamecity8_7
- Postal code8_7
- Elector signature8_7
- Witness initials8_7
- Internal use only8_7
- Printed name of elector9_7
- Full residential address street numbernamecity9_7
- Postal code9_7
- Elector signature9_7
- Witness initials9_7
- Internal use only9_7
- Printed name of elector10_7
- Full residential address street numbernamecity10_7
- Postal code10_7
- Elector signature10_7
- Witness initials10_7
- Internal use only10_7
- Printed name of elector1_8
- Full residential address street numbernamecity1_8
- Postal code1_8
- Elector signature1_8
- Witness initials1_8
- Internal use only1_8
- Printed name of elector2_8
- Full residential address street numbernamecity2_8
- Postal code2_8
- Elector signature2_8
- Witness initials2_8
- Internal use only2_8
- Printed name of elector3_8
- Full residential address street numbernamecity3_8
- Postal code3_8
- Elector signature3_8
- Witness initials3_8
- Internal use only3_8
- Printed name of elector4_8
- Full residential address street numbernamecity4_8
- Postal code4_8
- Elector signature4_8
- Witness initials4_8
- Internal use only4_8
- Printed name of elector5_8
- Full residential address street numbernamecity5_8
- Postal code5_8
- Elector signature5_8
- Witness initials5_8
- Internal use only5_8
- Printed name of elector6_8
- Full residential address street numbernamecity6_8
- Postal code6_8
- Elector signature6_8
- Witness initials6_8
- Internal use only6_8
- Printed name of elector7_8
- Full residential address street numbernamecity7_8
- Postal code7_8
- Elector signature7_8
- Witness initials7_8
- Internal use only7_8
- Printed name of elector8_8
- Full residential address street numbernamecity8_8
- Postal code8_8
- Elector signature8_8
- Witness initials8_8
- Internal use only8_8
- Printed name of elector9_8
- Full residential address street numbernamecity9_8
- Postal code9_8
- Elector signature9_8
- Witness initials9_8
- Internal use only9_8
- Printed name of elector10_8
- Full residential address street numbernamecity10_8
- Postal code10_8
- Elector signature10_8
- Witness initials10_8
- Internal use only10_8
- Printed name of elector1_9
- Full residential address street numbernamecity1_9
- Postal code1_9
- Elector signature1_9
- Witness initials1_9
- Internal use only1_9
- Printed name of elector2_9
- Full residential address street numbernamecity2_9
- Postal code2_9
- Elector signature2_9
- Witness initials2_9
- Internal use only2_9
- Printed name of elector3_9
- Full residential address street numbernamecity3_9
- Postal code3_9
- Elector signature3_9
- Witness initials3_9
- Internal use only3_9
- Printed name of elector4_9
- Full residential address street numbernamecity4_9
- Postal code4_9
- Elector signature4_9
- Witness initials4_9
- Internal use only4_9
- Printed name of elector5_9
- Full residential address street numbernamecity5_9
- Postal code5_9
- Elector signature5_9
- Witness initials5_9
- Internal use only5_9
- Printed name of elector6_9
- Full residential address street numbernamecity6_9
- Postal code6_9
- Elector signature6_9
- Witness initials6_9
- Internal use only6_9
- Printed name of elector7_9
- Full residential address street numbernamecity7_9
- Postal code7_9
- Elector signature7_9
- Witness initials7_9
- Internal use only7_9
- Printed name of elector8_9
- Full residential address street numbernamecity8_9
- Postal code8_9
- Elector signature8_9
- Witness initials8_9
- Internal use only8_9
- Printed name of elector9_9
- Full residential address street numbernamecity9_9
- Postal code9_9
- Elector signature9_9
- Witness initials9_9
- Internal use only9_9
- Printed name of elector10_9
- Full residential address street numbernamecity10_9
- Postal code10_9
- Elector signature10_9
- Witness initials10_9
- Internal use only10_9
- Printed name of elector1_10
- Full residential address street numbernamecity1_10
- Postal code1_10
- Elector signature1_10
- Witness initials1_10
- Internal use only1_10
- Printed name of elector2_10
- Full residential address street numbernamecity2_10
- Postal code2_10
- Elector signature2_10
- Witness initials2_10
- Internal use only2_10
- Printed name of elector3_10
- Full residential address street numbernamecity3_10
- Postal code3_10
- Elector signature3_10
- Witness initials3_10
- Internal use only3_10
- Printed name of elector4_10
- Full residential address street numbernamecity4_10
- Postal code4_10
- Elector signature4_10
- Witness initials4_10
- Internal use only4_10
- Printed name of elector5_10
- Full residential address street numbernamecity5_10
- Postal code5_10
- Elector signature5_10
- Witness initials5_10
- Internal use only5_10
- Printed name of elector6_10
- Full residential address street numbernamecity6_10
- Postal code6_10
- Elector signature6_10
- Witness initials6_10
- Internal use only6_10
- Printed name of elector7_10
- Full residential address street numbernamecity7_10
- Postal code7_10
- Elector signature7_10
- Witness initials7_10
- Internal use only7_10
- Printed name of elector8_10
- Full residential address street numbernamecity8_10
- Postal code8_10
- Elector signature8_10
- Witness initials8_10
- Internal use only8_10
- Printed name of elector9_10
- Full residential address street numbernamecity9_10
- Postal code9_10
- Elector signature9_10
- Witness initials9_10
- Internal use only9_10
- Printed name of elector10_10
- Full residential address street numbernamecity10_10
- Postal code10_10
- Elector signature10_10
- Witness initials10_10
- Internal use only10_10
- Printed name of elector1_11
- Full residential address street numbernamecity1_11
- Postal code1_11
- Elector signature1_11
- Witness initials1_11
- Internal use only1_11
- Printed name of elector2_11
- Full residential address street numbernamecity2_11
- Postal code2_11
- Elector signature2_11
- Witness initials2_11
- Internal use only2_11
- Printed name of elector3_11
- Full residential address street numbernamecity3_11
- Postal code3_11
- Elector signature3_11
- Witness initials3_11
- Internal use only3_11
- Printed name of elector4_11
- Full residential address street numbernamecity4_11
- Postal code4_11
- Elector signature4_11
- Witness initials4_11
- Internal use only4_11
- Printed name of elector5_11
- Full residential address street numbernamecity5_11
- Postal code5_11
- Elector signature5_11
- Witness initials5_11
- Internal use only5_11
- Printed name of elector6_11
- Full residential address street numbernamecity6_11
- Postal code6_11
- Elector signature6_11
- Witness initials6_11
- Internal use only6_11
- Printed name of elector7_11
- Full residential address street numbernamecity7_11
- Postal code7_11
- Elector signature7_11
- Witness initials7_11
- Internal use only7_11
- Printed name of elector8_11
- Full residential address street numbernamecity8_11
- Postal code8_11
- Elector signature8_11
- Witness initials8_11
- Internal use only8_11
- Printed name of elector9_11
- Full residential address street numbernamecity9_11
- Postal code9_11
- Elector signature9_11
- Witness initials9_11
- Internal use only9_11
- Printed name of elector10_11
- Full residential address street numbernamecity10_11
- Postal code10_11
- Elector signature10_11
- Witness initials10_11
- Internal use only10_11
- Printed name of elector1_12
- Full residential address street numbernamecity1_12
- Postal code1_12
- Elector signature1_12
- Witness initials1_12
- Internal use only1_12
- Printed name of elector2_12
- Full residential address street numbernamecity2_12
- Postal code2_12
- Elector signature2_12
- Witness initials2_12
- Internal use only2_12
- Printed name of elector3_12
- Full residential address street numbernamecity3_12
- Postal code3_12
- Elector signature3_12
- Witness initials3_12
- Internal use only3_12
- Printed name of elector4_12
- Full residential address street numbernamecity4_12
- Postal code4_12
- Elector signature4_12
- Witness initials4_12
- Internal use only4_12
- Printed name of elector5_12
- Full residential address street numbernamecity5_12
- Postal code5_12
- Elector signature5_12
- Witness initials5_12
- Internal use only5_12
- Printed name of elector6_12
- Full residential address street numbernamecity6_12
- Postal code6_12
- Elector signature6_12
- Witness initials6_12
- Internal use only6_12
- Printed name of elector7_12
- Full residential address street numbernamecity7_12
- Postal code7_12
- Elector signature7_12
- Witness initials7_12
- Internal use only7_12
- Printed name of elector8_12
- Full residential address street numbernamecity8_12
- Postal code8_12
- Elector signature8_12
- Witness initials8_12
- Internal use only8_12
- Printed name of elector9_12
- Full residential address street numbernamecity9_12
- Postal code9_12
- Elector signature9_12
- Witness initials9_12
- Internal use only9_12
- Printed name of elector10_12
- Full residential address street numbernamecity10_12
- Postal code10_12
- Elector signature10_12
- Witness initials10_12
- Internal use only10_12
- Printed name of elector1_13
- Full residential address street numbernamecity1_13
- Postal code1_13
- Elector signature1_13
- Witness initials1_13
- Internal use only1_13
- Printed name of elector2_13
- Full residential address street numbernamecity2_13
- Postal code2_13
- Elector signature2_13
- Witness initials2_13
- Internal use only2_13
- Printed name of elector3_13
- Full residential address street numbernamecity3_13
- Postal code3_13
- Elector signature3_13
- Witness initials3_13
- Internal use only3_13
- Printed name of elector4_13
- Full residential address street numbernamecity4_13
- Postal code4_13
- Elector signature4_13
- Witness initials4_13
- Internal use only4_13
- Printed name of elector5_13
- Full residential address street numbernamecity5_13
- Postal code5_13
- Elector signature5_13
- Witness initials5_13
- Internal use only5_13
- Printed name of elector6_13
- Full residential address street numbernamecity6_13
- Postal code6_13
- Elector signature6_13
- Witness initials6_13
- Internal use only6_13
- Printed name of elector7_13
- Full residential address street numbernamecity7_13
- Postal code7_13
- Elector signature7_13
- Witness initials7_13
- Internal use only7_13
- Printed name of elector8_13
- Full residential address street numbernamecity8_13
- Postal code8_13
- Elector signature8_13
- Witness initials8_13
- Internal use only8_13
- Printed name of elector9_13
- Full residential address street numbernamecity9_13
- Postal code9_13
- Elector signature9_13
- Witness initials9_13
- Internal use only9_13
- Printed name of elector10_13
- Full residential address street numbernamecity10_13
- Postal code10_13
- Elector signature10_13
- Witness initials10_13
- Internal use only10_13
- Printed name of elector1_14
- Full residential address street numbernamecity1_14
- Postal code1_14
- Elector signature1_14
- Witness initials1_14
- Internal use only1_14
- Printed name of elector2_14
- Full residential address street numbernamecity2_14
- Postal code2_14
- Elector signature2_14
- Witness initials2_14
- Internal use only2_14
- Printed name of elector3_14
- Full residential address street numbernamecity3_14
- Postal code3_14
- Elector signature3_14
- Witness initials3_14
- Internal use only3_14
- Printed name of elector4_14
- Full residential address street numbernamecity4_14
- Postal code4_14
- Elector signature4_14
- Witness initials4_14
- Internal use only4_14
- Printed name of elector5_14
- Full residential address street numbernamecity5_14
- Postal code5_14
- Elector signature5_14
- Witness initials5_14
- Internal use only5_14
- Printed name of elector6_14
- Full residential address street numbernamecity6_14
- Postal code6_14
- Elector signature6_14
- Witness initials6_14
- Internal use only6_14
- Printed name of elector7_14
- Full residential address street numbernamecity7_14
- Postal code7_14
- Elector signature7_14
- Witness initials7_14
- Internal use only7_14
- Printed name of elector8_14
- Full residential address street numbernamecity8_14
- Postal code8_14
- Elector signature8_14
- Witness initials8_14
- Internal use only8_14
- Printed name of elector9_14
- Full residential address street numbernamecity9_14
- Postal code9_14
- Elector signature9_14
- Witness initials9_14
- Internal use only9_14
- Printed name of elector10_14
- Full residential address street numbernamecity10_14
- Postal code10_14
- Elector signature10_14
- Witness initials10_14
- Internal use only10_14
- Printed name of elector1_15
- Full residential address street numbernamecity1_15
- Postal code1_15
- Elector signature1_15
- Witness initials1_15
- Internal use only1_15
- Printed name of elector2_15
- Full residential address street numbernamecity2_15
- Postal code2_15
- Elector signature2_15
- Witness initials2_15
- Internal use only2_15
- Printed name of elector3_15
- Full residential address street numbernamecity3_15
- Postal code3_15
- Elector signature3_15
- Witness initials3_15
- Internal use only3_15
- Printed name of elector4_15
- Full residential address street numbernamecity4_15
- Postal code4_15
- Elector signature4_15
- Witness initials4_15
- Internal use only4_15
- Printed name of elector5_15
- Full residential address street numbernamecity5_15
- Postal code5_15
- Elector signature5_15
- Witness initials5_15
- Internal use only5_15
- Printed name of elector6_15
- Full residential address street numbernamecity6_15
- Postal code6_15
- Elector signature6_15
- Witness initials6_15
- Internal use only6_15
- Printed name of elector7_15
- Full residential address street numbernamecity7_15
- Postal code7_15
- Elector signature7_15
- Witness initials7_15
- Internal use only7_15
- Printed name of elector8_15
- Full residential address street numbernamecity8_15
- Postal code8_15
- Elector signature8_15
- Witness initials8_15
- Internal use only8_15
- Printed name of elector9_15
- Full residential address street numbernamecity9_15
- Postal code9_15
- Elector signature9_15
- Witness initials9_15
- Internal use only9_15
- Printed name of elector10_15
- Full residential address street numbernamecity10_15
- Postal code10_15
- Elector signature10_15
- Witness initials10_15
- Internal use only10_15
- Printed name of elector1_16
- Full residential address street numbernamecity1_16
- Postal code1_16
- Elector signature1_16
- Witness initials1_16
- Internal use only1_16
- Printed name of elector2_16
- Full residential address street numbernamecity2_16
- Postal code2_16
- Elector signature2_16
- Witness initials2_16
- Internal use only2_16
- Printed name of elector3_16
- Full residential address street numbernamecity3_16
- Postal code3_16
- Elector signature3_16
- Witness initials3_16
- Internal use only3_16
- Printed name of elector4_16
- Full residential address street numbernamecity4_16
- Postal code4_16
- Elector signature4_16
- Witness initials4_16
- Internal use only4_16
- Printed name of elector5_16
- Full residential address street numbernamecity5_16
- Postal code5_16
- Elector signature5_16
- Witness initials5_16
- Internal use only5_16
- Printed name of elector6_16
- Full residential address street numbernamecity6_16
- Postal code6_16
- Elector signature6_16
- Witness initials6_16
- Internal use only6_16
- Printed name of elector7_16
- Full residential address street numbernamecity7_16
- Postal code7_16
- Elector signature7_16
- Witness initials7_16
- Internal use only7_16
- Printed name of elector8_16
- Full residential address street numbernamecity8_16
- Postal code8_16
- Elector signature8_16
- Witness initials8_16
- Internal use only8_16
- Printed name of elector9_16
- Full residential address street numbernamecity9_16
- Postal code9_16
- Elector signature9_16
- Witness initials9_16
- Internal use only9_16
- Printed name of elector10_16
- Full residential address street numbernamecity10_16
- Postal code10_16
- Elector signature10_16
- Witness initials10_16
- Internal use only10_16
- Have you completed the Nomination Paper EC 20010 Off
- Do you have authorized proof of identify Off
- Are you endorsed by a political party Off
- Have you made a nomination appointment Off
- Last name - Candidate Name
- First name - Candidate Name
- Name of electoral district- Candidate Information
- First name - Candidate Information
- Last name - Candidate Information
- Ballot Name Off
- Ballot First name(s)
- Ballot Last name(s)
- Gender -Candidate information
- Date of birth (YYY-MM-DD) - Gender -Candidate information
- language of correspondence - Candidate information Off
- Email -Contact information
- Primary phone number - Contact information
- Ext - Primary phone number
- Alternate phone number - Contact information
- Ext - Alternate phone number
- Fax number- Alternate phone number
- Unit -Residential address
- Street -Residential address
- Street name -Residential address
- City -Residential address
- ProvinceTerritory -Residential address
- Postal code - -Residential address
- Mailing address - same as residential address Off
- Occupation- Candidate occupation
- Sharing of information with the Conflict of Interest and Ethics Commissioner and the House of Commons including the Library of Parliament Off
- where applicable if the returning officer is unable to verify that I have been endorsed by the political party identified in section A of this Nomination Paper I wish to Off
- Date of Signature (YYYY-MM-DD) - Candidate signature
- Date of Signature (YYYY-MM-DD) -Signature of person receiving the solemn declaration
- Campaign delegate information
- First name - Campaign delegate information
- Last name - Campaign delegate information
- Language of correspondence - Campaign delegate information Off
- Email - Contact information -Campaign Delegate
- Primary phone number - Contact information -Campaign Delegate
- Primary phone number EXT - Contact information -Campaign Delegate
- Alternate phone number - Contact information -Campaign Delegate
- Alternate phone number EXT - Contact information -Campaign Delegate
- Fax nmuber- Contact information -Campaign Delegate
- Street - Residential address -Campaign delegate
- Street name - Residential address -Campaign delegate
- City - Residential address -Campaign delegate
- ProvinceTerritory - Residential address -Campaign delegate
- Postal Code - Residential address -Campaign delegate
- Campaign delegate - Mailing address ndash Same as residential address Off
- Unit - Residential address -Campaign delegate
- Date (YYYY-MM-DD) - Candidate authorization Signature
- Date (YYYY-MM-DD) - Candidate campaign Signature
- First name - Official agent information
- Last name - Official agent information
- Language of correspondence - Official agent information Off
- Email - Official agent information
- Primary phone number - Official agent information
- Primary phone number EXT - Official agent information
- Alternate phone number EXT - Official agent information
- Alternate phone number - Official agent information
- Fax number - Official agent information
- Unit -Residential address - Official Agent
- Street name -Residential address - Official Agent
- City -Residential address - Official Agent
- Street -Residential address - Official Agent
- ProvinceTerritory -Residential address - Official Agent
- Postal code-Residential address - Official Agent
- Mailing address ndash Same as residential address- Official Agent Off
- Date (YYYY-MM-DD) - Official agent signature
- First name - Auditor information
- Last name - Auditor information
- Language of correspondence - Auditor information Off
- Email - Auditor information
- Primary phone number - Auditor information
- Primary phone number EXT- Auditor information
- Alternate phone number - Auditor information
- Alternate phone number EXT- Auditor information
- Fax number - Auditor information
- Name of firm- Auditor organizational information
- Occupation of auditor - Auditor organizational information
- Professional designation - Auditor organizational information Off
- Designation registration number
- Make cheque payable to
- Unit - Address (where cheque is sent)
- Street - Address (where cheque is sent)
- Street name - Address (where cheque is sent)
- City - Address (where cheque is sent)
- ProvinceTerritory - Address (where cheque is sent)
- Postal code - Address (where cheque is sent)
- Date (YYY-MM-DD) - Auditor signature
- Unit - Campaign office address (optional)
- Street - Campaign office address (optional)
- Street name - Campaign office address (optional)
- City - Campaign office address (optional)
- ProvinceTerritory- Campaign office address (optional)
- Postal code - Campaign office address (optional)
- Name of witness
- Full address of witness
- Name of candidate
- Electoral district
- Year
- Name of candidate2
- Electoral district2
- Year2
- Name of witness2
- Full address of witness2
- Name of candidate3
- Electoral district3
- Year3
- Full address of witness3
- Name of witness3
- Name of candidate 4
- Electoral district4
- Year4
- Full address of witness 4
- Name of witness 4
- Name of candidate5
- Electoral district5
- Year5
- Full address of witness5
- Name of witness5
- Name of candidate6
- Electoral district6
- Year6
- Name of witness6
- Full address of witness6
- Name of candidate7
- Electoral district7
- Year7
- Full address of witness7
- Name of witness7
- Name of candidate8
- Electoral district8
- Year8
- Full address of witness8
- Name of witness8
- Name of candidate9
- Electoral district9
- Year9
- Full address of witness 9
- Name of witness 9
- Name of candidate10
- Electoral district10
- Year10
- Full address of witness10
- Name of witness10
- Name of candidate11
- Electoral district11
- Year11
- Full address of witness11
- Name of witness11
- Name of candidate12
- Electoral district12
- Year12
- Full address of witness12
- Name of witness12
- Name of candidate13
- Electoral district13
- Year13
- Full address of witness13
- Name of witness13
- Name of candidate14
- Electoral district14
- Year14
- Name of witness14
- Full address of witness14
- Name of candidate1
- Electoral district1
- Year1
- Name of witness1
- Full address of witness1
- Name of candidate15
- Electoral district15
- Year15
- Name of witness15
- Full address of witness15
- unit -Mailing address
- Street -Mailing address
- Street name -Mailing address
- City -Mailing address
- ProvinceTerritory -Mailing address
- Postal code -Mailing address
- Unit - Mailing address -Campaign delegate
- Street - Mailing address -Campaign delegate
- Street name - Mailing address -Campaign delegate
- City - Mailing address -Campaign delegate
- ProvinceTerritory- Mailing address -Campaign delegate
- Postal code- Mailing address -Campaign delegate
- Unit -Mailing address - Official Agent
- Street -Mailing address - Official Agent
- Street name -Mailing address - Official Agent
- city -Mailing address - Official Agent
- ProvinceTerritory-Mailing address - Official Agent
- Postal code-Mailing address - Official Agent
a
b
c
EC 20010 (052019)
SECTION A ndash Candidate Declaration and Signature (Mandatory)
All fields marked with are mandatory
Candidatersquos declaration
I the undersigned do hereby solemnly declare that
1 my name (including any alternative name I wish to have appear on the ballot) my addressand occupation are as stated in section A of this Nomination Paper
2 I designate the permanent residential address in this Nomination Paper as the address forservice of process and papers under the Canada Elections Act
3 the name and address of my official agent and the name address and occupation of myauditor (if applicable) are as stated in sections C and D of this Nomination Paper
4 the information regarding my political affiliation is as stated in section A of this NominationPaper and
5 where applicable if the returning officer is unable to verify that I have been endorsed by thepolitical party identified in section A of this Nomination Paper I wish to
Have the word ldquoindependentrdquo appear under my name on the ballot
have no designation of political affiliation (meaning that a series of black dashes will appear under my name on the ballot) or
withdraw my Nomination paper
I further state that
1 I consent to the nomination
2 I am a Canadian citizen at least 18 years of age on election day
3 as per section 65 of the Canada Elections Act I am not ineligible to be a candidate
4 I consent to allowing my official agent and candidate campaign delegate (if applicable) toaccess on my behalf electoral materials online or at the local Elections Canada officeincluding the lists of electors distributed by Elections Canada and
5 I am aware of my obligations under the Canada Elections Act
Candidate signature Date (YYYY-MM-DD)
Signature of person receiving the solemn declaration
As per subsection 549(1) of the Canada Elections Act the solemn declaration must be witnessed by a judge an election officer a unit election officer as defined in section 177 a notary public a provincial court judge a justice of the peace or a commissioner for taking oaths in the province
Signature of person receiving the solemn declaration Date (YYYY-MM-DD)
7
ndash
EC 20010 (052019)
SECTION B ndash 3BCampaign Delegate (Optional)
If appointing a campaign delegate all fields marked with are mandatory
Campaign delegate information
A candidate may authorize another individual (referred to in the Nomination Paper as the campaign delegate) to act on their behalf during the election The campaign delegate can submit the Nomination Paper and all associated supporting documents CEA 67(7) Note The campaign delegate does not have access to the candidatersquos financial returns
First name Last name Language of correspondence
English French
Contact information
Upon confirmation of the nomination Elections Canada will send to the email address listed below an invitation to the Political Entities Service Centre (PESC) online portal
Primary phone number Ext Alternate phone number Ext Fax number
Residential address
Unit Street Street name
City ProvinceTerritory Postal code
Mailing address Same as residential address
Unit Street Street name
City ProvinceTerritory Postal code
8
EC 20010 (052019)
SECTION B ndash Campaign Delegate ndash Privacy Notice and Declaration (Optional)
If appointing a campaign delegate all fields marked with are mandatory
Privacy notice
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA) Any person at the returning office may examine the completed Nomination Paper during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
Candidate authorization of the campaign delegate
As per subsection 66(1)(h) of the Canada Elections Act I authorize the individual identified in this section to act as my campaign delegate
Candidate signature Date (YYYY-MM-DD)
Candidate campaign delegate signature
I the undersigned candidate campaign delegate for the candidate named in this Nomination Paper state that
1 I hereby agree to act as the authorized person for the candidate named herein for the purposes of theCanada Elections Act
2 I am fully aware of the duties and responsibilities imposed on me by the Canada Elections Act
Campaign delegate signature Date (YYYY-MM-DD)
9
ndash
EC 20010 (052019)
SECTION C ndash 4BOfficial Agent (Mandatory)
All fields marked with are mandatory
Official agent information
The official agent is responsible for administering the campaignrsquos financial transactions and reporting those transactions to Elections Canada as required by the CEA For more information consult the Political Financing Handbook for Candidates and Official Agents Note The candidate official agent and auditor must all be different people
First name Last name Language of correspondence
English French
Contact information
Upon confirmation of the nomination Elections Canada will send to the email address listed below an invitation to the Political Entities Service Centre (PESC) online portal
Primary phone number Ext Alternate phone number Ext Fax number
Residential address Unit Street Street name
City ProvinceTerritory Postal code
Mailing address Same as residential address
Unit Street Street name
City ProvinceTerritory Postal code
10
EC 20010 (052019)
24BSECTION C ndash Official Agent ndash Privacy Notice and Declaration (Mandatory)
All fields marked with are mandatory
Privacy notice
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA) Any person at the returning office may examine the completed Nomination Paper during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
Official agent signature
I the undersigned official agent for the candidate named in this Nomination Paper hereby agree to act as official agent for the candidate named herein for the purposes of the Canada Elections Act I further state that
1 I am fully aware of the duties and responsibilities imposed on me by the Canada Elections Act
2 I am capable of entering into contracts in the provinceterritory in which this electoral district is located
3 I am eligible to act as official agent pursuant to section 4772 of the Canada Elections Act
Section 4772 of the Canada Elections Act states The following persons are ineligible to be an official agenta candidate an election officer or a member of the staff of a returning office an undischarged bankrupt anauditor appointed as required by this Act a person who is not qualified as an elector and a person who doesnot have the capacity to enter into contracts in the province in which they ordinarily reside
Official agent signature Date (YYYY-MM-DD)
11
EC 20010 (052019)
SECTION D ndash 5B Auditor (Optional)
If appointing an auditor all fields marked with are mandatory
Auditor information An auditor must be appointed if bull the candidatersquos campaign accepts contributions of $10000 or more bull the candidatersquos campaign incurs expenses of $10000 or more or bull the candidate receives 10 or more of votes cast in the electoral district If at the time of filing the Nomination Paper none of the above applies you do not need to appoint an auditor though you may still choose to do so If the above requirements are later met you must appoint an auditor without delay A person or partnership who wants to act as a candidatersquos auditor must be or have every partner be recognized as a professional accountant under provincial or territorial legislation CEA 4773(1) For more information consult the Political Financing Handbook for Candidates and Official Agents
First name Last name Language of correspondence
English French
Contact information Upon confirmation of the nomination Elections Canada will send to the email address listed below an invitation to the Political Entities Service Centre (PESC) online portal
Primary phone number Ext Alternate phone number Ext Fax number
Auditor organizational information Name of firm Occupation of auditor Professional designation
CPA FCPA
Designation registration number Make cheque payable to
Address (where cheque is sent) Unit Street Street name
City ProvinceTerritory Postal code
12
EC 20010 (052019)
SECTION D ndash Auditor ndash Privacy Notice and Declaration (Optional)
If appointing an auditor all fields marked with are mandatory
Privacy notice
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA) Any person at the returning office may examine the completed Nomination Paper during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information
Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
Auditor signature
I the undersigned hereby agree to act as the auditor for the candidate named in this Nomination Paper I further state that I am aware of the duties and responsibilities of this position under the Canada Elections Act and I am qualified to act as auditor under subsection 4773(1) and (2) of the Canada Elections Act
Auditor signature Date (YYYY-MM-DD)
13
EC 20010 (052019)
SECTION E ndash 6BCampaign Office (Optional)
Contact information to be made available on the Elections Canada website (optional)
Please note You may provide a telephone number andor a link to your website or social media platform of choice when filing your Nomination Paper with Elections Canada You do not have to provide this information but it is intended to help electors access campaign information Elections Canada may provide this information as part of the Voter Information Service Please include the full website address including prefix (http https)
Telephone number to be posted on electionsca
Website to be posted on electionsca (including prefix http https)
Campaign office address (optional)
Unit Street Street name
City ProvinceTerritory Postal code
14
SECTION F ndash 7BElectors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
15
8BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
16
9BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
17
10BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
18
11BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
19
12BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
20
13BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
21
14BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
22
15BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
23
16BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
24
17BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
25
18BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
26
19BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
27
20BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
28
21BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
29
22BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
30
EC 20010 (022019)
SECTION G ndash 23B Are You Ready to Submit Your Nomination
Have you completed the Nomination Paper (EC 20010)
bull Are all mandatory fields in sections AndashE complete
bull Have you collected the required number of signatures from qualified electors in section F
o For most electoral districts 100 electors must consent to your candidacy
o For electoral districts identified in Schedule 3 only 50 electors are required
o To ensure a smooth nomination process Elections Canada recommends collecting signatures from at least 150 electors
Do you have authorized proof of identify
bull For a list of authorized identification visit the Elections Canada website
bull If a campaign delegate is submitting on your behalf they must bring a copy of your identification documents signed by you
bull If you want an alternative name to appear on the ballot additional documentation is required visit electionsca for details
Are you endorsed by a political party
bull Make sure your party has submitted the required documentation to Elections Canada attesting your designated political affiliation
Have you made a nomination appointment
bull To facilitate the nomination process make an appointment with the returning officer to finalize the filing of the complete nomination package
bull The nomination period closes 21 days before election day at 200 pm local time
31
- Nomination Paperof a Candidate at a Federal General Election or By-election
- Table of Contents
- General Information
- SECTION A ndash Candidate Information (Mandatory)
- SECTION B ndash Campaign Delegate (Optional)
- SECTION C ndash Official Agent (Mandatory)
- SECTION D ndash Auditor (Optional)
- SECTION E ndash Campaign Office (Optional)
- SECTION F ndash Electors Consenting to Candidacy (Mandatory)
-
- Name of electoral district
- Political affiliation
- Telephone number to be posted on electionsca
- Website to be posted on electionsca including prefix http https
- Printed name of elector1
- Full residential address street numbernamecity1
- Postal code1
- Elector signature1
- Witness initials1
- Internal use only1
- Printed name of elector2
- Full residential address street numbernamecity2
- Postal code2
- Elector signature2
- Witness initials2
- Internal use only2
- Printed name of elector3
- Full residential address street numbernamecity3
- Postal code3
- Elector signature3
- Witness initials3
- Internal use only3
- Printed name of elector4
- Full residential address street numbernamecity4
- Postal code4
- Elector signature4
- Witness initials4
- Internal use only4
- Printed name of elector5
- Full residential address street numbernamecity5
- Postal code5
- Elector signature5
- Witness initials5
- Internal use only5
- Printed name of elector6
- Full residential address street numbernamecity6
- Postal code6
- Elector signature6
- Witness initials6
- Internal use only6
- Printed name of elector7
- Full residential address street numbernamecity7
- Postal code7
- Elector signature7
- Witness initials7
- Internal use only7
- Printed name of elector8
- Full residential address street numbernamecity8
- Postal code8
- Elector signature8
- Witness initials8
- Internal use only8
- Printed name of elector9
- Full residential address street numbernamecity9
- Postal code9
- Elector signature9
- Witness initials9
- Internal use only9
- Printed name of elector10
- Full residential address street numbernamecity10
- Postal code10
- Elector signature10
- Witness initials10
- Internal use only10
- Printed name of elector1_2
- Full residential address street numbernamecity1_2
- Postal code1_2
- Elector signature1_2
- Witness initials1_2
- Internal use only1_2
- Printed name of elector2_2
- Full residential address street numbernamecity2_2
- Postal code2_2
- Elector signature2_2
- Witness initials2_2
- Internal use only2_2
- Printed name of elector3_2
- Full residential address street numbernamecity3_2
- Postal code3_2
- Elector signature3_2
- Witness initials3_2
- Internal use only3_2
- Printed name of elector4_2
- Full residential address street numbernamecity4_2
- Postal code4_2
- Elector signature4_2
- Witness initials4_2
- Internal use only4_2
- Printed name of elector5_2
- Full residential address street numbernamecity5_2
- Postal code5_2
- Elector signature5_2
- Witness initials5_2
- Internal use only5_2
- Printed name of elector6_2
- Full residential address street numbernamecity6_2
- Postal code6_2
- Elector signature6_2
- Witness initials6_2
- Internal use only6_2
- Printed name of elector7_2
- Full residential address street numbernamecity7_2
- Postal code7_2
- Elector signature7_2
- Witness initials7_2
- Internal use only7_2
- Printed name of elector8_2
- Full residential address street numbernamecity8_2
- Postal code8_2
- Elector signature8_2
- Witness initials8_2
- Internal use only8_2
- Printed name of elector9_2
- Full residential address street numbernamecity9_2
- Postal code9_2
- Elector signature9_2
- Witness initials9_2
- Internal use only9_2
- Printed name of elector10_2
- Full residential address street numbernamecity10_2
- Postal code10_2
- Elector signature10_2
- Witness initials10_2
- Internal use only10_2
- Printed name of elector1_3
- Full residential address street numbernamecity1_3
- Postal code1_3
- Elector signature1_3
- Witness initials1_3
- Internal use only1_3
- Printed name of elector2_3
- Full residential address street numbernamecity2_3
- Postal code2_3
- Elector signature2_3
- Witness initials2_3
- Internal use only2_3
- Printed name of elector3_3
- Full residential address street numbernamecity3_3
- Postal code3_3
- Elector signature3_3
- Witness initials3_3
- Internal use only3_3
- Printed name of elector4_3
- Full residential address street numbernamecity4_3
- Postal code4_3
- Elector signature4_3
- Witness initials4_3
- Internal use only4_3
- Printed name of elector5_3
- Full residential address street numbernamecity5_3
- Postal code5_3
- Elector signature5_3
- Witness initials5_3
- Internal use only5_3
- Printed name of elector6_3
- Full residential address street numbernamecity6_3
- Postal code6_3
- Elector signature6_3
- Witness initials6_3
- Internal use only6_3
- Printed name of elector7_3
- Full residential address street numbernamecity7_3
- Postal code7_3
- Elector signature7_3
- Witness initials7_3
- Internal use only7_3
- Printed name of elector8_3
- Full residential address street numbernamecity8_3
- Postal code8_3
- Elector signature8_3
- Witness initials8_3
- Internal use only8_3
- Printed name of elector9_3
- Full residential address street numbernamecity9_3
- Postal code9_3
- Elector signature9_3
- Witness initials9_3
- Internal use only9_3
- Printed name of elector10_3
- Full residential address street numbernamecity10_3
- Postal code10_3
- Elector signature10_3
- Witness initials10_3
- Internal use only10_3
- Printed name of elector1_4
- Full residential address street numbernamecity1_4
- Postal code1_4
- Elector signature1_4
- Witness initials1_4
- Internal use only1_4
- Printed name of elector2_4
- Full residential address street numbernamecity2_4
- Postal code2_4
- Elector signature2_4
- Witness initials2_4
- Internal use only2_4
- Printed name of elector3_4
- Full residential address street numbernamecity3_4
- Postal code3_4
- Elector signature3_4
- Witness initials3_4
- Internal use only3_4
- Printed name of elector4_4
- Full residential address street numbernamecity4_4
- Postal code4_4
- Elector signature4_4
- Witness initials4_4
- Internal use only4_4
- Printed name of elector5_4
- Full residential address street numbernamecity5_4
- Postal code5_4
- Elector signature5_4
- Witness initials5_4
- Internal use only5_4
- Printed name of elector6_4
- Full residential address street numbernamecity6_4
- Postal code6_4
- Elector signature6_4
- Witness initials6_4
- Internal use only6_4
- Printed name of elector7_4
- Full residential address street numbernamecity7_4
- Postal code7_4
- Elector signature7_4
- Witness initials7_4
- Internal use only7_4
- Printed name of elector8_4
- Full residential address street numbernamecity8_4
- Postal code8_4
- Elector signature8_4
- Witness initials8_4
- Internal use only8_4
- Printed name of elector9_4
- Full residential address street numbernamecity9_4
- Postal code9_4
- Elector signature9_4
- Witness initials9_4
- Internal use only9_4
- Printed name of elector10_4
- Full residential address street numbernamecity10_4
- Postal code10_4
- Elector signature10_4
- Witness initials10_4
- Internal use only10_4
- Printed name of elector1_5
- Full residential address street numbernamecity1_5
- Postal code1_5
- Elector signature1_5
- Witness initials1_5
- Internal use only1_5
- Printed name of elector2_5
- Full residential address street numbernamecity2_5
- Postal code2_5
- Elector signature2_5
- Witness initials2_5
- Internal use only2_5
- Printed name of elector3_5
- Full residential address street numbernamecity3_5
- Postal code3_5
- Elector signature3_5
- Witness initials3_5
- Internal use only3_5
- Printed name of elector4_5
- Full residential address street numbernamecity4_5
- Postal code4_5
- Elector signature4_5
- Witness initials4_5
- Internal use only4_5
- Printed name of elector5_5
- Full residential address street numbernamecity5_5
- Postal code5_5
- Elector signature5_5
- Witness initials5_5
- Internal use only5_5
- Printed name of elector6_5
- Full residential address street numbernamecity6_5
- Postal code6_5
- Elector signature6_5
- Witness initials6_5
- Internal use only6_5
- Printed name of elector7_5
- Full residential address street numbernamecity7_5
- Postal code7_5
- Elector signature7_5
- Witness initials7_5
- Internal use only7_5
- Printed name of elector8_5
- Full residential address street numbernamecity8_5
- Postal code8_5
- Elector signature8_5
- Witness initials8_5
- Internal use only8_5
- Printed name of elector9_5
- Full residential address street numbernamecity9_5
- Postal code9_5
- Elector signature9_5
- Witness initials9_5
- Internal use only9_5
- Printed name of elector10_5
- Full residential address street numbernamecity10_5
- Postal code10_5
- Elector signature10_5
- Witness initials10_5
- Internal use only10_5
- Printed name of elector1_6
- Full residential address street numbernamecity1_6
- Postal code1_6
- Elector signature1_6
- Witness initials1_6
- Internal use only1_6
- Printed name of elector2_6
- Full residential address street numbernamecity2_6
- Postal code2_6
- Elector signature2_6
- Witness initials2_6
- Internal use only2_6
- Printed name of elector3_6
- Full residential address street numbernamecity3_6
- Postal code3_6
- Elector signature3_6
- Witness initials3_6
- Internal use only3_6
- Printed name of elector4_6
- Full residential address street numbernamecity4_6
- Postal code4_6
- Elector signature4_6
- Witness initials4_6
- Internal use only4_6
- Printed name of elector5_6
- Full residential address street numbernamecity5_6
- Postal code5_6
- Elector signature5_6
- Witness initials5_6
- Internal use only5_6
- Printed name of elector6_6
- Full residential address street numbernamecity6_6
- Postal code6_6
- Elector signature6_6
- Witness initials6_6
- Internal use only6_6
- Printed name of elector7_6
- Full residential address street numbernamecity7_6
- Postal code7_6
- Elector signature7_6
- Witness initials7_6
- Internal use only7_6
- Printed name of elector8_6
- Full residential address street numbernamecity8_6
- Postal code8_6
- Elector signature8_6
- Witness initials8_6
- Internal use only8_6
- Printed name of elector9_6
- Full residential address street numbernamecity9_6
- Postal code9_6
- Elector signature9_6
- Witness initials9_6
- Internal use only9_6
- Printed name of elector10_6
- Full residential address street numbernamecity10_6
- Postal code10_6
- Elector signature10_6
- Witness initials10_6
- Internal use only10_6
- Printed name of elector1_7
- Full residential address street numbernamecity1_7
- Postal code1_7
- Elector signature1_7
- Witness initials1_7
- Internal use only1_7
- Printed name of elector2_7
- Full residential address street numbernamecity2_7
- Postal code2_7
- Elector signature2_7
- Witness initials2_7
- Internal use only2_7
- Printed name of elector3_7
- Full residential address street numbernamecity3_7
- Postal code3_7
- Elector signature3_7
- Witness initials3_7
- Internal use only3_7
- Printed name of elector4_7
- Full residential address street numbernamecity4_7
- Postal code4_7
- Elector signature4_7
- Witness initials4_7
- Internal use only4_7
- Printed name of elector5_7
- Full residential address street numbernamecity5_7
- Postal code5_7
- Elector signature5_7
- Witness initials5_7
- Internal use only5_7
- Printed name of elector6_7
- Full residential address street numbernamecity6_7
- Postal code6_7
- Elector signature6_7
- Witness initials6_7
- Internal use only6_7
- Printed name of elector7_7
- Full residential address street numbernamecity7_7
- Postal code7_7
- Elector signature7_7
- Witness initials7_7
- Internal use only7_7
- Printed name of elector8_7
- Full residential address street numbernamecity8_7
- Postal code8_7
- Elector signature8_7
- Witness initials8_7
- Internal use only8_7
- Printed name of elector9_7
- Full residential address street numbernamecity9_7
- Postal code9_7
- Elector signature9_7
- Witness initials9_7
- Internal use only9_7
- Printed name of elector10_7
- Full residential address street numbernamecity10_7
- Postal code10_7
- Elector signature10_7
- Witness initials10_7
- Internal use only10_7
- Printed name of elector1_8
- Full residential address street numbernamecity1_8
- Postal code1_8
- Elector signature1_8
- Witness initials1_8
- Internal use only1_8
- Printed name of elector2_8
- Full residential address street numbernamecity2_8
- Postal code2_8
- Elector signature2_8
- Witness initials2_8
- Internal use only2_8
- Printed name of elector3_8
- Full residential address street numbernamecity3_8
- Postal code3_8
- Elector signature3_8
- Witness initials3_8
- Internal use only3_8
- Printed name of elector4_8
- Full residential address street numbernamecity4_8
- Postal code4_8
- Elector signature4_8
- Witness initials4_8
- Internal use only4_8
- Printed name of elector5_8
- Full residential address street numbernamecity5_8
- Postal code5_8
- Elector signature5_8
- Witness initials5_8
- Internal use only5_8
- Printed name of elector6_8
- Full residential address street numbernamecity6_8
- Postal code6_8
- Elector signature6_8
- Witness initials6_8
- Internal use only6_8
- Printed name of elector7_8
- Full residential address street numbernamecity7_8
- Postal code7_8
- Elector signature7_8
- Witness initials7_8
- Internal use only7_8
- Printed name of elector8_8
- Full residential address street numbernamecity8_8
- Postal code8_8
- Elector signature8_8
- Witness initials8_8
- Internal use only8_8
- Printed name of elector9_8
- Full residential address street numbernamecity9_8
- Postal code9_8
- Elector signature9_8
- Witness initials9_8
- Internal use only9_8
- Printed name of elector10_8
- Full residential address street numbernamecity10_8
- Postal code10_8
- Elector signature10_8
- Witness initials10_8
- Internal use only10_8
- Printed name of elector1_9
- Full residential address street numbernamecity1_9
- Postal code1_9
- Elector signature1_9
- Witness initials1_9
- Internal use only1_9
- Printed name of elector2_9
- Full residential address street numbernamecity2_9
- Postal code2_9
- Elector signature2_9
- Witness initials2_9
- Internal use only2_9
- Printed name of elector3_9
- Full residential address street numbernamecity3_9
- Postal code3_9
- Elector signature3_9
- Witness initials3_9
- Internal use only3_9
- Printed name of elector4_9
- Full residential address street numbernamecity4_9
- Postal code4_9
- Elector signature4_9
- Witness initials4_9
- Internal use only4_9
- Printed name of elector5_9
- Full residential address street numbernamecity5_9
- Postal code5_9
- Elector signature5_9
- Witness initials5_9
- Internal use only5_9
- Printed name of elector6_9
- Full residential address street numbernamecity6_9
- Postal code6_9
- Elector signature6_9
- Witness initials6_9
- Internal use only6_9
- Printed name of elector7_9
- Full residential address street numbernamecity7_9
- Postal code7_9
- Elector signature7_9
- Witness initials7_9
- Internal use only7_9
- Printed name of elector8_9
- Full residential address street numbernamecity8_9
- Postal code8_9
- Elector signature8_9
- Witness initials8_9
- Internal use only8_9
- Printed name of elector9_9
- Full residential address street numbernamecity9_9
- Postal code9_9
- Elector signature9_9
- Witness initials9_9
- Internal use only9_9
- Printed name of elector10_9
- Full residential address street numbernamecity10_9
- Postal code10_9
- Elector signature10_9
- Witness initials10_9
- Internal use only10_9
- Printed name of elector1_10
- Full residential address street numbernamecity1_10
- Postal code1_10
- Elector signature1_10
- Witness initials1_10
- Internal use only1_10
- Printed name of elector2_10
- Full residential address street numbernamecity2_10
- Postal code2_10
- Elector signature2_10
- Witness initials2_10
- Internal use only2_10
- Printed name of elector3_10
- Full residential address street numbernamecity3_10
- Postal code3_10
- Elector signature3_10
- Witness initials3_10
- Internal use only3_10
- Printed name of elector4_10
- Full residential address street numbernamecity4_10
- Postal code4_10
- Elector signature4_10
- Witness initials4_10
- Internal use only4_10
- Printed name of elector5_10
- Full residential address street numbernamecity5_10
- Postal code5_10
- Elector signature5_10
- Witness initials5_10
- Internal use only5_10
- Printed name of elector6_10
- Full residential address street numbernamecity6_10
- Postal code6_10
- Elector signature6_10
- Witness initials6_10
- Internal use only6_10
- Printed name of elector7_10
- Full residential address street numbernamecity7_10
- Postal code7_10
- Elector signature7_10
- Witness initials7_10
- Internal use only7_10
- Printed name of elector8_10
- Full residential address street numbernamecity8_10
- Postal code8_10
- Elector signature8_10
- Witness initials8_10
- Internal use only8_10
- Printed name of elector9_10
- Full residential address street numbernamecity9_10
- Postal code9_10
- Elector signature9_10
- Witness initials9_10
- Internal use only9_10
- Printed name of elector10_10
- Full residential address street numbernamecity10_10
- Postal code10_10
- Elector signature10_10
- Witness initials10_10
- Internal use only10_10
- Printed name of elector1_11
- Full residential address street numbernamecity1_11
- Postal code1_11
- Elector signature1_11
- Witness initials1_11
- Internal use only1_11
- Printed name of elector2_11
- Full residential address street numbernamecity2_11
- Postal code2_11
- Elector signature2_11
- Witness initials2_11
- Internal use only2_11
- Printed name of elector3_11
- Full residential address street numbernamecity3_11
- Postal code3_11
- Elector signature3_11
- Witness initials3_11
- Internal use only3_11
- Printed name of elector4_11
- Full residential address street numbernamecity4_11
- Postal code4_11
- Elector signature4_11
- Witness initials4_11
- Internal use only4_11
- Printed name of elector5_11
- Full residential address street numbernamecity5_11
- Postal code5_11
- Elector signature5_11
- Witness initials5_11
- Internal use only5_11
- Printed name of elector6_11
- Full residential address street numbernamecity6_11
- Postal code6_11
- Elector signature6_11
- Witness initials6_11
- Internal use only6_11
- Printed name of elector7_11
- Full residential address street numbernamecity7_11
- Postal code7_11
- Elector signature7_11
- Witness initials7_11
- Internal use only7_11
- Printed name of elector8_11
- Full residential address street numbernamecity8_11
- Postal code8_11
- Elector signature8_11
- Witness initials8_11
- Internal use only8_11
- Printed name of elector9_11
- Full residential address street numbernamecity9_11
- Postal code9_11
- Elector signature9_11
- Witness initials9_11
- Internal use only9_11
- Printed name of elector10_11
- Full residential address street numbernamecity10_11
- Postal code10_11
- Elector signature10_11
- Witness initials10_11
- Internal use only10_11
- Printed name of elector1_12
- Full residential address street numbernamecity1_12
- Postal code1_12
- Elector signature1_12
- Witness initials1_12
- Internal use only1_12
- Printed name of elector2_12
- Full residential address street numbernamecity2_12
- Postal code2_12
- Elector signature2_12
- Witness initials2_12
- Internal use only2_12
- Printed name of elector3_12
- Full residential address street numbernamecity3_12
- Postal code3_12
- Elector signature3_12
- Witness initials3_12
- Internal use only3_12
- Printed name of elector4_12
- Full residential address street numbernamecity4_12
- Postal code4_12
- Elector signature4_12
- Witness initials4_12
- Internal use only4_12
- Printed name of elector5_12
- Full residential address street numbernamecity5_12
- Postal code5_12
- Elector signature5_12
- Witness initials5_12
- Internal use only5_12
- Printed name of elector6_12
- Full residential address street numbernamecity6_12
- Postal code6_12
- Elector signature6_12
- Witness initials6_12
- Internal use only6_12
- Printed name of elector7_12
- Full residential address street numbernamecity7_12
- Postal code7_12
- Elector signature7_12
- Witness initials7_12
- Internal use only7_12
- Printed name of elector8_12
- Full residential address street numbernamecity8_12
- Postal code8_12
- Elector signature8_12
- Witness initials8_12
- Internal use only8_12
- Printed name of elector9_12
- Full residential address street numbernamecity9_12
- Postal code9_12
- Elector signature9_12
- Witness initials9_12
- Internal use only9_12
- Printed name of elector10_12
- Full residential address street numbernamecity10_12
- Postal code10_12
- Elector signature10_12
- Witness initials10_12
- Internal use only10_12
- Printed name of elector1_13
- Full residential address street numbernamecity1_13
- Postal code1_13
- Elector signature1_13
- Witness initials1_13
- Internal use only1_13
- Printed name of elector2_13
- Full residential address street numbernamecity2_13
- Postal code2_13
- Elector signature2_13
- Witness initials2_13
- Internal use only2_13
- Printed name of elector3_13
- Full residential address street numbernamecity3_13
- Postal code3_13
- Elector signature3_13
- Witness initials3_13
- Internal use only3_13
- Printed name of elector4_13
- Full residential address street numbernamecity4_13
- Postal code4_13
- Elector signature4_13
- Witness initials4_13
- Internal use only4_13
- Printed name of elector5_13
- Full residential address street numbernamecity5_13
- Postal code5_13
- Elector signature5_13
- Witness initials5_13
- Internal use only5_13
- Printed name of elector6_13
- Full residential address street numbernamecity6_13
- Postal code6_13
- Elector signature6_13
- Witness initials6_13
- Internal use only6_13
- Printed name of elector7_13
- Full residential address street numbernamecity7_13
- Postal code7_13
- Elector signature7_13
- Witness initials7_13
- Internal use only7_13
- Printed name of elector8_13
- Full residential address street numbernamecity8_13
- Postal code8_13
- Elector signature8_13
- Witness initials8_13
- Internal use only8_13
- Printed name of elector9_13
- Full residential address street numbernamecity9_13
- Postal code9_13
- Elector signature9_13
- Witness initials9_13
- Internal use only9_13
- Printed name of elector10_13
- Full residential address street numbernamecity10_13
- Postal code10_13
- Elector signature10_13
- Witness initials10_13
- Internal use only10_13
- Printed name of elector1_14
- Full residential address street numbernamecity1_14
- Postal code1_14
- Elector signature1_14
- Witness initials1_14
- Internal use only1_14
- Printed name of elector2_14
- Full residential address street numbernamecity2_14
- Postal code2_14
- Elector signature2_14
- Witness initials2_14
- Internal use only2_14
- Printed name of elector3_14
- Full residential address street numbernamecity3_14
- Postal code3_14
- Elector signature3_14
- Witness initials3_14
- Internal use only3_14
- Printed name of elector4_14
- Full residential address street numbernamecity4_14
- Postal code4_14
- Elector signature4_14
- Witness initials4_14
- Internal use only4_14
- Printed name of elector5_14
- Full residential address street numbernamecity5_14
- Postal code5_14
- Elector signature5_14
- Witness initials5_14
- Internal use only5_14
- Printed name of elector6_14
- Full residential address street numbernamecity6_14
- Postal code6_14
- Elector signature6_14
- Witness initials6_14
- Internal use only6_14
- Printed name of elector7_14
- Full residential address street numbernamecity7_14
- Postal code7_14
- Elector signature7_14
- Witness initials7_14
- Internal use only7_14
- Printed name of elector8_14
- Full residential address street numbernamecity8_14
- Postal code8_14
- Elector signature8_14
- Witness initials8_14
- Internal use only8_14
- Printed name of elector9_14
- Full residential address street numbernamecity9_14
- Postal code9_14
- Elector signature9_14
- Witness initials9_14
- Internal use only9_14
- Printed name of elector10_14
- Full residential address street numbernamecity10_14
- Postal code10_14
- Elector signature10_14
- Witness initials10_14
- Internal use only10_14
- Printed name of elector1_15
- Full residential address street numbernamecity1_15
- Postal code1_15
- Elector signature1_15
- Witness initials1_15
- Internal use only1_15
- Printed name of elector2_15
- Full residential address street numbernamecity2_15
- Postal code2_15
- Elector signature2_15
- Witness initials2_15
- Internal use only2_15
- Printed name of elector3_15
- Full residential address street numbernamecity3_15
- Postal code3_15
- Elector signature3_15
- Witness initials3_15
- Internal use only3_15
- Printed name of elector4_15
- Full residential address street numbernamecity4_15
- Postal code4_15
- Elector signature4_15
- Witness initials4_15
- Internal use only4_15
- Printed name of elector5_15
- Full residential address street numbernamecity5_15
- Postal code5_15
- Elector signature5_15
- Witness initials5_15
- Internal use only5_15
- Printed name of elector6_15
- Full residential address street numbernamecity6_15
- Postal code6_15
- Elector signature6_15
- Witness initials6_15
- Internal use only6_15
- Printed name of elector7_15
- Full residential address street numbernamecity7_15
- Postal code7_15
- Elector signature7_15
- Witness initials7_15
- Internal use only7_15
- Printed name of elector8_15
- Full residential address street numbernamecity8_15
- Postal code8_15
- Elector signature8_15
- Witness initials8_15
- Internal use only8_15
- Printed name of elector9_15
- Full residential address street numbernamecity9_15
- Postal code9_15
- Elector signature9_15
- Witness initials9_15
- Internal use only9_15
- Printed name of elector10_15
- Full residential address street numbernamecity10_15
- Postal code10_15
- Elector signature10_15
- Witness initials10_15
- Internal use only10_15
- Printed name of elector1_16
- Full residential address street numbernamecity1_16
- Postal code1_16
- Elector signature1_16
- Witness initials1_16
- Internal use only1_16
- Printed name of elector2_16
- Full residential address street numbernamecity2_16
- Postal code2_16
- Elector signature2_16
- Witness initials2_16
- Internal use only2_16
- Printed name of elector3_16
- Full residential address street numbernamecity3_16
- Postal code3_16
- Elector signature3_16
- Witness initials3_16
- Internal use only3_16
- Printed name of elector4_16
- Full residential address street numbernamecity4_16
- Postal code4_16
- Elector signature4_16
- Witness initials4_16
- Internal use only4_16
- Printed name of elector5_16
- Full residential address street numbernamecity5_16
- Postal code5_16
- Elector signature5_16
- Witness initials5_16
- Internal use only5_16
- Printed name of elector6_16
- Full residential address street numbernamecity6_16
- Postal code6_16
- Elector signature6_16
- Witness initials6_16
- Internal use only6_16
- Printed name of elector7_16
- Full residential address street numbernamecity7_16
- Postal code7_16
- Elector signature7_16
- Witness initials7_16
- Internal use only7_16
- Printed name of elector8_16
- Full residential address street numbernamecity8_16
- Postal code8_16
- Elector signature8_16
- Witness initials8_16
- Internal use only8_16
- Printed name of elector9_16
- Full residential address street numbernamecity9_16
- Postal code9_16
- Elector signature9_16
- Witness initials9_16
- Internal use only9_16
- Printed name of elector10_16
- Full residential address street numbernamecity10_16
- Postal code10_16
- Elector signature10_16
- Witness initials10_16
- Internal use only10_16
- Have you completed the Nomination Paper EC 20010 Off
- Do you have authorized proof of identify Off
- Are you endorsed by a political party Off
- Have you made a nomination appointment Off
- Last name - Candidate Name
- First name - Candidate Name
- Name of electoral district- Candidate Information
- First name - Candidate Information
- Last name - Candidate Information
- Ballot Name Off
- Ballot First name(s)
- Ballot Last name(s)
- Gender -Candidate information
- Date of birth (YYY-MM-DD) - Gender -Candidate information
- language of correspondence - Candidate information Off
- Email -Contact information
- Primary phone number - Contact information
- Ext - Primary phone number
- Alternate phone number - Contact information
- Ext - Alternate phone number
- Fax number- Alternate phone number
- Unit -Residential address
- Street -Residential address
- Street name -Residential address
- City -Residential address
- ProvinceTerritory -Residential address
- Postal code - -Residential address
- Mailing address - same as residential address Off
- Occupation- Candidate occupation
- Sharing of information with the Conflict of Interest and Ethics Commissioner and the House of Commons including the Library of Parliament Off
- where applicable if the returning officer is unable to verify that I have been endorsed by the political party identified in section A of this Nomination Paper I wish to Off
- Date of Signature (YYYY-MM-DD) - Candidate signature
- Date of Signature (YYYY-MM-DD) -Signature of person receiving the solemn declaration
- Campaign delegate information
- First name - Campaign delegate information
- Last name - Campaign delegate information
- Language of correspondence - Campaign delegate information Off
- Email - Contact information -Campaign Delegate
- Primary phone number - Contact information -Campaign Delegate
- Primary phone number EXT - Contact information -Campaign Delegate
- Alternate phone number - Contact information -Campaign Delegate
- Alternate phone number EXT - Contact information -Campaign Delegate
- Fax nmuber- Contact information -Campaign Delegate
- Street - Residential address -Campaign delegate
- Street name - Residential address -Campaign delegate
- City - Residential address -Campaign delegate
- ProvinceTerritory - Residential address -Campaign delegate
- Postal Code - Residential address -Campaign delegate
- Campaign delegate - Mailing address ndash Same as residential address Off
- Unit - Residential address -Campaign delegate
- Date (YYYY-MM-DD) - Candidate authorization Signature
- Date (YYYY-MM-DD) - Candidate campaign Signature
- First name - Official agent information
- Last name - Official agent information
- Language of correspondence - Official agent information Off
- Email - Official agent information
- Primary phone number - Official agent information
- Primary phone number EXT - Official agent information
- Alternate phone number EXT - Official agent information
- Alternate phone number - Official agent information
- Fax number - Official agent information
- Unit -Residential address - Official Agent
- Street name -Residential address - Official Agent
- City -Residential address - Official Agent
- Street -Residential address - Official Agent
- ProvinceTerritory -Residential address - Official Agent
- Postal code-Residential address - Official Agent
- Mailing address ndash Same as residential address- Official Agent Off
- Date (YYYY-MM-DD) - Official agent signature
- First name - Auditor information
- Last name - Auditor information
- Language of correspondence - Auditor information Off
- Email - Auditor information
- Primary phone number - Auditor information
- Primary phone number EXT- Auditor information
- Alternate phone number - Auditor information
- Alternate phone number EXT- Auditor information
- Fax number - Auditor information
- Name of firm- Auditor organizational information
- Occupation of auditor - Auditor organizational information
- Professional designation - Auditor organizational information Off
- Designation registration number
- Make cheque payable to
- Unit - Address (where cheque is sent)
- Street - Address (where cheque is sent)
- Street name - Address (where cheque is sent)
- City - Address (where cheque is sent)
- ProvinceTerritory - Address (where cheque is sent)
- Postal code - Address (where cheque is sent)
- Date (YYY-MM-DD) - Auditor signature
- Unit - Campaign office address (optional)
- Street - Campaign office address (optional)
- Street name - Campaign office address (optional)
- City - Campaign office address (optional)
- ProvinceTerritory- Campaign office address (optional)
- Postal code - Campaign office address (optional)
- Name of witness
- Full address of witness
- Name of candidate
- Electoral district
- Year
- Name of candidate2
- Electoral district2
- Year2
- Name of witness2
- Full address of witness2
- Name of candidate3
- Electoral district3
- Year3
- Full address of witness3
- Name of witness3
- Name of candidate 4
- Electoral district4
- Year4
- Full address of witness 4
- Name of witness 4
- Name of candidate5
- Electoral district5
- Year5
- Full address of witness5
- Name of witness5
- Name of candidate6
- Electoral district6
- Year6
- Name of witness6
- Full address of witness6
- Name of candidate7
- Electoral district7
- Year7
- Full address of witness7
- Name of witness7
- Name of candidate8
- Electoral district8
- Year8
- Full address of witness8
- Name of witness8
- Name of candidate9
- Electoral district9
- Year9
- Full address of witness 9
- Name of witness 9
- Name of candidate10
- Electoral district10
- Year10
- Full address of witness10
- Name of witness10
- Name of candidate11
- Electoral district11
- Year11
- Full address of witness11
- Name of witness11
- Name of candidate12
- Electoral district12
- Year12
- Full address of witness12
- Name of witness12
- Name of candidate13
- Electoral district13
- Year13
- Full address of witness13
- Name of witness13
- Name of candidate14
- Electoral district14
- Year14
- Name of witness14
- Full address of witness14
- Name of candidate1
- Electoral district1
- Year1
- Name of witness1
- Full address of witness1
- Name of candidate15
- Electoral district15
- Year15
- Name of witness15
- Full address of witness15
- unit -Mailing address
- Street -Mailing address
- Street name -Mailing address
- City -Mailing address
- ProvinceTerritory -Mailing address
- Postal code -Mailing address
- Unit - Mailing address -Campaign delegate
- Street - Mailing address -Campaign delegate
- Street name - Mailing address -Campaign delegate
- City - Mailing address -Campaign delegate
- ProvinceTerritory- Mailing address -Campaign delegate
- Postal code- Mailing address -Campaign delegate
- Unit -Mailing address - Official Agent
- Street -Mailing address - Official Agent
- Street name -Mailing address - Official Agent
- city -Mailing address - Official Agent
- ProvinceTerritory-Mailing address - Official Agent
- Postal code-Mailing address - Official Agent
ndash
EC 20010 (052019)
SECTION B ndash 3BCampaign Delegate (Optional)
If appointing a campaign delegate all fields marked with are mandatory
Campaign delegate information
A candidate may authorize another individual (referred to in the Nomination Paper as the campaign delegate) to act on their behalf during the election The campaign delegate can submit the Nomination Paper and all associated supporting documents CEA 67(7) Note The campaign delegate does not have access to the candidatersquos financial returns
First name Last name Language of correspondence
English French
Contact information
Upon confirmation of the nomination Elections Canada will send to the email address listed below an invitation to the Political Entities Service Centre (PESC) online portal
Primary phone number Ext Alternate phone number Ext Fax number
Residential address
Unit Street Street name
City ProvinceTerritory Postal code
Mailing address Same as residential address
Unit Street Street name
City ProvinceTerritory Postal code
8
EC 20010 (052019)
SECTION B ndash Campaign Delegate ndash Privacy Notice and Declaration (Optional)
If appointing a campaign delegate all fields marked with are mandatory
Privacy notice
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA) Any person at the returning office may examine the completed Nomination Paper during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
Candidate authorization of the campaign delegate
As per subsection 66(1)(h) of the Canada Elections Act I authorize the individual identified in this section to act as my campaign delegate
Candidate signature Date (YYYY-MM-DD)
Candidate campaign delegate signature
I the undersigned candidate campaign delegate for the candidate named in this Nomination Paper state that
1 I hereby agree to act as the authorized person for the candidate named herein for the purposes of theCanada Elections Act
2 I am fully aware of the duties and responsibilities imposed on me by the Canada Elections Act
Campaign delegate signature Date (YYYY-MM-DD)
9
ndash
EC 20010 (052019)
SECTION C ndash 4BOfficial Agent (Mandatory)
All fields marked with are mandatory
Official agent information
The official agent is responsible for administering the campaignrsquos financial transactions and reporting those transactions to Elections Canada as required by the CEA For more information consult the Political Financing Handbook for Candidates and Official Agents Note The candidate official agent and auditor must all be different people
First name Last name Language of correspondence
English French
Contact information
Upon confirmation of the nomination Elections Canada will send to the email address listed below an invitation to the Political Entities Service Centre (PESC) online portal
Primary phone number Ext Alternate phone number Ext Fax number
Residential address Unit Street Street name
City ProvinceTerritory Postal code
Mailing address Same as residential address
Unit Street Street name
City ProvinceTerritory Postal code
10
EC 20010 (052019)
24BSECTION C ndash Official Agent ndash Privacy Notice and Declaration (Mandatory)
All fields marked with are mandatory
Privacy notice
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA) Any person at the returning office may examine the completed Nomination Paper during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
Official agent signature
I the undersigned official agent for the candidate named in this Nomination Paper hereby agree to act as official agent for the candidate named herein for the purposes of the Canada Elections Act I further state that
1 I am fully aware of the duties and responsibilities imposed on me by the Canada Elections Act
2 I am capable of entering into contracts in the provinceterritory in which this electoral district is located
3 I am eligible to act as official agent pursuant to section 4772 of the Canada Elections Act
Section 4772 of the Canada Elections Act states The following persons are ineligible to be an official agenta candidate an election officer or a member of the staff of a returning office an undischarged bankrupt anauditor appointed as required by this Act a person who is not qualified as an elector and a person who doesnot have the capacity to enter into contracts in the province in which they ordinarily reside
Official agent signature Date (YYYY-MM-DD)
11
EC 20010 (052019)
SECTION D ndash 5B Auditor (Optional)
If appointing an auditor all fields marked with are mandatory
Auditor information An auditor must be appointed if bull the candidatersquos campaign accepts contributions of $10000 or more bull the candidatersquos campaign incurs expenses of $10000 or more or bull the candidate receives 10 or more of votes cast in the electoral district If at the time of filing the Nomination Paper none of the above applies you do not need to appoint an auditor though you may still choose to do so If the above requirements are later met you must appoint an auditor without delay A person or partnership who wants to act as a candidatersquos auditor must be or have every partner be recognized as a professional accountant under provincial or territorial legislation CEA 4773(1) For more information consult the Political Financing Handbook for Candidates and Official Agents
First name Last name Language of correspondence
English French
Contact information Upon confirmation of the nomination Elections Canada will send to the email address listed below an invitation to the Political Entities Service Centre (PESC) online portal
Primary phone number Ext Alternate phone number Ext Fax number
Auditor organizational information Name of firm Occupation of auditor Professional designation
CPA FCPA
Designation registration number Make cheque payable to
Address (where cheque is sent) Unit Street Street name
City ProvinceTerritory Postal code
12
EC 20010 (052019)
SECTION D ndash Auditor ndash Privacy Notice and Declaration (Optional)
If appointing an auditor all fields marked with are mandatory
Privacy notice
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA) Any person at the returning office may examine the completed Nomination Paper during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information
Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
Auditor signature
I the undersigned hereby agree to act as the auditor for the candidate named in this Nomination Paper I further state that I am aware of the duties and responsibilities of this position under the Canada Elections Act and I am qualified to act as auditor under subsection 4773(1) and (2) of the Canada Elections Act
Auditor signature Date (YYYY-MM-DD)
13
EC 20010 (052019)
SECTION E ndash 6BCampaign Office (Optional)
Contact information to be made available on the Elections Canada website (optional)
Please note You may provide a telephone number andor a link to your website or social media platform of choice when filing your Nomination Paper with Elections Canada You do not have to provide this information but it is intended to help electors access campaign information Elections Canada may provide this information as part of the Voter Information Service Please include the full website address including prefix (http https)
Telephone number to be posted on electionsca
Website to be posted on electionsca (including prefix http https)
Campaign office address (optional)
Unit Street Street name
City ProvinceTerritory Postal code
14
SECTION F ndash 7BElectors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
15
8BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
16
9BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
17
10BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
18
11BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
19
12BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
20
13BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
21
14BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
22
15BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
23
16BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
24
17BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
25
18BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
26
19BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
27
20BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
28
21BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
29
22BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
30
EC 20010 (022019)
SECTION G ndash 23B Are You Ready to Submit Your Nomination
Have you completed the Nomination Paper (EC 20010)
bull Are all mandatory fields in sections AndashE complete
bull Have you collected the required number of signatures from qualified electors in section F
o For most electoral districts 100 electors must consent to your candidacy
o For electoral districts identified in Schedule 3 only 50 electors are required
o To ensure a smooth nomination process Elections Canada recommends collecting signatures from at least 150 electors
Do you have authorized proof of identify
bull For a list of authorized identification visit the Elections Canada website
bull If a campaign delegate is submitting on your behalf they must bring a copy of your identification documents signed by you
bull If you want an alternative name to appear on the ballot additional documentation is required visit electionsca for details
Are you endorsed by a political party
bull Make sure your party has submitted the required documentation to Elections Canada attesting your designated political affiliation
Have you made a nomination appointment
bull To facilitate the nomination process make an appointment with the returning officer to finalize the filing of the complete nomination package
bull The nomination period closes 21 days before election day at 200 pm local time
31
- Nomination Paperof a Candidate at a Federal General Election or By-election
- Table of Contents
- General Information
- SECTION A ndash Candidate Information (Mandatory)
- SECTION B ndash Campaign Delegate (Optional)
- SECTION C ndash Official Agent (Mandatory)
- SECTION D ndash Auditor (Optional)
- SECTION E ndash Campaign Office (Optional)
- SECTION F ndash Electors Consenting to Candidacy (Mandatory)
-
- Name of electoral district
- Political affiliation
- Telephone number to be posted on electionsca
- Website to be posted on electionsca including prefix http https
- Printed name of elector1
- Full residential address street numbernamecity1
- Postal code1
- Elector signature1
- Witness initials1
- Internal use only1
- Printed name of elector2
- Full residential address street numbernamecity2
- Postal code2
- Elector signature2
- Witness initials2
- Internal use only2
- Printed name of elector3
- Full residential address street numbernamecity3
- Postal code3
- Elector signature3
- Witness initials3
- Internal use only3
- Printed name of elector4
- Full residential address street numbernamecity4
- Postal code4
- Elector signature4
- Witness initials4
- Internal use only4
- Printed name of elector5
- Full residential address street numbernamecity5
- Postal code5
- Elector signature5
- Witness initials5
- Internal use only5
- Printed name of elector6
- Full residential address street numbernamecity6
- Postal code6
- Elector signature6
- Witness initials6
- Internal use only6
- Printed name of elector7
- Full residential address street numbernamecity7
- Postal code7
- Elector signature7
- Witness initials7
- Internal use only7
- Printed name of elector8
- Full residential address street numbernamecity8
- Postal code8
- Elector signature8
- Witness initials8
- Internal use only8
- Printed name of elector9
- Full residential address street numbernamecity9
- Postal code9
- Elector signature9
- Witness initials9
- Internal use only9
- Printed name of elector10
- Full residential address street numbernamecity10
- Postal code10
- Elector signature10
- Witness initials10
- Internal use only10
- Printed name of elector1_2
- Full residential address street numbernamecity1_2
- Postal code1_2
- Elector signature1_2
- Witness initials1_2
- Internal use only1_2
- Printed name of elector2_2
- Full residential address street numbernamecity2_2
- Postal code2_2
- Elector signature2_2
- Witness initials2_2
- Internal use only2_2
- Printed name of elector3_2
- Full residential address street numbernamecity3_2
- Postal code3_2
- Elector signature3_2
- Witness initials3_2
- Internal use only3_2
- Printed name of elector4_2
- Full residential address street numbernamecity4_2
- Postal code4_2
- Elector signature4_2
- Witness initials4_2
- Internal use only4_2
- Printed name of elector5_2
- Full residential address street numbernamecity5_2
- Postal code5_2
- Elector signature5_2
- Witness initials5_2
- Internal use only5_2
- Printed name of elector6_2
- Full residential address street numbernamecity6_2
- Postal code6_2
- Elector signature6_2
- Witness initials6_2
- Internal use only6_2
- Printed name of elector7_2
- Full residential address street numbernamecity7_2
- Postal code7_2
- Elector signature7_2
- Witness initials7_2
- Internal use only7_2
- Printed name of elector8_2
- Full residential address street numbernamecity8_2
- Postal code8_2
- Elector signature8_2
- Witness initials8_2
- Internal use only8_2
- Printed name of elector9_2
- Full residential address street numbernamecity9_2
- Postal code9_2
- Elector signature9_2
- Witness initials9_2
- Internal use only9_2
- Printed name of elector10_2
- Full residential address street numbernamecity10_2
- Postal code10_2
- Elector signature10_2
- Witness initials10_2
- Internal use only10_2
- Printed name of elector1_3
- Full residential address street numbernamecity1_3
- Postal code1_3
- Elector signature1_3
- Witness initials1_3
- Internal use only1_3
- Printed name of elector2_3
- Full residential address street numbernamecity2_3
- Postal code2_3
- Elector signature2_3
- Witness initials2_3
- Internal use only2_3
- Printed name of elector3_3
- Full residential address street numbernamecity3_3
- Postal code3_3
- Elector signature3_3
- Witness initials3_3
- Internal use only3_3
- Printed name of elector4_3
- Full residential address street numbernamecity4_3
- Postal code4_3
- Elector signature4_3
- Witness initials4_3
- Internal use only4_3
- Printed name of elector5_3
- Full residential address street numbernamecity5_3
- Postal code5_3
- Elector signature5_3
- Witness initials5_3
- Internal use only5_3
- Printed name of elector6_3
- Full residential address street numbernamecity6_3
- Postal code6_3
- Elector signature6_3
- Witness initials6_3
- Internal use only6_3
- Printed name of elector7_3
- Full residential address street numbernamecity7_3
- Postal code7_3
- Elector signature7_3
- Witness initials7_3
- Internal use only7_3
- Printed name of elector8_3
- Full residential address street numbernamecity8_3
- Postal code8_3
- Elector signature8_3
- Witness initials8_3
- Internal use only8_3
- Printed name of elector9_3
- Full residential address street numbernamecity9_3
- Postal code9_3
- Elector signature9_3
- Witness initials9_3
- Internal use only9_3
- Printed name of elector10_3
- Full residential address street numbernamecity10_3
- Postal code10_3
- Elector signature10_3
- Witness initials10_3
- Internal use only10_3
- Printed name of elector1_4
- Full residential address street numbernamecity1_4
- Postal code1_4
- Elector signature1_4
- Witness initials1_4
- Internal use only1_4
- Printed name of elector2_4
- Full residential address street numbernamecity2_4
- Postal code2_4
- Elector signature2_4
- Witness initials2_4
- Internal use only2_4
- Printed name of elector3_4
- Full residential address street numbernamecity3_4
- Postal code3_4
- Elector signature3_4
- Witness initials3_4
- Internal use only3_4
- Printed name of elector4_4
- Full residential address street numbernamecity4_4
- Postal code4_4
- Elector signature4_4
- Witness initials4_4
- Internal use only4_4
- Printed name of elector5_4
- Full residential address street numbernamecity5_4
- Postal code5_4
- Elector signature5_4
- Witness initials5_4
- Internal use only5_4
- Printed name of elector6_4
- Full residential address street numbernamecity6_4
- Postal code6_4
- Elector signature6_4
- Witness initials6_4
- Internal use only6_4
- Printed name of elector7_4
- Full residential address street numbernamecity7_4
- Postal code7_4
- Elector signature7_4
- Witness initials7_4
- Internal use only7_4
- Printed name of elector8_4
- Full residential address street numbernamecity8_4
- Postal code8_4
- Elector signature8_4
- Witness initials8_4
- Internal use only8_4
- Printed name of elector9_4
- Full residential address street numbernamecity9_4
- Postal code9_4
- Elector signature9_4
- Witness initials9_4
- Internal use only9_4
- Printed name of elector10_4
- Full residential address street numbernamecity10_4
- Postal code10_4
- Elector signature10_4
- Witness initials10_4
- Internal use only10_4
- Printed name of elector1_5
- Full residential address street numbernamecity1_5
- Postal code1_5
- Elector signature1_5
- Witness initials1_5
- Internal use only1_5
- Printed name of elector2_5
- Full residential address street numbernamecity2_5
- Postal code2_5
- Elector signature2_5
- Witness initials2_5
- Internal use only2_5
- Printed name of elector3_5
- Full residential address street numbernamecity3_5
- Postal code3_5
- Elector signature3_5
- Witness initials3_5
- Internal use only3_5
- Printed name of elector4_5
- Full residential address street numbernamecity4_5
- Postal code4_5
- Elector signature4_5
- Witness initials4_5
- Internal use only4_5
- Printed name of elector5_5
- Full residential address street numbernamecity5_5
- Postal code5_5
- Elector signature5_5
- Witness initials5_5
- Internal use only5_5
- Printed name of elector6_5
- Full residential address street numbernamecity6_5
- Postal code6_5
- Elector signature6_5
- Witness initials6_5
- Internal use only6_5
- Printed name of elector7_5
- Full residential address street numbernamecity7_5
- Postal code7_5
- Elector signature7_5
- Witness initials7_5
- Internal use only7_5
- Printed name of elector8_5
- Full residential address street numbernamecity8_5
- Postal code8_5
- Elector signature8_5
- Witness initials8_5
- Internal use only8_5
- Printed name of elector9_5
- Full residential address street numbernamecity9_5
- Postal code9_5
- Elector signature9_5
- Witness initials9_5
- Internal use only9_5
- Printed name of elector10_5
- Full residential address street numbernamecity10_5
- Postal code10_5
- Elector signature10_5
- Witness initials10_5
- Internal use only10_5
- Printed name of elector1_6
- Full residential address street numbernamecity1_6
- Postal code1_6
- Elector signature1_6
- Witness initials1_6
- Internal use only1_6
- Printed name of elector2_6
- Full residential address street numbernamecity2_6
- Postal code2_6
- Elector signature2_6
- Witness initials2_6
- Internal use only2_6
- Printed name of elector3_6
- Full residential address street numbernamecity3_6
- Postal code3_6
- Elector signature3_6
- Witness initials3_6
- Internal use only3_6
- Printed name of elector4_6
- Full residential address street numbernamecity4_6
- Postal code4_6
- Elector signature4_6
- Witness initials4_6
- Internal use only4_6
- Printed name of elector5_6
- Full residential address street numbernamecity5_6
- Postal code5_6
- Elector signature5_6
- Witness initials5_6
- Internal use only5_6
- Printed name of elector6_6
- Full residential address street numbernamecity6_6
- Postal code6_6
- Elector signature6_6
- Witness initials6_6
- Internal use only6_6
- Printed name of elector7_6
- Full residential address street numbernamecity7_6
- Postal code7_6
- Elector signature7_6
- Witness initials7_6
- Internal use only7_6
- Printed name of elector8_6
- Full residential address street numbernamecity8_6
- Postal code8_6
- Elector signature8_6
- Witness initials8_6
- Internal use only8_6
- Printed name of elector9_6
- Full residential address street numbernamecity9_6
- Postal code9_6
- Elector signature9_6
- Witness initials9_6
- Internal use only9_6
- Printed name of elector10_6
- Full residential address street numbernamecity10_6
- Postal code10_6
- Elector signature10_6
- Witness initials10_6
- Internal use only10_6
- Printed name of elector1_7
- Full residential address street numbernamecity1_7
- Postal code1_7
- Elector signature1_7
- Witness initials1_7
- Internal use only1_7
- Printed name of elector2_7
- Full residential address street numbernamecity2_7
- Postal code2_7
- Elector signature2_7
- Witness initials2_7
- Internal use only2_7
- Printed name of elector3_7
- Full residential address street numbernamecity3_7
- Postal code3_7
- Elector signature3_7
- Witness initials3_7
- Internal use only3_7
- Printed name of elector4_7
- Full residential address street numbernamecity4_7
- Postal code4_7
- Elector signature4_7
- Witness initials4_7
- Internal use only4_7
- Printed name of elector5_7
- Full residential address street numbernamecity5_7
- Postal code5_7
- Elector signature5_7
- Witness initials5_7
- Internal use only5_7
- Printed name of elector6_7
- Full residential address street numbernamecity6_7
- Postal code6_7
- Elector signature6_7
- Witness initials6_7
- Internal use only6_7
- Printed name of elector7_7
- Full residential address street numbernamecity7_7
- Postal code7_7
- Elector signature7_7
- Witness initials7_7
- Internal use only7_7
- Printed name of elector8_7
- Full residential address street numbernamecity8_7
- Postal code8_7
- Elector signature8_7
- Witness initials8_7
- Internal use only8_7
- Printed name of elector9_7
- Full residential address street numbernamecity9_7
- Postal code9_7
- Elector signature9_7
- Witness initials9_7
- Internal use only9_7
- Printed name of elector10_7
- Full residential address street numbernamecity10_7
- Postal code10_7
- Elector signature10_7
- Witness initials10_7
- Internal use only10_7
- Printed name of elector1_8
- Full residential address street numbernamecity1_8
- Postal code1_8
- Elector signature1_8
- Witness initials1_8
- Internal use only1_8
- Printed name of elector2_8
- Full residential address street numbernamecity2_8
- Postal code2_8
- Elector signature2_8
- Witness initials2_8
- Internal use only2_8
- Printed name of elector3_8
- Full residential address street numbernamecity3_8
- Postal code3_8
- Elector signature3_8
- Witness initials3_8
- Internal use only3_8
- Printed name of elector4_8
- Full residential address street numbernamecity4_8
- Postal code4_8
- Elector signature4_8
- Witness initials4_8
- Internal use only4_8
- Printed name of elector5_8
- Full residential address street numbernamecity5_8
- Postal code5_8
- Elector signature5_8
- Witness initials5_8
- Internal use only5_8
- Printed name of elector6_8
- Full residential address street numbernamecity6_8
- Postal code6_8
- Elector signature6_8
- Witness initials6_8
- Internal use only6_8
- Printed name of elector7_8
- Full residential address street numbernamecity7_8
- Postal code7_8
- Elector signature7_8
- Witness initials7_8
- Internal use only7_8
- Printed name of elector8_8
- Full residential address street numbernamecity8_8
- Postal code8_8
- Elector signature8_8
- Witness initials8_8
- Internal use only8_8
- Printed name of elector9_8
- Full residential address street numbernamecity9_8
- Postal code9_8
- Elector signature9_8
- Witness initials9_8
- Internal use only9_8
- Printed name of elector10_8
- Full residential address street numbernamecity10_8
- Postal code10_8
- Elector signature10_8
- Witness initials10_8
- Internal use only10_8
- Printed name of elector1_9
- Full residential address street numbernamecity1_9
- Postal code1_9
- Elector signature1_9
- Witness initials1_9
- Internal use only1_9
- Printed name of elector2_9
- Full residential address street numbernamecity2_9
- Postal code2_9
- Elector signature2_9
- Witness initials2_9
- Internal use only2_9
- Printed name of elector3_9
- Full residential address street numbernamecity3_9
- Postal code3_9
- Elector signature3_9
- Witness initials3_9
- Internal use only3_9
- Printed name of elector4_9
- Full residential address street numbernamecity4_9
- Postal code4_9
- Elector signature4_9
- Witness initials4_9
- Internal use only4_9
- Printed name of elector5_9
- Full residential address street numbernamecity5_9
- Postal code5_9
- Elector signature5_9
- Witness initials5_9
- Internal use only5_9
- Printed name of elector6_9
- Full residential address street numbernamecity6_9
- Postal code6_9
- Elector signature6_9
- Witness initials6_9
- Internal use only6_9
- Printed name of elector7_9
- Full residential address street numbernamecity7_9
- Postal code7_9
- Elector signature7_9
- Witness initials7_9
- Internal use only7_9
- Printed name of elector8_9
- Full residential address street numbernamecity8_9
- Postal code8_9
- Elector signature8_9
- Witness initials8_9
- Internal use only8_9
- Printed name of elector9_9
- Full residential address street numbernamecity9_9
- Postal code9_9
- Elector signature9_9
- Witness initials9_9
- Internal use only9_9
- Printed name of elector10_9
- Full residential address street numbernamecity10_9
- Postal code10_9
- Elector signature10_9
- Witness initials10_9
- Internal use only10_9
- Printed name of elector1_10
- Full residential address street numbernamecity1_10
- Postal code1_10
- Elector signature1_10
- Witness initials1_10
- Internal use only1_10
- Printed name of elector2_10
- Full residential address street numbernamecity2_10
- Postal code2_10
- Elector signature2_10
- Witness initials2_10
- Internal use only2_10
- Printed name of elector3_10
- Full residential address street numbernamecity3_10
- Postal code3_10
- Elector signature3_10
- Witness initials3_10
- Internal use only3_10
- Printed name of elector4_10
- Full residential address street numbernamecity4_10
- Postal code4_10
- Elector signature4_10
- Witness initials4_10
- Internal use only4_10
- Printed name of elector5_10
- Full residential address street numbernamecity5_10
- Postal code5_10
- Elector signature5_10
- Witness initials5_10
- Internal use only5_10
- Printed name of elector6_10
- Full residential address street numbernamecity6_10
- Postal code6_10
- Elector signature6_10
- Witness initials6_10
- Internal use only6_10
- Printed name of elector7_10
- Full residential address street numbernamecity7_10
- Postal code7_10
- Elector signature7_10
- Witness initials7_10
- Internal use only7_10
- Printed name of elector8_10
- Full residential address street numbernamecity8_10
- Postal code8_10
- Elector signature8_10
- Witness initials8_10
- Internal use only8_10
- Printed name of elector9_10
- Full residential address street numbernamecity9_10
- Postal code9_10
- Elector signature9_10
- Witness initials9_10
- Internal use only9_10
- Printed name of elector10_10
- Full residential address street numbernamecity10_10
- Postal code10_10
- Elector signature10_10
- Witness initials10_10
- Internal use only10_10
- Printed name of elector1_11
- Full residential address street numbernamecity1_11
- Postal code1_11
- Elector signature1_11
- Witness initials1_11
- Internal use only1_11
- Printed name of elector2_11
- Full residential address street numbernamecity2_11
- Postal code2_11
- Elector signature2_11
- Witness initials2_11
- Internal use only2_11
- Printed name of elector3_11
- Full residential address street numbernamecity3_11
- Postal code3_11
- Elector signature3_11
- Witness initials3_11
- Internal use only3_11
- Printed name of elector4_11
- Full residential address street numbernamecity4_11
- Postal code4_11
- Elector signature4_11
- Witness initials4_11
- Internal use only4_11
- Printed name of elector5_11
- Full residential address street numbernamecity5_11
- Postal code5_11
- Elector signature5_11
- Witness initials5_11
- Internal use only5_11
- Printed name of elector6_11
- Full residential address street numbernamecity6_11
- Postal code6_11
- Elector signature6_11
- Witness initials6_11
- Internal use only6_11
- Printed name of elector7_11
- Full residential address street numbernamecity7_11
- Postal code7_11
- Elector signature7_11
- Witness initials7_11
- Internal use only7_11
- Printed name of elector8_11
- Full residential address street numbernamecity8_11
- Postal code8_11
- Elector signature8_11
- Witness initials8_11
- Internal use only8_11
- Printed name of elector9_11
- Full residential address street numbernamecity9_11
- Postal code9_11
- Elector signature9_11
- Witness initials9_11
- Internal use only9_11
- Printed name of elector10_11
- Full residential address street numbernamecity10_11
- Postal code10_11
- Elector signature10_11
- Witness initials10_11
- Internal use only10_11
- Printed name of elector1_12
- Full residential address street numbernamecity1_12
- Postal code1_12
- Elector signature1_12
- Witness initials1_12
- Internal use only1_12
- Printed name of elector2_12
- Full residential address street numbernamecity2_12
- Postal code2_12
- Elector signature2_12
- Witness initials2_12
- Internal use only2_12
- Printed name of elector3_12
- Full residential address street numbernamecity3_12
- Postal code3_12
- Elector signature3_12
- Witness initials3_12
- Internal use only3_12
- Printed name of elector4_12
- Full residential address street numbernamecity4_12
- Postal code4_12
- Elector signature4_12
- Witness initials4_12
- Internal use only4_12
- Printed name of elector5_12
- Full residential address street numbernamecity5_12
- Postal code5_12
- Elector signature5_12
- Witness initials5_12
- Internal use only5_12
- Printed name of elector6_12
- Full residential address street numbernamecity6_12
- Postal code6_12
- Elector signature6_12
- Witness initials6_12
- Internal use only6_12
- Printed name of elector7_12
- Full residential address street numbernamecity7_12
- Postal code7_12
- Elector signature7_12
- Witness initials7_12
- Internal use only7_12
- Printed name of elector8_12
- Full residential address street numbernamecity8_12
- Postal code8_12
- Elector signature8_12
- Witness initials8_12
- Internal use only8_12
- Printed name of elector9_12
- Full residential address street numbernamecity9_12
- Postal code9_12
- Elector signature9_12
- Witness initials9_12
- Internal use only9_12
- Printed name of elector10_12
- Full residential address street numbernamecity10_12
- Postal code10_12
- Elector signature10_12
- Witness initials10_12
- Internal use only10_12
- Printed name of elector1_13
- Full residential address street numbernamecity1_13
- Postal code1_13
- Elector signature1_13
- Witness initials1_13
- Internal use only1_13
- Printed name of elector2_13
- Full residential address street numbernamecity2_13
- Postal code2_13
- Elector signature2_13
- Witness initials2_13
- Internal use only2_13
- Printed name of elector3_13
- Full residential address street numbernamecity3_13
- Postal code3_13
- Elector signature3_13
- Witness initials3_13
- Internal use only3_13
- Printed name of elector4_13
- Full residential address street numbernamecity4_13
- Postal code4_13
- Elector signature4_13
- Witness initials4_13
- Internal use only4_13
- Printed name of elector5_13
- Full residential address street numbernamecity5_13
- Postal code5_13
- Elector signature5_13
- Witness initials5_13
- Internal use only5_13
- Printed name of elector6_13
- Full residential address street numbernamecity6_13
- Postal code6_13
- Elector signature6_13
- Witness initials6_13
- Internal use only6_13
- Printed name of elector7_13
- Full residential address street numbernamecity7_13
- Postal code7_13
- Elector signature7_13
- Witness initials7_13
- Internal use only7_13
- Printed name of elector8_13
- Full residential address street numbernamecity8_13
- Postal code8_13
- Elector signature8_13
- Witness initials8_13
- Internal use only8_13
- Printed name of elector9_13
- Full residential address street numbernamecity9_13
- Postal code9_13
- Elector signature9_13
- Witness initials9_13
- Internal use only9_13
- Printed name of elector10_13
- Full residential address street numbernamecity10_13
- Postal code10_13
- Elector signature10_13
- Witness initials10_13
- Internal use only10_13
- Printed name of elector1_14
- Full residential address street numbernamecity1_14
- Postal code1_14
- Elector signature1_14
- Witness initials1_14
- Internal use only1_14
- Printed name of elector2_14
- Full residential address street numbernamecity2_14
- Postal code2_14
- Elector signature2_14
- Witness initials2_14
- Internal use only2_14
- Printed name of elector3_14
- Full residential address street numbernamecity3_14
- Postal code3_14
- Elector signature3_14
- Witness initials3_14
- Internal use only3_14
- Printed name of elector4_14
- Full residential address street numbernamecity4_14
- Postal code4_14
- Elector signature4_14
- Witness initials4_14
- Internal use only4_14
- Printed name of elector5_14
- Full residential address street numbernamecity5_14
- Postal code5_14
- Elector signature5_14
- Witness initials5_14
- Internal use only5_14
- Printed name of elector6_14
- Full residential address street numbernamecity6_14
- Postal code6_14
- Elector signature6_14
- Witness initials6_14
- Internal use only6_14
- Printed name of elector7_14
- Full residential address street numbernamecity7_14
- Postal code7_14
- Elector signature7_14
- Witness initials7_14
- Internal use only7_14
- Printed name of elector8_14
- Full residential address street numbernamecity8_14
- Postal code8_14
- Elector signature8_14
- Witness initials8_14
- Internal use only8_14
- Printed name of elector9_14
- Full residential address street numbernamecity9_14
- Postal code9_14
- Elector signature9_14
- Witness initials9_14
- Internal use only9_14
- Printed name of elector10_14
- Full residential address street numbernamecity10_14
- Postal code10_14
- Elector signature10_14
- Witness initials10_14
- Internal use only10_14
- Printed name of elector1_15
- Full residential address street numbernamecity1_15
- Postal code1_15
- Elector signature1_15
- Witness initials1_15
- Internal use only1_15
- Printed name of elector2_15
- Full residential address street numbernamecity2_15
- Postal code2_15
- Elector signature2_15
- Witness initials2_15
- Internal use only2_15
- Printed name of elector3_15
- Full residential address street numbernamecity3_15
- Postal code3_15
- Elector signature3_15
- Witness initials3_15
- Internal use only3_15
- Printed name of elector4_15
- Full residential address street numbernamecity4_15
- Postal code4_15
- Elector signature4_15
- Witness initials4_15
- Internal use only4_15
- Printed name of elector5_15
- Full residential address street numbernamecity5_15
- Postal code5_15
- Elector signature5_15
- Witness initials5_15
- Internal use only5_15
- Printed name of elector6_15
- Full residential address street numbernamecity6_15
- Postal code6_15
- Elector signature6_15
- Witness initials6_15
- Internal use only6_15
- Printed name of elector7_15
- Full residential address street numbernamecity7_15
- Postal code7_15
- Elector signature7_15
- Witness initials7_15
- Internal use only7_15
- Printed name of elector8_15
- Full residential address street numbernamecity8_15
- Postal code8_15
- Elector signature8_15
- Witness initials8_15
- Internal use only8_15
- Printed name of elector9_15
- Full residential address street numbernamecity9_15
- Postal code9_15
- Elector signature9_15
- Witness initials9_15
- Internal use only9_15
- Printed name of elector10_15
- Full residential address street numbernamecity10_15
- Postal code10_15
- Elector signature10_15
- Witness initials10_15
- Internal use only10_15
- Printed name of elector1_16
- Full residential address street numbernamecity1_16
- Postal code1_16
- Elector signature1_16
- Witness initials1_16
- Internal use only1_16
- Printed name of elector2_16
- Full residential address street numbernamecity2_16
- Postal code2_16
- Elector signature2_16
- Witness initials2_16
- Internal use only2_16
- Printed name of elector3_16
- Full residential address street numbernamecity3_16
- Postal code3_16
- Elector signature3_16
- Witness initials3_16
- Internal use only3_16
- Printed name of elector4_16
- Full residential address street numbernamecity4_16
- Postal code4_16
- Elector signature4_16
- Witness initials4_16
- Internal use only4_16
- Printed name of elector5_16
- Full residential address street numbernamecity5_16
- Postal code5_16
- Elector signature5_16
- Witness initials5_16
- Internal use only5_16
- Printed name of elector6_16
- Full residential address street numbernamecity6_16
- Postal code6_16
- Elector signature6_16
- Witness initials6_16
- Internal use only6_16
- Printed name of elector7_16
- Full residential address street numbernamecity7_16
- Postal code7_16
- Elector signature7_16
- Witness initials7_16
- Internal use only7_16
- Printed name of elector8_16
- Full residential address street numbernamecity8_16
- Postal code8_16
- Elector signature8_16
- Witness initials8_16
- Internal use only8_16
- Printed name of elector9_16
- Full residential address street numbernamecity9_16
- Postal code9_16
- Elector signature9_16
- Witness initials9_16
- Internal use only9_16
- Printed name of elector10_16
- Full residential address street numbernamecity10_16
- Postal code10_16
- Elector signature10_16
- Witness initials10_16
- Internal use only10_16
- Have you completed the Nomination Paper EC 20010 Off
- Do you have authorized proof of identify Off
- Are you endorsed by a political party Off
- Have you made a nomination appointment Off
- Last name - Candidate Name
- First name - Candidate Name
- Name of electoral district- Candidate Information
- First name - Candidate Information
- Last name - Candidate Information
- Ballot Name Off
- Ballot First name(s)
- Ballot Last name(s)
- Gender -Candidate information
- Date of birth (YYY-MM-DD) - Gender -Candidate information
- language of correspondence - Candidate information Off
- Email -Contact information
- Primary phone number - Contact information
- Ext - Primary phone number
- Alternate phone number - Contact information
- Ext - Alternate phone number
- Fax number- Alternate phone number
- Unit -Residential address
- Street -Residential address
- Street name -Residential address
- City -Residential address
- ProvinceTerritory -Residential address
- Postal code - -Residential address
- Mailing address - same as residential address Off
- Occupation- Candidate occupation
- Sharing of information with the Conflict of Interest and Ethics Commissioner and the House of Commons including the Library of Parliament Off
- where applicable if the returning officer is unable to verify that I have been endorsed by the political party identified in section A of this Nomination Paper I wish to Off
- Date of Signature (YYYY-MM-DD) - Candidate signature
- Date of Signature (YYYY-MM-DD) -Signature of person receiving the solemn declaration
- Campaign delegate information
- First name - Campaign delegate information
- Last name - Campaign delegate information
- Language of correspondence - Campaign delegate information Off
- Email - Contact information -Campaign Delegate
- Primary phone number - Contact information -Campaign Delegate
- Primary phone number EXT - Contact information -Campaign Delegate
- Alternate phone number - Contact information -Campaign Delegate
- Alternate phone number EXT - Contact information -Campaign Delegate
- Fax nmuber- Contact information -Campaign Delegate
- Street - Residential address -Campaign delegate
- Street name - Residential address -Campaign delegate
- City - Residential address -Campaign delegate
- ProvinceTerritory - Residential address -Campaign delegate
- Postal Code - Residential address -Campaign delegate
- Campaign delegate - Mailing address ndash Same as residential address Off
- Unit - Residential address -Campaign delegate
- Date (YYYY-MM-DD) - Candidate authorization Signature
- Date (YYYY-MM-DD) - Candidate campaign Signature
- First name - Official agent information
- Last name - Official agent information
- Language of correspondence - Official agent information Off
- Email - Official agent information
- Primary phone number - Official agent information
- Primary phone number EXT - Official agent information
- Alternate phone number EXT - Official agent information
- Alternate phone number - Official agent information
- Fax number - Official agent information
- Unit -Residential address - Official Agent
- Street name -Residential address - Official Agent
- City -Residential address - Official Agent
- Street -Residential address - Official Agent
- ProvinceTerritory -Residential address - Official Agent
- Postal code-Residential address - Official Agent
- Mailing address ndash Same as residential address- Official Agent Off
- Date (YYYY-MM-DD) - Official agent signature
- First name - Auditor information
- Last name - Auditor information
- Language of correspondence - Auditor information Off
- Email - Auditor information
- Primary phone number - Auditor information
- Primary phone number EXT- Auditor information
- Alternate phone number - Auditor information
- Alternate phone number EXT- Auditor information
- Fax number - Auditor information
- Name of firm- Auditor organizational information
- Occupation of auditor - Auditor organizational information
- Professional designation - Auditor organizational information Off
- Designation registration number
- Make cheque payable to
- Unit - Address (where cheque is sent)
- Street - Address (where cheque is sent)
- Street name - Address (where cheque is sent)
- City - Address (where cheque is sent)
- ProvinceTerritory - Address (where cheque is sent)
- Postal code - Address (where cheque is sent)
- Date (YYY-MM-DD) - Auditor signature
- Unit - Campaign office address (optional)
- Street - Campaign office address (optional)
- Street name - Campaign office address (optional)
- City - Campaign office address (optional)
- ProvinceTerritory- Campaign office address (optional)
- Postal code - Campaign office address (optional)
- Name of witness
- Full address of witness
- Name of candidate
- Electoral district
- Year
- Name of candidate2
- Electoral district2
- Year2
- Name of witness2
- Full address of witness2
- Name of candidate3
- Electoral district3
- Year3
- Full address of witness3
- Name of witness3
- Name of candidate 4
- Electoral district4
- Year4
- Full address of witness 4
- Name of witness 4
- Name of candidate5
- Electoral district5
- Year5
- Full address of witness5
- Name of witness5
- Name of candidate6
- Electoral district6
- Year6
- Name of witness6
- Full address of witness6
- Name of candidate7
- Electoral district7
- Year7
- Full address of witness7
- Name of witness7
- Name of candidate8
- Electoral district8
- Year8
- Full address of witness8
- Name of witness8
- Name of candidate9
- Electoral district9
- Year9
- Full address of witness 9
- Name of witness 9
- Name of candidate10
- Electoral district10
- Year10
- Full address of witness10
- Name of witness10
- Name of candidate11
- Electoral district11
- Year11
- Full address of witness11
- Name of witness11
- Name of candidate12
- Electoral district12
- Year12
- Full address of witness12
- Name of witness12
- Name of candidate13
- Electoral district13
- Year13
- Full address of witness13
- Name of witness13
- Name of candidate14
- Electoral district14
- Year14
- Name of witness14
- Full address of witness14
- Name of candidate1
- Electoral district1
- Year1
- Name of witness1
- Full address of witness1
- Name of candidate15
- Electoral district15
- Year15
- Name of witness15
- Full address of witness15
- unit -Mailing address
- Street -Mailing address
- Street name -Mailing address
- City -Mailing address
- ProvinceTerritory -Mailing address
- Postal code -Mailing address
- Unit - Mailing address -Campaign delegate
- Street - Mailing address -Campaign delegate
- Street name - Mailing address -Campaign delegate
- City - Mailing address -Campaign delegate
- ProvinceTerritory- Mailing address -Campaign delegate
- Postal code- Mailing address -Campaign delegate
- Unit -Mailing address - Official Agent
- Street -Mailing address - Official Agent
- Street name -Mailing address - Official Agent
- city -Mailing address - Official Agent
- ProvinceTerritory-Mailing address - Official Agent
- Postal code-Mailing address - Official Agent
EC 20010 (052019)
SECTION B ndash Campaign Delegate ndash Privacy Notice and Declaration (Optional)
If appointing a campaign delegate all fields marked with are mandatory
Privacy notice
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA) Any person at the returning office may examine the completed Nomination Paper during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
Candidate authorization of the campaign delegate
As per subsection 66(1)(h) of the Canada Elections Act I authorize the individual identified in this section to act as my campaign delegate
Candidate signature Date (YYYY-MM-DD)
Candidate campaign delegate signature
I the undersigned candidate campaign delegate for the candidate named in this Nomination Paper state that
1 I hereby agree to act as the authorized person for the candidate named herein for the purposes of theCanada Elections Act
2 I am fully aware of the duties and responsibilities imposed on me by the Canada Elections Act
Campaign delegate signature Date (YYYY-MM-DD)
9
ndash
EC 20010 (052019)
SECTION C ndash 4BOfficial Agent (Mandatory)
All fields marked with are mandatory
Official agent information
The official agent is responsible for administering the campaignrsquos financial transactions and reporting those transactions to Elections Canada as required by the CEA For more information consult the Political Financing Handbook for Candidates and Official Agents Note The candidate official agent and auditor must all be different people
First name Last name Language of correspondence
English French
Contact information
Upon confirmation of the nomination Elections Canada will send to the email address listed below an invitation to the Political Entities Service Centre (PESC) online portal
Primary phone number Ext Alternate phone number Ext Fax number
Residential address Unit Street Street name
City ProvinceTerritory Postal code
Mailing address Same as residential address
Unit Street Street name
City ProvinceTerritory Postal code
10
EC 20010 (052019)
24BSECTION C ndash Official Agent ndash Privacy Notice and Declaration (Mandatory)
All fields marked with are mandatory
Privacy notice
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA) Any person at the returning office may examine the completed Nomination Paper during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
Official agent signature
I the undersigned official agent for the candidate named in this Nomination Paper hereby agree to act as official agent for the candidate named herein for the purposes of the Canada Elections Act I further state that
1 I am fully aware of the duties and responsibilities imposed on me by the Canada Elections Act
2 I am capable of entering into contracts in the provinceterritory in which this electoral district is located
3 I am eligible to act as official agent pursuant to section 4772 of the Canada Elections Act
Section 4772 of the Canada Elections Act states The following persons are ineligible to be an official agenta candidate an election officer or a member of the staff of a returning office an undischarged bankrupt anauditor appointed as required by this Act a person who is not qualified as an elector and a person who doesnot have the capacity to enter into contracts in the province in which they ordinarily reside
Official agent signature Date (YYYY-MM-DD)
11
EC 20010 (052019)
SECTION D ndash 5B Auditor (Optional)
If appointing an auditor all fields marked with are mandatory
Auditor information An auditor must be appointed if bull the candidatersquos campaign accepts contributions of $10000 or more bull the candidatersquos campaign incurs expenses of $10000 or more or bull the candidate receives 10 or more of votes cast in the electoral district If at the time of filing the Nomination Paper none of the above applies you do not need to appoint an auditor though you may still choose to do so If the above requirements are later met you must appoint an auditor without delay A person or partnership who wants to act as a candidatersquos auditor must be or have every partner be recognized as a professional accountant under provincial or territorial legislation CEA 4773(1) For more information consult the Political Financing Handbook for Candidates and Official Agents
First name Last name Language of correspondence
English French
Contact information Upon confirmation of the nomination Elections Canada will send to the email address listed below an invitation to the Political Entities Service Centre (PESC) online portal
Primary phone number Ext Alternate phone number Ext Fax number
Auditor organizational information Name of firm Occupation of auditor Professional designation
CPA FCPA
Designation registration number Make cheque payable to
Address (where cheque is sent) Unit Street Street name
City ProvinceTerritory Postal code
12
EC 20010 (052019)
SECTION D ndash Auditor ndash Privacy Notice and Declaration (Optional)
If appointing an auditor all fields marked with are mandatory
Privacy notice
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA) Any person at the returning office may examine the completed Nomination Paper during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information
Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
Auditor signature
I the undersigned hereby agree to act as the auditor for the candidate named in this Nomination Paper I further state that I am aware of the duties and responsibilities of this position under the Canada Elections Act and I am qualified to act as auditor under subsection 4773(1) and (2) of the Canada Elections Act
Auditor signature Date (YYYY-MM-DD)
13
EC 20010 (052019)
SECTION E ndash 6BCampaign Office (Optional)
Contact information to be made available on the Elections Canada website (optional)
Please note You may provide a telephone number andor a link to your website or social media platform of choice when filing your Nomination Paper with Elections Canada You do not have to provide this information but it is intended to help electors access campaign information Elections Canada may provide this information as part of the Voter Information Service Please include the full website address including prefix (http https)
Telephone number to be posted on electionsca
Website to be posted on electionsca (including prefix http https)
Campaign office address (optional)
Unit Street Street name
City ProvinceTerritory Postal code
14
SECTION F ndash 7BElectors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
15
8BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
16
9BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
17
10BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
18
11BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
19
12BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
20
13BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
21
14BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
22
15BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
23
16BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
24
17BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
25
18BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
26
19BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
27
20BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
28
21BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
29
22BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
30
EC 20010 (022019)
SECTION G ndash 23B Are You Ready to Submit Your Nomination
Have you completed the Nomination Paper (EC 20010)
bull Are all mandatory fields in sections AndashE complete
bull Have you collected the required number of signatures from qualified electors in section F
o For most electoral districts 100 electors must consent to your candidacy
o For electoral districts identified in Schedule 3 only 50 electors are required
o To ensure a smooth nomination process Elections Canada recommends collecting signatures from at least 150 electors
Do you have authorized proof of identify
bull For a list of authorized identification visit the Elections Canada website
bull If a campaign delegate is submitting on your behalf they must bring a copy of your identification documents signed by you
bull If you want an alternative name to appear on the ballot additional documentation is required visit electionsca for details
Are you endorsed by a political party
bull Make sure your party has submitted the required documentation to Elections Canada attesting your designated political affiliation
Have you made a nomination appointment
bull To facilitate the nomination process make an appointment with the returning officer to finalize the filing of the complete nomination package
bull The nomination period closes 21 days before election day at 200 pm local time
31
- Nomination Paperof a Candidate at a Federal General Election or By-election
- Table of Contents
- General Information
- SECTION A ndash Candidate Information (Mandatory)
- SECTION B ndash Campaign Delegate (Optional)
- SECTION C ndash Official Agent (Mandatory)
- SECTION D ndash Auditor (Optional)
- SECTION E ndash Campaign Office (Optional)
- SECTION F ndash Electors Consenting to Candidacy (Mandatory)
-
- Name of electoral district
- Political affiliation
- Telephone number to be posted on electionsca
- Website to be posted on electionsca including prefix http https
- Printed name of elector1
- Full residential address street numbernamecity1
- Postal code1
- Elector signature1
- Witness initials1
- Internal use only1
- Printed name of elector2
- Full residential address street numbernamecity2
- Postal code2
- Elector signature2
- Witness initials2
- Internal use only2
- Printed name of elector3
- Full residential address street numbernamecity3
- Postal code3
- Elector signature3
- Witness initials3
- Internal use only3
- Printed name of elector4
- Full residential address street numbernamecity4
- Postal code4
- Elector signature4
- Witness initials4
- Internal use only4
- Printed name of elector5
- Full residential address street numbernamecity5
- Postal code5
- Elector signature5
- Witness initials5
- Internal use only5
- Printed name of elector6
- Full residential address street numbernamecity6
- Postal code6
- Elector signature6
- Witness initials6
- Internal use only6
- Printed name of elector7
- Full residential address street numbernamecity7
- Postal code7
- Elector signature7
- Witness initials7
- Internal use only7
- Printed name of elector8
- Full residential address street numbernamecity8
- Postal code8
- Elector signature8
- Witness initials8
- Internal use only8
- Printed name of elector9
- Full residential address street numbernamecity9
- Postal code9
- Elector signature9
- Witness initials9
- Internal use only9
- Printed name of elector10
- Full residential address street numbernamecity10
- Postal code10
- Elector signature10
- Witness initials10
- Internal use only10
- Printed name of elector1_2
- Full residential address street numbernamecity1_2
- Postal code1_2
- Elector signature1_2
- Witness initials1_2
- Internal use only1_2
- Printed name of elector2_2
- Full residential address street numbernamecity2_2
- Postal code2_2
- Elector signature2_2
- Witness initials2_2
- Internal use only2_2
- Printed name of elector3_2
- Full residential address street numbernamecity3_2
- Postal code3_2
- Elector signature3_2
- Witness initials3_2
- Internal use only3_2
- Printed name of elector4_2
- Full residential address street numbernamecity4_2
- Postal code4_2
- Elector signature4_2
- Witness initials4_2
- Internal use only4_2
- Printed name of elector5_2
- Full residential address street numbernamecity5_2
- Postal code5_2
- Elector signature5_2
- Witness initials5_2
- Internal use only5_2
- Printed name of elector6_2
- Full residential address street numbernamecity6_2
- Postal code6_2
- Elector signature6_2
- Witness initials6_2
- Internal use only6_2
- Printed name of elector7_2
- Full residential address street numbernamecity7_2
- Postal code7_2
- Elector signature7_2
- Witness initials7_2
- Internal use only7_2
- Printed name of elector8_2
- Full residential address street numbernamecity8_2
- Postal code8_2
- Elector signature8_2
- Witness initials8_2
- Internal use only8_2
- Printed name of elector9_2
- Full residential address street numbernamecity9_2
- Postal code9_2
- Elector signature9_2
- Witness initials9_2
- Internal use only9_2
- Printed name of elector10_2
- Full residential address street numbernamecity10_2
- Postal code10_2
- Elector signature10_2
- Witness initials10_2
- Internal use only10_2
- Printed name of elector1_3
- Full residential address street numbernamecity1_3
- Postal code1_3
- Elector signature1_3
- Witness initials1_3
- Internal use only1_3
- Printed name of elector2_3
- Full residential address street numbernamecity2_3
- Postal code2_3
- Elector signature2_3
- Witness initials2_3
- Internal use only2_3
- Printed name of elector3_3
- Full residential address street numbernamecity3_3
- Postal code3_3
- Elector signature3_3
- Witness initials3_3
- Internal use only3_3
- Printed name of elector4_3
- Full residential address street numbernamecity4_3
- Postal code4_3
- Elector signature4_3
- Witness initials4_3
- Internal use only4_3
- Printed name of elector5_3
- Full residential address street numbernamecity5_3
- Postal code5_3
- Elector signature5_3
- Witness initials5_3
- Internal use only5_3
- Printed name of elector6_3
- Full residential address street numbernamecity6_3
- Postal code6_3
- Elector signature6_3
- Witness initials6_3
- Internal use only6_3
- Printed name of elector7_3
- Full residential address street numbernamecity7_3
- Postal code7_3
- Elector signature7_3
- Witness initials7_3
- Internal use only7_3
- Printed name of elector8_3
- Full residential address street numbernamecity8_3
- Postal code8_3
- Elector signature8_3
- Witness initials8_3
- Internal use only8_3
- Printed name of elector9_3
- Full residential address street numbernamecity9_3
- Postal code9_3
- Elector signature9_3
- Witness initials9_3
- Internal use only9_3
- Printed name of elector10_3
- Full residential address street numbernamecity10_3
- Postal code10_3
- Elector signature10_3
- Witness initials10_3
- Internal use only10_3
- Printed name of elector1_4
- Full residential address street numbernamecity1_4
- Postal code1_4
- Elector signature1_4
- Witness initials1_4
- Internal use only1_4
- Printed name of elector2_4
- Full residential address street numbernamecity2_4
- Postal code2_4
- Elector signature2_4
- Witness initials2_4
- Internal use only2_4
- Printed name of elector3_4
- Full residential address street numbernamecity3_4
- Postal code3_4
- Elector signature3_4
- Witness initials3_4
- Internal use only3_4
- Printed name of elector4_4
- Full residential address street numbernamecity4_4
- Postal code4_4
- Elector signature4_4
- Witness initials4_4
- Internal use only4_4
- Printed name of elector5_4
- Full residential address street numbernamecity5_4
- Postal code5_4
- Elector signature5_4
- Witness initials5_4
- Internal use only5_4
- Printed name of elector6_4
- Full residential address street numbernamecity6_4
- Postal code6_4
- Elector signature6_4
- Witness initials6_4
- Internal use only6_4
- Printed name of elector7_4
- Full residential address street numbernamecity7_4
- Postal code7_4
- Elector signature7_4
- Witness initials7_4
- Internal use only7_4
- Printed name of elector8_4
- Full residential address street numbernamecity8_4
- Postal code8_4
- Elector signature8_4
- Witness initials8_4
- Internal use only8_4
- Printed name of elector9_4
- Full residential address street numbernamecity9_4
- Postal code9_4
- Elector signature9_4
- Witness initials9_4
- Internal use only9_4
- Printed name of elector10_4
- Full residential address street numbernamecity10_4
- Postal code10_4
- Elector signature10_4
- Witness initials10_4
- Internal use only10_4
- Printed name of elector1_5
- Full residential address street numbernamecity1_5
- Postal code1_5
- Elector signature1_5
- Witness initials1_5
- Internal use only1_5
- Printed name of elector2_5
- Full residential address street numbernamecity2_5
- Postal code2_5
- Elector signature2_5
- Witness initials2_5
- Internal use only2_5
- Printed name of elector3_5
- Full residential address street numbernamecity3_5
- Postal code3_5
- Elector signature3_5
- Witness initials3_5
- Internal use only3_5
- Printed name of elector4_5
- Full residential address street numbernamecity4_5
- Postal code4_5
- Elector signature4_5
- Witness initials4_5
- Internal use only4_5
- Printed name of elector5_5
- Full residential address street numbernamecity5_5
- Postal code5_5
- Elector signature5_5
- Witness initials5_5
- Internal use only5_5
- Printed name of elector6_5
- Full residential address street numbernamecity6_5
- Postal code6_5
- Elector signature6_5
- Witness initials6_5
- Internal use only6_5
- Printed name of elector7_5
- Full residential address street numbernamecity7_5
- Postal code7_5
- Elector signature7_5
- Witness initials7_5
- Internal use only7_5
- Printed name of elector8_5
- Full residential address street numbernamecity8_5
- Postal code8_5
- Elector signature8_5
- Witness initials8_5
- Internal use only8_5
- Printed name of elector9_5
- Full residential address street numbernamecity9_5
- Postal code9_5
- Elector signature9_5
- Witness initials9_5
- Internal use only9_5
- Printed name of elector10_5
- Full residential address street numbernamecity10_5
- Postal code10_5
- Elector signature10_5
- Witness initials10_5
- Internal use only10_5
- Printed name of elector1_6
- Full residential address street numbernamecity1_6
- Postal code1_6
- Elector signature1_6
- Witness initials1_6
- Internal use only1_6
- Printed name of elector2_6
- Full residential address street numbernamecity2_6
- Postal code2_6
- Elector signature2_6
- Witness initials2_6
- Internal use only2_6
- Printed name of elector3_6
- Full residential address street numbernamecity3_6
- Postal code3_6
- Elector signature3_6
- Witness initials3_6
- Internal use only3_6
- Printed name of elector4_6
- Full residential address street numbernamecity4_6
- Postal code4_6
- Elector signature4_6
- Witness initials4_6
- Internal use only4_6
- Printed name of elector5_6
- Full residential address street numbernamecity5_6
- Postal code5_6
- Elector signature5_6
- Witness initials5_6
- Internal use only5_6
- Printed name of elector6_6
- Full residential address street numbernamecity6_6
- Postal code6_6
- Elector signature6_6
- Witness initials6_6
- Internal use only6_6
- Printed name of elector7_6
- Full residential address street numbernamecity7_6
- Postal code7_6
- Elector signature7_6
- Witness initials7_6
- Internal use only7_6
- Printed name of elector8_6
- Full residential address street numbernamecity8_6
- Postal code8_6
- Elector signature8_6
- Witness initials8_6
- Internal use only8_6
- Printed name of elector9_6
- Full residential address street numbernamecity9_6
- Postal code9_6
- Elector signature9_6
- Witness initials9_6
- Internal use only9_6
- Printed name of elector10_6
- Full residential address street numbernamecity10_6
- Postal code10_6
- Elector signature10_6
- Witness initials10_6
- Internal use only10_6
- Printed name of elector1_7
- Full residential address street numbernamecity1_7
- Postal code1_7
- Elector signature1_7
- Witness initials1_7
- Internal use only1_7
- Printed name of elector2_7
- Full residential address street numbernamecity2_7
- Postal code2_7
- Elector signature2_7
- Witness initials2_7
- Internal use only2_7
- Printed name of elector3_7
- Full residential address street numbernamecity3_7
- Postal code3_7
- Elector signature3_7
- Witness initials3_7
- Internal use only3_7
- Printed name of elector4_7
- Full residential address street numbernamecity4_7
- Postal code4_7
- Elector signature4_7
- Witness initials4_7
- Internal use only4_7
- Printed name of elector5_7
- Full residential address street numbernamecity5_7
- Postal code5_7
- Elector signature5_7
- Witness initials5_7
- Internal use only5_7
- Printed name of elector6_7
- Full residential address street numbernamecity6_7
- Postal code6_7
- Elector signature6_7
- Witness initials6_7
- Internal use only6_7
- Printed name of elector7_7
- Full residential address street numbernamecity7_7
- Postal code7_7
- Elector signature7_7
- Witness initials7_7
- Internal use only7_7
- Printed name of elector8_7
- Full residential address street numbernamecity8_7
- Postal code8_7
- Elector signature8_7
- Witness initials8_7
- Internal use only8_7
- Printed name of elector9_7
- Full residential address street numbernamecity9_7
- Postal code9_7
- Elector signature9_7
- Witness initials9_7
- Internal use only9_7
- Printed name of elector10_7
- Full residential address street numbernamecity10_7
- Postal code10_7
- Elector signature10_7
- Witness initials10_7
- Internal use only10_7
- Printed name of elector1_8
- Full residential address street numbernamecity1_8
- Postal code1_8
- Elector signature1_8
- Witness initials1_8
- Internal use only1_8
- Printed name of elector2_8
- Full residential address street numbernamecity2_8
- Postal code2_8
- Elector signature2_8
- Witness initials2_8
- Internal use only2_8
- Printed name of elector3_8
- Full residential address street numbernamecity3_8
- Postal code3_8
- Elector signature3_8
- Witness initials3_8
- Internal use only3_8
- Printed name of elector4_8
- Full residential address street numbernamecity4_8
- Postal code4_8
- Elector signature4_8
- Witness initials4_8
- Internal use only4_8
- Printed name of elector5_8
- Full residential address street numbernamecity5_8
- Postal code5_8
- Elector signature5_8
- Witness initials5_8
- Internal use only5_8
- Printed name of elector6_8
- Full residential address street numbernamecity6_8
- Postal code6_8
- Elector signature6_8
- Witness initials6_8
- Internal use only6_8
- Printed name of elector7_8
- Full residential address street numbernamecity7_8
- Postal code7_8
- Elector signature7_8
- Witness initials7_8
- Internal use only7_8
- Printed name of elector8_8
- Full residential address street numbernamecity8_8
- Postal code8_8
- Elector signature8_8
- Witness initials8_8
- Internal use only8_8
- Printed name of elector9_8
- Full residential address street numbernamecity9_8
- Postal code9_8
- Elector signature9_8
- Witness initials9_8
- Internal use only9_8
- Printed name of elector10_8
- Full residential address street numbernamecity10_8
- Postal code10_8
- Elector signature10_8
- Witness initials10_8
- Internal use only10_8
- Printed name of elector1_9
- Full residential address street numbernamecity1_9
- Postal code1_9
- Elector signature1_9
- Witness initials1_9
- Internal use only1_9
- Printed name of elector2_9
- Full residential address street numbernamecity2_9
- Postal code2_9
- Elector signature2_9
- Witness initials2_9
- Internal use only2_9
- Printed name of elector3_9
- Full residential address street numbernamecity3_9
- Postal code3_9
- Elector signature3_9
- Witness initials3_9
- Internal use only3_9
- Printed name of elector4_9
- Full residential address street numbernamecity4_9
- Postal code4_9
- Elector signature4_9
- Witness initials4_9
- Internal use only4_9
- Printed name of elector5_9
- Full residential address street numbernamecity5_9
- Postal code5_9
- Elector signature5_9
- Witness initials5_9
- Internal use only5_9
- Printed name of elector6_9
- Full residential address street numbernamecity6_9
- Postal code6_9
- Elector signature6_9
- Witness initials6_9
- Internal use only6_9
- Printed name of elector7_9
- Full residential address street numbernamecity7_9
- Postal code7_9
- Elector signature7_9
- Witness initials7_9
- Internal use only7_9
- Printed name of elector8_9
- Full residential address street numbernamecity8_9
- Postal code8_9
- Elector signature8_9
- Witness initials8_9
- Internal use only8_9
- Printed name of elector9_9
- Full residential address street numbernamecity9_9
- Postal code9_9
- Elector signature9_9
- Witness initials9_9
- Internal use only9_9
- Printed name of elector10_9
- Full residential address street numbernamecity10_9
- Postal code10_9
- Elector signature10_9
- Witness initials10_9
- Internal use only10_9
- Printed name of elector1_10
- Full residential address street numbernamecity1_10
- Postal code1_10
- Elector signature1_10
- Witness initials1_10
- Internal use only1_10
- Printed name of elector2_10
- Full residential address street numbernamecity2_10
- Postal code2_10
- Elector signature2_10
- Witness initials2_10
- Internal use only2_10
- Printed name of elector3_10
- Full residential address street numbernamecity3_10
- Postal code3_10
- Elector signature3_10
- Witness initials3_10
- Internal use only3_10
- Printed name of elector4_10
- Full residential address street numbernamecity4_10
- Postal code4_10
- Elector signature4_10
- Witness initials4_10
- Internal use only4_10
- Printed name of elector5_10
- Full residential address street numbernamecity5_10
- Postal code5_10
- Elector signature5_10
- Witness initials5_10
- Internal use only5_10
- Printed name of elector6_10
- Full residential address street numbernamecity6_10
- Postal code6_10
- Elector signature6_10
- Witness initials6_10
- Internal use only6_10
- Printed name of elector7_10
- Full residential address street numbernamecity7_10
- Postal code7_10
- Elector signature7_10
- Witness initials7_10
- Internal use only7_10
- Printed name of elector8_10
- Full residential address street numbernamecity8_10
- Postal code8_10
- Elector signature8_10
- Witness initials8_10
- Internal use only8_10
- Printed name of elector9_10
- Full residential address street numbernamecity9_10
- Postal code9_10
- Elector signature9_10
- Witness initials9_10
- Internal use only9_10
- Printed name of elector10_10
- Full residential address street numbernamecity10_10
- Postal code10_10
- Elector signature10_10
- Witness initials10_10
- Internal use only10_10
- Printed name of elector1_11
- Full residential address street numbernamecity1_11
- Postal code1_11
- Elector signature1_11
- Witness initials1_11
- Internal use only1_11
- Printed name of elector2_11
- Full residential address street numbernamecity2_11
- Postal code2_11
- Elector signature2_11
- Witness initials2_11
- Internal use only2_11
- Printed name of elector3_11
- Full residential address street numbernamecity3_11
- Postal code3_11
- Elector signature3_11
- Witness initials3_11
- Internal use only3_11
- Printed name of elector4_11
- Full residential address street numbernamecity4_11
- Postal code4_11
- Elector signature4_11
- Witness initials4_11
- Internal use only4_11
- Printed name of elector5_11
- Full residential address street numbernamecity5_11
- Postal code5_11
- Elector signature5_11
- Witness initials5_11
- Internal use only5_11
- Printed name of elector6_11
- Full residential address street numbernamecity6_11
- Postal code6_11
- Elector signature6_11
- Witness initials6_11
- Internal use only6_11
- Printed name of elector7_11
- Full residential address street numbernamecity7_11
- Postal code7_11
- Elector signature7_11
- Witness initials7_11
- Internal use only7_11
- Printed name of elector8_11
- Full residential address street numbernamecity8_11
- Postal code8_11
- Elector signature8_11
- Witness initials8_11
- Internal use only8_11
- Printed name of elector9_11
- Full residential address street numbernamecity9_11
- Postal code9_11
- Elector signature9_11
- Witness initials9_11
- Internal use only9_11
- Printed name of elector10_11
- Full residential address street numbernamecity10_11
- Postal code10_11
- Elector signature10_11
- Witness initials10_11
- Internal use only10_11
- Printed name of elector1_12
- Full residential address street numbernamecity1_12
- Postal code1_12
- Elector signature1_12
- Witness initials1_12
- Internal use only1_12
- Printed name of elector2_12
- Full residential address street numbernamecity2_12
- Postal code2_12
- Elector signature2_12
- Witness initials2_12
- Internal use only2_12
- Printed name of elector3_12
- Full residential address street numbernamecity3_12
- Postal code3_12
- Elector signature3_12
- Witness initials3_12
- Internal use only3_12
- Printed name of elector4_12
- Full residential address street numbernamecity4_12
- Postal code4_12
- Elector signature4_12
- Witness initials4_12
- Internal use only4_12
- Printed name of elector5_12
- Full residential address street numbernamecity5_12
- Postal code5_12
- Elector signature5_12
- Witness initials5_12
- Internal use only5_12
- Printed name of elector6_12
- Full residential address street numbernamecity6_12
- Postal code6_12
- Elector signature6_12
- Witness initials6_12
- Internal use only6_12
- Printed name of elector7_12
- Full residential address street numbernamecity7_12
- Postal code7_12
- Elector signature7_12
- Witness initials7_12
- Internal use only7_12
- Printed name of elector8_12
- Full residential address street numbernamecity8_12
- Postal code8_12
- Elector signature8_12
- Witness initials8_12
- Internal use only8_12
- Printed name of elector9_12
- Full residential address street numbernamecity9_12
- Postal code9_12
- Elector signature9_12
- Witness initials9_12
- Internal use only9_12
- Printed name of elector10_12
- Full residential address street numbernamecity10_12
- Postal code10_12
- Elector signature10_12
- Witness initials10_12
- Internal use only10_12
- Printed name of elector1_13
- Full residential address street numbernamecity1_13
- Postal code1_13
- Elector signature1_13
- Witness initials1_13
- Internal use only1_13
- Printed name of elector2_13
- Full residential address street numbernamecity2_13
- Postal code2_13
- Elector signature2_13
- Witness initials2_13
- Internal use only2_13
- Printed name of elector3_13
- Full residential address street numbernamecity3_13
- Postal code3_13
- Elector signature3_13
- Witness initials3_13
- Internal use only3_13
- Printed name of elector4_13
- Full residential address street numbernamecity4_13
- Postal code4_13
- Elector signature4_13
- Witness initials4_13
- Internal use only4_13
- Printed name of elector5_13
- Full residential address street numbernamecity5_13
- Postal code5_13
- Elector signature5_13
- Witness initials5_13
- Internal use only5_13
- Printed name of elector6_13
- Full residential address street numbernamecity6_13
- Postal code6_13
- Elector signature6_13
- Witness initials6_13
- Internal use only6_13
- Printed name of elector7_13
- Full residential address street numbernamecity7_13
- Postal code7_13
- Elector signature7_13
- Witness initials7_13
- Internal use only7_13
- Printed name of elector8_13
- Full residential address street numbernamecity8_13
- Postal code8_13
- Elector signature8_13
- Witness initials8_13
- Internal use only8_13
- Printed name of elector9_13
- Full residential address street numbernamecity9_13
- Postal code9_13
- Elector signature9_13
- Witness initials9_13
- Internal use only9_13
- Printed name of elector10_13
- Full residential address street numbernamecity10_13
- Postal code10_13
- Elector signature10_13
- Witness initials10_13
- Internal use only10_13
- Printed name of elector1_14
- Full residential address street numbernamecity1_14
- Postal code1_14
- Elector signature1_14
- Witness initials1_14
- Internal use only1_14
- Printed name of elector2_14
- Full residential address street numbernamecity2_14
- Postal code2_14
- Elector signature2_14
- Witness initials2_14
- Internal use only2_14
- Printed name of elector3_14
- Full residential address street numbernamecity3_14
- Postal code3_14
- Elector signature3_14
- Witness initials3_14
- Internal use only3_14
- Printed name of elector4_14
- Full residential address street numbernamecity4_14
- Postal code4_14
- Elector signature4_14
- Witness initials4_14
- Internal use only4_14
- Printed name of elector5_14
- Full residential address street numbernamecity5_14
- Postal code5_14
- Elector signature5_14
- Witness initials5_14
- Internal use only5_14
- Printed name of elector6_14
- Full residential address street numbernamecity6_14
- Postal code6_14
- Elector signature6_14
- Witness initials6_14
- Internal use only6_14
- Printed name of elector7_14
- Full residential address street numbernamecity7_14
- Postal code7_14
- Elector signature7_14
- Witness initials7_14
- Internal use only7_14
- Printed name of elector8_14
- Full residential address street numbernamecity8_14
- Postal code8_14
- Elector signature8_14
- Witness initials8_14
- Internal use only8_14
- Printed name of elector9_14
- Full residential address street numbernamecity9_14
- Postal code9_14
- Elector signature9_14
- Witness initials9_14
- Internal use only9_14
- Printed name of elector10_14
- Full residential address street numbernamecity10_14
- Postal code10_14
- Elector signature10_14
- Witness initials10_14
- Internal use only10_14
- Printed name of elector1_15
- Full residential address street numbernamecity1_15
- Postal code1_15
- Elector signature1_15
- Witness initials1_15
- Internal use only1_15
- Printed name of elector2_15
- Full residential address street numbernamecity2_15
- Postal code2_15
- Elector signature2_15
- Witness initials2_15
- Internal use only2_15
- Printed name of elector3_15
- Full residential address street numbernamecity3_15
- Postal code3_15
- Elector signature3_15
- Witness initials3_15
- Internal use only3_15
- Printed name of elector4_15
- Full residential address street numbernamecity4_15
- Postal code4_15
- Elector signature4_15
- Witness initials4_15
- Internal use only4_15
- Printed name of elector5_15
- Full residential address street numbernamecity5_15
- Postal code5_15
- Elector signature5_15
- Witness initials5_15
- Internal use only5_15
- Printed name of elector6_15
- Full residential address street numbernamecity6_15
- Postal code6_15
- Elector signature6_15
- Witness initials6_15
- Internal use only6_15
- Printed name of elector7_15
- Full residential address street numbernamecity7_15
- Postal code7_15
- Elector signature7_15
- Witness initials7_15
- Internal use only7_15
- Printed name of elector8_15
- Full residential address street numbernamecity8_15
- Postal code8_15
- Elector signature8_15
- Witness initials8_15
- Internal use only8_15
- Printed name of elector9_15
- Full residential address street numbernamecity9_15
- Postal code9_15
- Elector signature9_15
- Witness initials9_15
- Internal use only9_15
- Printed name of elector10_15
- Full residential address street numbernamecity10_15
- Postal code10_15
- Elector signature10_15
- Witness initials10_15
- Internal use only10_15
- Printed name of elector1_16
- Full residential address street numbernamecity1_16
- Postal code1_16
- Elector signature1_16
- Witness initials1_16
- Internal use only1_16
- Printed name of elector2_16
- Full residential address street numbernamecity2_16
- Postal code2_16
- Elector signature2_16
- Witness initials2_16
- Internal use only2_16
- Printed name of elector3_16
- Full residential address street numbernamecity3_16
- Postal code3_16
- Elector signature3_16
- Witness initials3_16
- Internal use only3_16
- Printed name of elector4_16
- Full residential address street numbernamecity4_16
- Postal code4_16
- Elector signature4_16
- Witness initials4_16
- Internal use only4_16
- Printed name of elector5_16
- Full residential address street numbernamecity5_16
- Postal code5_16
- Elector signature5_16
- Witness initials5_16
- Internal use only5_16
- Printed name of elector6_16
- Full residential address street numbernamecity6_16
- Postal code6_16
- Elector signature6_16
- Witness initials6_16
- Internal use only6_16
- Printed name of elector7_16
- Full residential address street numbernamecity7_16
- Postal code7_16
- Elector signature7_16
- Witness initials7_16
- Internal use only7_16
- Printed name of elector8_16
- Full residential address street numbernamecity8_16
- Postal code8_16
- Elector signature8_16
- Witness initials8_16
- Internal use only8_16
- Printed name of elector9_16
- Full residential address street numbernamecity9_16
- Postal code9_16
- Elector signature9_16
- Witness initials9_16
- Internal use only9_16
- Printed name of elector10_16
- Full residential address street numbernamecity10_16
- Postal code10_16
- Elector signature10_16
- Witness initials10_16
- Internal use only10_16
- Have you completed the Nomination Paper EC 20010 Off
- Do you have authorized proof of identify Off
- Are you endorsed by a political party Off
- Have you made a nomination appointment Off
- Last name - Candidate Name
- First name - Candidate Name
- Name of electoral district- Candidate Information
- First name - Candidate Information
- Last name - Candidate Information
- Ballot Name Off
- Ballot First name(s)
- Ballot Last name(s)
- Gender -Candidate information
- Date of birth (YYY-MM-DD) - Gender -Candidate information
- language of correspondence - Candidate information Off
- Email -Contact information
- Primary phone number - Contact information
- Ext - Primary phone number
- Alternate phone number - Contact information
- Ext - Alternate phone number
- Fax number- Alternate phone number
- Unit -Residential address
- Street -Residential address
- Street name -Residential address
- City -Residential address
- ProvinceTerritory -Residential address
- Postal code - -Residential address
- Mailing address - same as residential address Off
- Occupation- Candidate occupation
- Sharing of information with the Conflict of Interest and Ethics Commissioner and the House of Commons including the Library of Parliament Off
- where applicable if the returning officer is unable to verify that I have been endorsed by the political party identified in section A of this Nomination Paper I wish to Off
- Date of Signature (YYYY-MM-DD) - Candidate signature
- Date of Signature (YYYY-MM-DD) -Signature of person receiving the solemn declaration
- Campaign delegate information
- First name - Campaign delegate information
- Last name - Campaign delegate information
- Language of correspondence - Campaign delegate information Off
- Email - Contact information -Campaign Delegate
- Primary phone number - Contact information -Campaign Delegate
- Primary phone number EXT - Contact information -Campaign Delegate
- Alternate phone number - Contact information -Campaign Delegate
- Alternate phone number EXT - Contact information -Campaign Delegate
- Fax nmuber- Contact information -Campaign Delegate
- Street - Residential address -Campaign delegate
- Street name - Residential address -Campaign delegate
- City - Residential address -Campaign delegate
- ProvinceTerritory - Residential address -Campaign delegate
- Postal Code - Residential address -Campaign delegate
- Campaign delegate - Mailing address ndash Same as residential address Off
- Unit - Residential address -Campaign delegate
- Date (YYYY-MM-DD) - Candidate authorization Signature
- Date (YYYY-MM-DD) - Candidate campaign Signature
- First name - Official agent information
- Last name - Official agent information
- Language of correspondence - Official agent information Off
- Email - Official agent information
- Primary phone number - Official agent information
- Primary phone number EXT - Official agent information
- Alternate phone number EXT - Official agent information
- Alternate phone number - Official agent information
- Fax number - Official agent information
- Unit -Residential address - Official Agent
- Street name -Residential address - Official Agent
- City -Residential address - Official Agent
- Street -Residential address - Official Agent
- ProvinceTerritory -Residential address - Official Agent
- Postal code-Residential address - Official Agent
- Mailing address ndash Same as residential address- Official Agent Off
- Date (YYYY-MM-DD) - Official agent signature
- First name - Auditor information
- Last name - Auditor information
- Language of correspondence - Auditor information Off
- Email - Auditor information
- Primary phone number - Auditor information
- Primary phone number EXT- Auditor information
- Alternate phone number - Auditor information
- Alternate phone number EXT- Auditor information
- Fax number - Auditor information
- Name of firm- Auditor organizational information
- Occupation of auditor - Auditor organizational information
- Professional designation - Auditor organizational information Off
- Designation registration number
- Make cheque payable to
- Unit - Address (where cheque is sent)
- Street - Address (where cheque is sent)
- Street name - Address (where cheque is sent)
- City - Address (where cheque is sent)
- ProvinceTerritory - Address (where cheque is sent)
- Postal code - Address (where cheque is sent)
- Date (YYY-MM-DD) - Auditor signature
- Unit - Campaign office address (optional)
- Street - Campaign office address (optional)
- Street name - Campaign office address (optional)
- City - Campaign office address (optional)
- ProvinceTerritory- Campaign office address (optional)
- Postal code - Campaign office address (optional)
- Name of witness
- Full address of witness
- Name of candidate
- Electoral district
- Year
- Name of candidate2
- Electoral district2
- Year2
- Name of witness2
- Full address of witness2
- Name of candidate3
- Electoral district3
- Year3
- Full address of witness3
- Name of witness3
- Name of candidate 4
- Electoral district4
- Year4
- Full address of witness 4
- Name of witness 4
- Name of candidate5
- Electoral district5
- Year5
- Full address of witness5
- Name of witness5
- Name of candidate6
- Electoral district6
- Year6
- Name of witness6
- Full address of witness6
- Name of candidate7
- Electoral district7
- Year7
- Full address of witness7
- Name of witness7
- Name of candidate8
- Electoral district8
- Year8
- Full address of witness8
- Name of witness8
- Name of candidate9
- Electoral district9
- Year9
- Full address of witness 9
- Name of witness 9
- Name of candidate10
- Electoral district10
- Year10
- Full address of witness10
- Name of witness10
- Name of candidate11
- Electoral district11
- Year11
- Full address of witness11
- Name of witness11
- Name of candidate12
- Electoral district12
- Year12
- Full address of witness12
- Name of witness12
- Name of candidate13
- Electoral district13
- Year13
- Full address of witness13
- Name of witness13
- Name of candidate14
- Electoral district14
- Year14
- Name of witness14
- Full address of witness14
- Name of candidate1
- Electoral district1
- Year1
- Name of witness1
- Full address of witness1
- Name of candidate15
- Electoral district15
- Year15
- Name of witness15
- Full address of witness15
- unit -Mailing address
- Street -Mailing address
- Street name -Mailing address
- City -Mailing address
- ProvinceTerritory -Mailing address
- Postal code -Mailing address
- Unit - Mailing address -Campaign delegate
- Street - Mailing address -Campaign delegate
- Street name - Mailing address -Campaign delegate
- City - Mailing address -Campaign delegate
- ProvinceTerritory- Mailing address -Campaign delegate
- Postal code- Mailing address -Campaign delegate
- Unit -Mailing address - Official Agent
- Street -Mailing address - Official Agent
- Street name -Mailing address - Official Agent
- city -Mailing address - Official Agent
- ProvinceTerritory-Mailing address - Official Agent
- Postal code-Mailing address - Official Agent
ndash
EC 20010 (052019)
SECTION C ndash 4BOfficial Agent (Mandatory)
All fields marked with are mandatory
Official agent information
The official agent is responsible for administering the campaignrsquos financial transactions and reporting those transactions to Elections Canada as required by the CEA For more information consult the Political Financing Handbook for Candidates and Official Agents Note The candidate official agent and auditor must all be different people
First name Last name Language of correspondence
English French
Contact information
Upon confirmation of the nomination Elections Canada will send to the email address listed below an invitation to the Political Entities Service Centre (PESC) online portal
Primary phone number Ext Alternate phone number Ext Fax number
Residential address Unit Street Street name
City ProvinceTerritory Postal code
Mailing address Same as residential address
Unit Street Street name
City ProvinceTerritory Postal code
10
EC 20010 (052019)
24BSECTION C ndash Official Agent ndash Privacy Notice and Declaration (Mandatory)
All fields marked with are mandatory
Privacy notice
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA) Any person at the returning office may examine the completed Nomination Paper during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
Official agent signature
I the undersigned official agent for the candidate named in this Nomination Paper hereby agree to act as official agent for the candidate named herein for the purposes of the Canada Elections Act I further state that
1 I am fully aware of the duties and responsibilities imposed on me by the Canada Elections Act
2 I am capable of entering into contracts in the provinceterritory in which this electoral district is located
3 I am eligible to act as official agent pursuant to section 4772 of the Canada Elections Act
Section 4772 of the Canada Elections Act states The following persons are ineligible to be an official agenta candidate an election officer or a member of the staff of a returning office an undischarged bankrupt anauditor appointed as required by this Act a person who is not qualified as an elector and a person who doesnot have the capacity to enter into contracts in the province in which they ordinarily reside
Official agent signature Date (YYYY-MM-DD)
11
EC 20010 (052019)
SECTION D ndash 5B Auditor (Optional)
If appointing an auditor all fields marked with are mandatory
Auditor information An auditor must be appointed if bull the candidatersquos campaign accepts contributions of $10000 or more bull the candidatersquos campaign incurs expenses of $10000 or more or bull the candidate receives 10 or more of votes cast in the electoral district If at the time of filing the Nomination Paper none of the above applies you do not need to appoint an auditor though you may still choose to do so If the above requirements are later met you must appoint an auditor without delay A person or partnership who wants to act as a candidatersquos auditor must be or have every partner be recognized as a professional accountant under provincial or territorial legislation CEA 4773(1) For more information consult the Political Financing Handbook for Candidates and Official Agents
First name Last name Language of correspondence
English French
Contact information Upon confirmation of the nomination Elections Canada will send to the email address listed below an invitation to the Political Entities Service Centre (PESC) online portal
Primary phone number Ext Alternate phone number Ext Fax number
Auditor organizational information Name of firm Occupation of auditor Professional designation
CPA FCPA
Designation registration number Make cheque payable to
Address (where cheque is sent) Unit Street Street name
City ProvinceTerritory Postal code
12
EC 20010 (052019)
SECTION D ndash Auditor ndash Privacy Notice and Declaration (Optional)
If appointing an auditor all fields marked with are mandatory
Privacy notice
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA) Any person at the returning office may examine the completed Nomination Paper during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information
Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
Auditor signature
I the undersigned hereby agree to act as the auditor for the candidate named in this Nomination Paper I further state that I am aware of the duties and responsibilities of this position under the Canada Elections Act and I am qualified to act as auditor under subsection 4773(1) and (2) of the Canada Elections Act
Auditor signature Date (YYYY-MM-DD)
13
EC 20010 (052019)
SECTION E ndash 6BCampaign Office (Optional)
Contact information to be made available on the Elections Canada website (optional)
Please note You may provide a telephone number andor a link to your website or social media platform of choice when filing your Nomination Paper with Elections Canada You do not have to provide this information but it is intended to help electors access campaign information Elections Canada may provide this information as part of the Voter Information Service Please include the full website address including prefix (http https)
Telephone number to be posted on electionsca
Website to be posted on electionsca (including prefix http https)
Campaign office address (optional)
Unit Street Street name
City ProvinceTerritory Postal code
14
SECTION F ndash 7BElectors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
15
8BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
16
9BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
17
10BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
18
11BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
19
12BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
20
13BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
21
14BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
22
15BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
23
16BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
24
17BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
25
18BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
26
19BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
27
20BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
28
21BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
29
22BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
30
EC 20010 (022019)
SECTION G ndash 23B Are You Ready to Submit Your Nomination
Have you completed the Nomination Paper (EC 20010)
bull Are all mandatory fields in sections AndashE complete
bull Have you collected the required number of signatures from qualified electors in section F
o For most electoral districts 100 electors must consent to your candidacy
o For electoral districts identified in Schedule 3 only 50 electors are required
o To ensure a smooth nomination process Elections Canada recommends collecting signatures from at least 150 electors
Do you have authorized proof of identify
bull For a list of authorized identification visit the Elections Canada website
bull If a campaign delegate is submitting on your behalf they must bring a copy of your identification documents signed by you
bull If you want an alternative name to appear on the ballot additional documentation is required visit electionsca for details
Are you endorsed by a political party
bull Make sure your party has submitted the required documentation to Elections Canada attesting your designated political affiliation
Have you made a nomination appointment
bull To facilitate the nomination process make an appointment with the returning officer to finalize the filing of the complete nomination package
bull The nomination period closes 21 days before election day at 200 pm local time
31
- Nomination Paperof a Candidate at a Federal General Election or By-election
- Table of Contents
- General Information
- SECTION A ndash Candidate Information (Mandatory)
- SECTION B ndash Campaign Delegate (Optional)
- SECTION C ndash Official Agent (Mandatory)
- SECTION D ndash Auditor (Optional)
- SECTION E ndash Campaign Office (Optional)
- SECTION F ndash Electors Consenting to Candidacy (Mandatory)
-
- Name of electoral district
- Political affiliation
- Telephone number to be posted on electionsca
- Website to be posted on electionsca including prefix http https
- Printed name of elector1
- Full residential address street numbernamecity1
- Postal code1
- Elector signature1
- Witness initials1
- Internal use only1
- Printed name of elector2
- Full residential address street numbernamecity2
- Postal code2
- Elector signature2
- Witness initials2
- Internal use only2
- Printed name of elector3
- Full residential address street numbernamecity3
- Postal code3
- Elector signature3
- Witness initials3
- Internal use only3
- Printed name of elector4
- Full residential address street numbernamecity4
- Postal code4
- Elector signature4
- Witness initials4
- Internal use only4
- Printed name of elector5
- Full residential address street numbernamecity5
- Postal code5
- Elector signature5
- Witness initials5
- Internal use only5
- Printed name of elector6
- Full residential address street numbernamecity6
- Postal code6
- Elector signature6
- Witness initials6
- Internal use only6
- Printed name of elector7
- Full residential address street numbernamecity7
- Postal code7
- Elector signature7
- Witness initials7
- Internal use only7
- Printed name of elector8
- Full residential address street numbernamecity8
- Postal code8
- Elector signature8
- Witness initials8
- Internal use only8
- Printed name of elector9
- Full residential address street numbernamecity9
- Postal code9
- Elector signature9
- Witness initials9
- Internal use only9
- Printed name of elector10
- Full residential address street numbernamecity10
- Postal code10
- Elector signature10
- Witness initials10
- Internal use only10
- Printed name of elector1_2
- Full residential address street numbernamecity1_2
- Postal code1_2
- Elector signature1_2
- Witness initials1_2
- Internal use only1_2
- Printed name of elector2_2
- Full residential address street numbernamecity2_2
- Postal code2_2
- Elector signature2_2
- Witness initials2_2
- Internal use only2_2
- Printed name of elector3_2
- Full residential address street numbernamecity3_2
- Postal code3_2
- Elector signature3_2
- Witness initials3_2
- Internal use only3_2
- Printed name of elector4_2
- Full residential address street numbernamecity4_2
- Postal code4_2
- Elector signature4_2
- Witness initials4_2
- Internal use only4_2
- Printed name of elector5_2
- Full residential address street numbernamecity5_2
- Postal code5_2
- Elector signature5_2
- Witness initials5_2
- Internal use only5_2
- Printed name of elector6_2
- Full residential address street numbernamecity6_2
- Postal code6_2
- Elector signature6_2
- Witness initials6_2
- Internal use only6_2
- Printed name of elector7_2
- Full residential address street numbernamecity7_2
- Postal code7_2
- Elector signature7_2
- Witness initials7_2
- Internal use only7_2
- Printed name of elector8_2
- Full residential address street numbernamecity8_2
- Postal code8_2
- Elector signature8_2
- Witness initials8_2
- Internal use only8_2
- Printed name of elector9_2
- Full residential address street numbernamecity9_2
- Postal code9_2
- Elector signature9_2
- Witness initials9_2
- Internal use only9_2
- Printed name of elector10_2
- Full residential address street numbernamecity10_2
- Postal code10_2
- Elector signature10_2
- Witness initials10_2
- Internal use only10_2
- Printed name of elector1_3
- Full residential address street numbernamecity1_3
- Postal code1_3
- Elector signature1_3
- Witness initials1_3
- Internal use only1_3
- Printed name of elector2_3
- Full residential address street numbernamecity2_3
- Postal code2_3
- Elector signature2_3
- Witness initials2_3
- Internal use only2_3
- Printed name of elector3_3
- Full residential address street numbernamecity3_3
- Postal code3_3
- Elector signature3_3
- Witness initials3_3
- Internal use only3_3
- Printed name of elector4_3
- Full residential address street numbernamecity4_3
- Postal code4_3
- Elector signature4_3
- Witness initials4_3
- Internal use only4_3
- Printed name of elector5_3
- Full residential address street numbernamecity5_3
- Postal code5_3
- Elector signature5_3
- Witness initials5_3
- Internal use only5_3
- Printed name of elector6_3
- Full residential address street numbernamecity6_3
- Postal code6_3
- Elector signature6_3
- Witness initials6_3
- Internal use only6_3
- Printed name of elector7_3
- Full residential address street numbernamecity7_3
- Postal code7_3
- Elector signature7_3
- Witness initials7_3
- Internal use only7_3
- Printed name of elector8_3
- Full residential address street numbernamecity8_3
- Postal code8_3
- Elector signature8_3
- Witness initials8_3
- Internal use only8_3
- Printed name of elector9_3
- Full residential address street numbernamecity9_3
- Postal code9_3
- Elector signature9_3
- Witness initials9_3
- Internal use only9_3
- Printed name of elector10_3
- Full residential address street numbernamecity10_3
- Postal code10_3
- Elector signature10_3
- Witness initials10_3
- Internal use only10_3
- Printed name of elector1_4
- Full residential address street numbernamecity1_4
- Postal code1_4
- Elector signature1_4
- Witness initials1_4
- Internal use only1_4
- Printed name of elector2_4
- Full residential address street numbernamecity2_4
- Postal code2_4
- Elector signature2_4
- Witness initials2_4
- Internal use only2_4
- Printed name of elector3_4
- Full residential address street numbernamecity3_4
- Postal code3_4
- Elector signature3_4
- Witness initials3_4
- Internal use only3_4
- Printed name of elector4_4
- Full residential address street numbernamecity4_4
- Postal code4_4
- Elector signature4_4
- Witness initials4_4
- Internal use only4_4
- Printed name of elector5_4
- Full residential address street numbernamecity5_4
- Postal code5_4
- Elector signature5_4
- Witness initials5_4
- Internal use only5_4
- Printed name of elector6_4
- Full residential address street numbernamecity6_4
- Postal code6_4
- Elector signature6_4
- Witness initials6_4
- Internal use only6_4
- Printed name of elector7_4
- Full residential address street numbernamecity7_4
- Postal code7_4
- Elector signature7_4
- Witness initials7_4
- Internal use only7_4
- Printed name of elector8_4
- Full residential address street numbernamecity8_4
- Postal code8_4
- Elector signature8_4
- Witness initials8_4
- Internal use only8_4
- Printed name of elector9_4
- Full residential address street numbernamecity9_4
- Postal code9_4
- Elector signature9_4
- Witness initials9_4
- Internal use only9_4
- Printed name of elector10_4
- Full residential address street numbernamecity10_4
- Postal code10_4
- Elector signature10_4
- Witness initials10_4
- Internal use only10_4
- Printed name of elector1_5
- Full residential address street numbernamecity1_5
- Postal code1_5
- Elector signature1_5
- Witness initials1_5
- Internal use only1_5
- Printed name of elector2_5
- Full residential address street numbernamecity2_5
- Postal code2_5
- Elector signature2_5
- Witness initials2_5
- Internal use only2_5
- Printed name of elector3_5
- Full residential address street numbernamecity3_5
- Postal code3_5
- Elector signature3_5
- Witness initials3_5
- Internal use only3_5
- Printed name of elector4_5
- Full residential address street numbernamecity4_5
- Postal code4_5
- Elector signature4_5
- Witness initials4_5
- Internal use only4_5
- Printed name of elector5_5
- Full residential address street numbernamecity5_5
- Postal code5_5
- Elector signature5_5
- Witness initials5_5
- Internal use only5_5
- Printed name of elector6_5
- Full residential address street numbernamecity6_5
- Postal code6_5
- Elector signature6_5
- Witness initials6_5
- Internal use only6_5
- Printed name of elector7_5
- Full residential address street numbernamecity7_5
- Postal code7_5
- Elector signature7_5
- Witness initials7_5
- Internal use only7_5
- Printed name of elector8_5
- Full residential address street numbernamecity8_5
- Postal code8_5
- Elector signature8_5
- Witness initials8_5
- Internal use only8_5
- Printed name of elector9_5
- Full residential address street numbernamecity9_5
- Postal code9_5
- Elector signature9_5
- Witness initials9_5
- Internal use only9_5
- Printed name of elector10_5
- Full residential address street numbernamecity10_5
- Postal code10_5
- Elector signature10_5
- Witness initials10_5
- Internal use only10_5
- Printed name of elector1_6
- Full residential address street numbernamecity1_6
- Postal code1_6
- Elector signature1_6
- Witness initials1_6
- Internal use only1_6
- Printed name of elector2_6
- Full residential address street numbernamecity2_6
- Postal code2_6
- Elector signature2_6
- Witness initials2_6
- Internal use only2_6
- Printed name of elector3_6
- Full residential address street numbernamecity3_6
- Postal code3_6
- Elector signature3_6
- Witness initials3_6
- Internal use only3_6
- Printed name of elector4_6
- Full residential address street numbernamecity4_6
- Postal code4_6
- Elector signature4_6
- Witness initials4_6
- Internal use only4_6
- Printed name of elector5_6
- Full residential address street numbernamecity5_6
- Postal code5_6
- Elector signature5_6
- Witness initials5_6
- Internal use only5_6
- Printed name of elector6_6
- Full residential address street numbernamecity6_6
- Postal code6_6
- Elector signature6_6
- Witness initials6_6
- Internal use only6_6
- Printed name of elector7_6
- Full residential address street numbernamecity7_6
- Postal code7_6
- Elector signature7_6
- Witness initials7_6
- Internal use only7_6
- Printed name of elector8_6
- Full residential address street numbernamecity8_6
- Postal code8_6
- Elector signature8_6
- Witness initials8_6
- Internal use only8_6
- Printed name of elector9_6
- Full residential address street numbernamecity9_6
- Postal code9_6
- Elector signature9_6
- Witness initials9_6
- Internal use only9_6
- Printed name of elector10_6
- Full residential address street numbernamecity10_6
- Postal code10_6
- Elector signature10_6
- Witness initials10_6
- Internal use only10_6
- Printed name of elector1_7
- Full residential address street numbernamecity1_7
- Postal code1_7
- Elector signature1_7
- Witness initials1_7
- Internal use only1_7
- Printed name of elector2_7
- Full residential address street numbernamecity2_7
- Postal code2_7
- Elector signature2_7
- Witness initials2_7
- Internal use only2_7
- Printed name of elector3_7
- Full residential address street numbernamecity3_7
- Postal code3_7
- Elector signature3_7
- Witness initials3_7
- Internal use only3_7
- Printed name of elector4_7
- Full residential address street numbernamecity4_7
- Postal code4_7
- Elector signature4_7
- Witness initials4_7
- Internal use only4_7
- Printed name of elector5_7
- Full residential address street numbernamecity5_7
- Postal code5_7
- Elector signature5_7
- Witness initials5_7
- Internal use only5_7
- Printed name of elector6_7
- Full residential address street numbernamecity6_7
- Postal code6_7
- Elector signature6_7
- Witness initials6_7
- Internal use only6_7
- Printed name of elector7_7
- Full residential address street numbernamecity7_7
- Postal code7_7
- Elector signature7_7
- Witness initials7_7
- Internal use only7_7
- Printed name of elector8_7
- Full residential address street numbernamecity8_7
- Postal code8_7
- Elector signature8_7
- Witness initials8_7
- Internal use only8_7
- Printed name of elector9_7
- Full residential address street numbernamecity9_7
- Postal code9_7
- Elector signature9_7
- Witness initials9_7
- Internal use only9_7
- Printed name of elector10_7
- Full residential address street numbernamecity10_7
- Postal code10_7
- Elector signature10_7
- Witness initials10_7
- Internal use only10_7
- Printed name of elector1_8
- Full residential address street numbernamecity1_8
- Postal code1_8
- Elector signature1_8
- Witness initials1_8
- Internal use only1_8
- Printed name of elector2_8
- Full residential address street numbernamecity2_8
- Postal code2_8
- Elector signature2_8
- Witness initials2_8
- Internal use only2_8
- Printed name of elector3_8
- Full residential address street numbernamecity3_8
- Postal code3_8
- Elector signature3_8
- Witness initials3_8
- Internal use only3_8
- Printed name of elector4_8
- Full residential address street numbernamecity4_8
- Postal code4_8
- Elector signature4_8
- Witness initials4_8
- Internal use only4_8
- Printed name of elector5_8
- Full residential address street numbernamecity5_8
- Postal code5_8
- Elector signature5_8
- Witness initials5_8
- Internal use only5_8
- Printed name of elector6_8
- Full residential address street numbernamecity6_8
- Postal code6_8
- Elector signature6_8
- Witness initials6_8
- Internal use only6_8
- Printed name of elector7_8
- Full residential address street numbernamecity7_8
- Postal code7_8
- Elector signature7_8
- Witness initials7_8
- Internal use only7_8
- Printed name of elector8_8
- Full residential address street numbernamecity8_8
- Postal code8_8
- Elector signature8_8
- Witness initials8_8
- Internal use only8_8
- Printed name of elector9_8
- Full residential address street numbernamecity9_8
- Postal code9_8
- Elector signature9_8
- Witness initials9_8
- Internal use only9_8
- Printed name of elector10_8
- Full residential address street numbernamecity10_8
- Postal code10_8
- Elector signature10_8
- Witness initials10_8
- Internal use only10_8
- Printed name of elector1_9
- Full residential address street numbernamecity1_9
- Postal code1_9
- Elector signature1_9
- Witness initials1_9
- Internal use only1_9
- Printed name of elector2_9
- Full residential address street numbernamecity2_9
- Postal code2_9
- Elector signature2_9
- Witness initials2_9
- Internal use only2_9
- Printed name of elector3_9
- Full residential address street numbernamecity3_9
- Postal code3_9
- Elector signature3_9
- Witness initials3_9
- Internal use only3_9
- Printed name of elector4_9
- Full residential address street numbernamecity4_9
- Postal code4_9
- Elector signature4_9
- Witness initials4_9
- Internal use only4_9
- Printed name of elector5_9
- Full residential address street numbernamecity5_9
- Postal code5_9
- Elector signature5_9
- Witness initials5_9
- Internal use only5_9
- Printed name of elector6_9
- Full residential address street numbernamecity6_9
- Postal code6_9
- Elector signature6_9
- Witness initials6_9
- Internal use only6_9
- Printed name of elector7_9
- Full residential address street numbernamecity7_9
- Postal code7_9
- Elector signature7_9
- Witness initials7_9
- Internal use only7_9
- Printed name of elector8_9
- Full residential address street numbernamecity8_9
- Postal code8_9
- Elector signature8_9
- Witness initials8_9
- Internal use only8_9
- Printed name of elector9_9
- Full residential address street numbernamecity9_9
- Postal code9_9
- Elector signature9_9
- Witness initials9_9
- Internal use only9_9
- Printed name of elector10_9
- Full residential address street numbernamecity10_9
- Postal code10_9
- Elector signature10_9
- Witness initials10_9
- Internal use only10_9
- Printed name of elector1_10
- Full residential address street numbernamecity1_10
- Postal code1_10
- Elector signature1_10
- Witness initials1_10
- Internal use only1_10
- Printed name of elector2_10
- Full residential address street numbernamecity2_10
- Postal code2_10
- Elector signature2_10
- Witness initials2_10
- Internal use only2_10
- Printed name of elector3_10
- Full residential address street numbernamecity3_10
- Postal code3_10
- Elector signature3_10
- Witness initials3_10
- Internal use only3_10
- Printed name of elector4_10
- Full residential address street numbernamecity4_10
- Postal code4_10
- Elector signature4_10
- Witness initials4_10
- Internal use only4_10
- Printed name of elector5_10
- Full residential address street numbernamecity5_10
- Postal code5_10
- Elector signature5_10
- Witness initials5_10
- Internal use only5_10
- Printed name of elector6_10
- Full residential address street numbernamecity6_10
- Postal code6_10
- Elector signature6_10
- Witness initials6_10
- Internal use only6_10
- Printed name of elector7_10
- Full residential address street numbernamecity7_10
- Postal code7_10
- Elector signature7_10
- Witness initials7_10
- Internal use only7_10
- Printed name of elector8_10
- Full residential address street numbernamecity8_10
- Postal code8_10
- Elector signature8_10
- Witness initials8_10
- Internal use only8_10
- Printed name of elector9_10
- Full residential address street numbernamecity9_10
- Postal code9_10
- Elector signature9_10
- Witness initials9_10
- Internal use only9_10
- Printed name of elector10_10
- Full residential address street numbernamecity10_10
- Postal code10_10
- Elector signature10_10
- Witness initials10_10
- Internal use only10_10
- Printed name of elector1_11
- Full residential address street numbernamecity1_11
- Postal code1_11
- Elector signature1_11
- Witness initials1_11
- Internal use only1_11
- Printed name of elector2_11
- Full residential address street numbernamecity2_11
- Postal code2_11
- Elector signature2_11
- Witness initials2_11
- Internal use only2_11
- Printed name of elector3_11
- Full residential address street numbernamecity3_11
- Postal code3_11
- Elector signature3_11
- Witness initials3_11
- Internal use only3_11
- Printed name of elector4_11
- Full residential address street numbernamecity4_11
- Postal code4_11
- Elector signature4_11
- Witness initials4_11
- Internal use only4_11
- Printed name of elector5_11
- Full residential address street numbernamecity5_11
- Postal code5_11
- Elector signature5_11
- Witness initials5_11
- Internal use only5_11
- Printed name of elector6_11
- Full residential address street numbernamecity6_11
- Postal code6_11
- Elector signature6_11
- Witness initials6_11
- Internal use only6_11
- Printed name of elector7_11
- Full residential address street numbernamecity7_11
- Postal code7_11
- Elector signature7_11
- Witness initials7_11
- Internal use only7_11
- Printed name of elector8_11
- Full residential address street numbernamecity8_11
- Postal code8_11
- Elector signature8_11
- Witness initials8_11
- Internal use only8_11
- Printed name of elector9_11
- Full residential address street numbernamecity9_11
- Postal code9_11
- Elector signature9_11
- Witness initials9_11
- Internal use only9_11
- Printed name of elector10_11
- Full residential address street numbernamecity10_11
- Postal code10_11
- Elector signature10_11
- Witness initials10_11
- Internal use only10_11
- Printed name of elector1_12
- Full residential address street numbernamecity1_12
- Postal code1_12
- Elector signature1_12
- Witness initials1_12
- Internal use only1_12
- Printed name of elector2_12
- Full residential address street numbernamecity2_12
- Postal code2_12
- Elector signature2_12
- Witness initials2_12
- Internal use only2_12
- Printed name of elector3_12
- Full residential address street numbernamecity3_12
- Postal code3_12
- Elector signature3_12
- Witness initials3_12
- Internal use only3_12
- Printed name of elector4_12
- Full residential address street numbernamecity4_12
- Postal code4_12
- Elector signature4_12
- Witness initials4_12
- Internal use only4_12
- Printed name of elector5_12
- Full residential address street numbernamecity5_12
- Postal code5_12
- Elector signature5_12
- Witness initials5_12
- Internal use only5_12
- Printed name of elector6_12
- Full residential address street numbernamecity6_12
- Postal code6_12
- Elector signature6_12
- Witness initials6_12
- Internal use only6_12
- Printed name of elector7_12
- Full residential address street numbernamecity7_12
- Postal code7_12
- Elector signature7_12
- Witness initials7_12
- Internal use only7_12
- Printed name of elector8_12
- Full residential address street numbernamecity8_12
- Postal code8_12
- Elector signature8_12
- Witness initials8_12
- Internal use only8_12
- Printed name of elector9_12
- Full residential address street numbernamecity9_12
- Postal code9_12
- Elector signature9_12
- Witness initials9_12
- Internal use only9_12
- Printed name of elector10_12
- Full residential address street numbernamecity10_12
- Postal code10_12
- Elector signature10_12
- Witness initials10_12
- Internal use only10_12
- Printed name of elector1_13
- Full residential address street numbernamecity1_13
- Postal code1_13
- Elector signature1_13
- Witness initials1_13
- Internal use only1_13
- Printed name of elector2_13
- Full residential address street numbernamecity2_13
- Postal code2_13
- Elector signature2_13
- Witness initials2_13
- Internal use only2_13
- Printed name of elector3_13
- Full residential address street numbernamecity3_13
- Postal code3_13
- Elector signature3_13
- Witness initials3_13
- Internal use only3_13
- Printed name of elector4_13
- Full residential address street numbernamecity4_13
- Postal code4_13
- Elector signature4_13
- Witness initials4_13
- Internal use only4_13
- Printed name of elector5_13
- Full residential address street numbernamecity5_13
- Postal code5_13
- Elector signature5_13
- Witness initials5_13
- Internal use only5_13
- Printed name of elector6_13
- Full residential address street numbernamecity6_13
- Postal code6_13
- Elector signature6_13
- Witness initials6_13
- Internal use only6_13
- Printed name of elector7_13
- Full residential address street numbernamecity7_13
- Postal code7_13
- Elector signature7_13
- Witness initials7_13
- Internal use only7_13
- Printed name of elector8_13
- Full residential address street numbernamecity8_13
- Postal code8_13
- Elector signature8_13
- Witness initials8_13
- Internal use only8_13
- Printed name of elector9_13
- Full residential address street numbernamecity9_13
- Postal code9_13
- Elector signature9_13
- Witness initials9_13
- Internal use only9_13
- Printed name of elector10_13
- Full residential address street numbernamecity10_13
- Postal code10_13
- Elector signature10_13
- Witness initials10_13
- Internal use only10_13
- Printed name of elector1_14
- Full residential address street numbernamecity1_14
- Postal code1_14
- Elector signature1_14
- Witness initials1_14
- Internal use only1_14
- Printed name of elector2_14
- Full residential address street numbernamecity2_14
- Postal code2_14
- Elector signature2_14
- Witness initials2_14
- Internal use only2_14
- Printed name of elector3_14
- Full residential address street numbernamecity3_14
- Postal code3_14
- Elector signature3_14
- Witness initials3_14
- Internal use only3_14
- Printed name of elector4_14
- Full residential address street numbernamecity4_14
- Postal code4_14
- Elector signature4_14
- Witness initials4_14
- Internal use only4_14
- Printed name of elector5_14
- Full residential address street numbernamecity5_14
- Postal code5_14
- Elector signature5_14
- Witness initials5_14
- Internal use only5_14
- Printed name of elector6_14
- Full residential address street numbernamecity6_14
- Postal code6_14
- Elector signature6_14
- Witness initials6_14
- Internal use only6_14
- Printed name of elector7_14
- Full residential address street numbernamecity7_14
- Postal code7_14
- Elector signature7_14
- Witness initials7_14
- Internal use only7_14
- Printed name of elector8_14
- Full residential address street numbernamecity8_14
- Postal code8_14
- Elector signature8_14
- Witness initials8_14
- Internal use only8_14
- Printed name of elector9_14
- Full residential address street numbernamecity9_14
- Postal code9_14
- Elector signature9_14
- Witness initials9_14
- Internal use only9_14
- Printed name of elector10_14
- Full residential address street numbernamecity10_14
- Postal code10_14
- Elector signature10_14
- Witness initials10_14
- Internal use only10_14
- Printed name of elector1_15
- Full residential address street numbernamecity1_15
- Postal code1_15
- Elector signature1_15
- Witness initials1_15
- Internal use only1_15
- Printed name of elector2_15
- Full residential address street numbernamecity2_15
- Postal code2_15
- Elector signature2_15
- Witness initials2_15
- Internal use only2_15
- Printed name of elector3_15
- Full residential address street numbernamecity3_15
- Postal code3_15
- Elector signature3_15
- Witness initials3_15
- Internal use only3_15
- Printed name of elector4_15
- Full residential address street numbernamecity4_15
- Postal code4_15
- Elector signature4_15
- Witness initials4_15
- Internal use only4_15
- Printed name of elector5_15
- Full residential address street numbernamecity5_15
- Postal code5_15
- Elector signature5_15
- Witness initials5_15
- Internal use only5_15
- Printed name of elector6_15
- Full residential address street numbernamecity6_15
- Postal code6_15
- Elector signature6_15
- Witness initials6_15
- Internal use only6_15
- Printed name of elector7_15
- Full residential address street numbernamecity7_15
- Postal code7_15
- Elector signature7_15
- Witness initials7_15
- Internal use only7_15
- Printed name of elector8_15
- Full residential address street numbernamecity8_15
- Postal code8_15
- Elector signature8_15
- Witness initials8_15
- Internal use only8_15
- Printed name of elector9_15
- Full residential address street numbernamecity9_15
- Postal code9_15
- Elector signature9_15
- Witness initials9_15
- Internal use only9_15
- Printed name of elector10_15
- Full residential address street numbernamecity10_15
- Postal code10_15
- Elector signature10_15
- Witness initials10_15
- Internal use only10_15
- Printed name of elector1_16
- Full residential address street numbernamecity1_16
- Postal code1_16
- Elector signature1_16
- Witness initials1_16
- Internal use only1_16
- Printed name of elector2_16
- Full residential address street numbernamecity2_16
- Postal code2_16
- Elector signature2_16
- Witness initials2_16
- Internal use only2_16
- Printed name of elector3_16
- Full residential address street numbernamecity3_16
- Postal code3_16
- Elector signature3_16
- Witness initials3_16
- Internal use only3_16
- Printed name of elector4_16
- Full residential address street numbernamecity4_16
- Postal code4_16
- Elector signature4_16
- Witness initials4_16
- Internal use only4_16
- Printed name of elector5_16
- Full residential address street numbernamecity5_16
- Postal code5_16
- Elector signature5_16
- Witness initials5_16
- Internal use only5_16
- Printed name of elector6_16
- Full residential address street numbernamecity6_16
- Postal code6_16
- Elector signature6_16
- Witness initials6_16
- Internal use only6_16
- Printed name of elector7_16
- Full residential address street numbernamecity7_16
- Postal code7_16
- Elector signature7_16
- Witness initials7_16
- Internal use only7_16
- Printed name of elector8_16
- Full residential address street numbernamecity8_16
- Postal code8_16
- Elector signature8_16
- Witness initials8_16
- Internal use only8_16
- Printed name of elector9_16
- Full residential address street numbernamecity9_16
- Postal code9_16
- Elector signature9_16
- Witness initials9_16
- Internal use only9_16
- Printed name of elector10_16
- Full residential address street numbernamecity10_16
- Postal code10_16
- Elector signature10_16
- Witness initials10_16
- Internal use only10_16
- Have you completed the Nomination Paper EC 20010 Off
- Do you have authorized proof of identify Off
- Are you endorsed by a political party Off
- Have you made a nomination appointment Off
- Last name - Candidate Name
- First name - Candidate Name
- Name of electoral district- Candidate Information
- First name - Candidate Information
- Last name - Candidate Information
- Ballot Name Off
- Ballot First name(s)
- Ballot Last name(s)
- Gender -Candidate information
- Date of birth (YYY-MM-DD) - Gender -Candidate information
- language of correspondence - Candidate information Off
- Email -Contact information
- Primary phone number - Contact information
- Ext - Primary phone number
- Alternate phone number - Contact information
- Ext - Alternate phone number
- Fax number- Alternate phone number
- Unit -Residential address
- Street -Residential address
- Street name -Residential address
- City -Residential address
- ProvinceTerritory -Residential address
- Postal code - -Residential address
- Mailing address - same as residential address Off
- Occupation- Candidate occupation
- Sharing of information with the Conflict of Interest and Ethics Commissioner and the House of Commons including the Library of Parliament Off
- where applicable if the returning officer is unable to verify that I have been endorsed by the political party identified in section A of this Nomination Paper I wish to Off
- Date of Signature (YYYY-MM-DD) - Candidate signature
- Date of Signature (YYYY-MM-DD) -Signature of person receiving the solemn declaration
- Campaign delegate information
- First name - Campaign delegate information
- Last name - Campaign delegate information
- Language of correspondence - Campaign delegate information Off
- Email - Contact information -Campaign Delegate
- Primary phone number - Contact information -Campaign Delegate
- Primary phone number EXT - Contact information -Campaign Delegate
- Alternate phone number - Contact information -Campaign Delegate
- Alternate phone number EXT - Contact information -Campaign Delegate
- Fax nmuber- Contact information -Campaign Delegate
- Street - Residential address -Campaign delegate
- Street name - Residential address -Campaign delegate
- City - Residential address -Campaign delegate
- ProvinceTerritory - Residential address -Campaign delegate
- Postal Code - Residential address -Campaign delegate
- Campaign delegate - Mailing address ndash Same as residential address Off
- Unit - Residential address -Campaign delegate
- Date (YYYY-MM-DD) - Candidate authorization Signature
- Date (YYYY-MM-DD) - Candidate campaign Signature
- First name - Official agent information
- Last name - Official agent information
- Language of correspondence - Official agent information Off
- Email - Official agent information
- Primary phone number - Official agent information
- Primary phone number EXT - Official agent information
- Alternate phone number EXT - Official agent information
- Alternate phone number - Official agent information
- Fax number - Official agent information
- Unit -Residential address - Official Agent
- Street name -Residential address - Official Agent
- City -Residential address - Official Agent
- Street -Residential address - Official Agent
- ProvinceTerritory -Residential address - Official Agent
- Postal code-Residential address - Official Agent
- Mailing address ndash Same as residential address- Official Agent Off
- Date (YYYY-MM-DD) - Official agent signature
- First name - Auditor information
- Last name - Auditor information
- Language of correspondence - Auditor information Off
- Email - Auditor information
- Primary phone number - Auditor information
- Primary phone number EXT- Auditor information
- Alternate phone number - Auditor information
- Alternate phone number EXT- Auditor information
- Fax number - Auditor information
- Name of firm- Auditor organizational information
- Occupation of auditor - Auditor organizational information
- Professional designation - Auditor organizational information Off
- Designation registration number
- Make cheque payable to
- Unit - Address (where cheque is sent)
- Street - Address (where cheque is sent)
- Street name - Address (where cheque is sent)
- City - Address (where cheque is sent)
- ProvinceTerritory - Address (where cheque is sent)
- Postal code - Address (where cheque is sent)
- Date (YYY-MM-DD) - Auditor signature
- Unit - Campaign office address (optional)
- Street - Campaign office address (optional)
- Street name - Campaign office address (optional)
- City - Campaign office address (optional)
- ProvinceTerritory- Campaign office address (optional)
- Postal code - Campaign office address (optional)
- Name of witness
- Full address of witness
- Name of candidate
- Electoral district
- Year
- Name of candidate2
- Electoral district2
- Year2
- Name of witness2
- Full address of witness2
- Name of candidate3
- Electoral district3
- Year3
- Full address of witness3
- Name of witness3
- Name of candidate 4
- Electoral district4
- Year4
- Full address of witness 4
- Name of witness 4
- Name of candidate5
- Electoral district5
- Year5
- Full address of witness5
- Name of witness5
- Name of candidate6
- Electoral district6
- Year6
- Name of witness6
- Full address of witness6
- Name of candidate7
- Electoral district7
- Year7
- Full address of witness7
- Name of witness7
- Name of candidate8
- Electoral district8
- Year8
- Full address of witness8
- Name of witness8
- Name of candidate9
- Electoral district9
- Year9
- Full address of witness 9
- Name of witness 9
- Name of candidate10
- Electoral district10
- Year10
- Full address of witness10
- Name of witness10
- Name of candidate11
- Electoral district11
- Year11
- Full address of witness11
- Name of witness11
- Name of candidate12
- Electoral district12
- Year12
- Full address of witness12
- Name of witness12
- Name of candidate13
- Electoral district13
- Year13
- Full address of witness13
- Name of witness13
- Name of candidate14
- Electoral district14
- Year14
- Name of witness14
- Full address of witness14
- Name of candidate1
- Electoral district1
- Year1
- Name of witness1
- Full address of witness1
- Name of candidate15
- Electoral district15
- Year15
- Name of witness15
- Full address of witness15
- unit -Mailing address
- Street -Mailing address
- Street name -Mailing address
- City -Mailing address
- ProvinceTerritory -Mailing address
- Postal code -Mailing address
- Unit - Mailing address -Campaign delegate
- Street - Mailing address -Campaign delegate
- Street name - Mailing address -Campaign delegate
- City - Mailing address -Campaign delegate
- ProvinceTerritory- Mailing address -Campaign delegate
- Postal code- Mailing address -Campaign delegate
- Unit -Mailing address - Official Agent
- Street -Mailing address - Official Agent
- Street name -Mailing address - Official Agent
- city -Mailing address - Official Agent
- ProvinceTerritory-Mailing address - Official Agent
- Postal code-Mailing address - Official Agent
EC 20010 (052019)
24BSECTION C ndash Official Agent ndash Privacy Notice and Declaration (Mandatory)
All fields marked with are mandatory
Privacy notice
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA) Any person at the returning office may examine the completed Nomination Paper during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
Official agent signature
I the undersigned official agent for the candidate named in this Nomination Paper hereby agree to act as official agent for the candidate named herein for the purposes of the Canada Elections Act I further state that
1 I am fully aware of the duties and responsibilities imposed on me by the Canada Elections Act
2 I am capable of entering into contracts in the provinceterritory in which this electoral district is located
3 I am eligible to act as official agent pursuant to section 4772 of the Canada Elections Act
Section 4772 of the Canada Elections Act states The following persons are ineligible to be an official agenta candidate an election officer or a member of the staff of a returning office an undischarged bankrupt anauditor appointed as required by this Act a person who is not qualified as an elector and a person who doesnot have the capacity to enter into contracts in the province in which they ordinarily reside
Official agent signature Date (YYYY-MM-DD)
11
EC 20010 (052019)
SECTION D ndash 5B Auditor (Optional)
If appointing an auditor all fields marked with are mandatory
Auditor information An auditor must be appointed if bull the candidatersquos campaign accepts contributions of $10000 or more bull the candidatersquos campaign incurs expenses of $10000 or more or bull the candidate receives 10 or more of votes cast in the electoral district If at the time of filing the Nomination Paper none of the above applies you do not need to appoint an auditor though you may still choose to do so If the above requirements are later met you must appoint an auditor without delay A person or partnership who wants to act as a candidatersquos auditor must be or have every partner be recognized as a professional accountant under provincial or territorial legislation CEA 4773(1) For more information consult the Political Financing Handbook for Candidates and Official Agents
First name Last name Language of correspondence
English French
Contact information Upon confirmation of the nomination Elections Canada will send to the email address listed below an invitation to the Political Entities Service Centre (PESC) online portal
Primary phone number Ext Alternate phone number Ext Fax number
Auditor organizational information Name of firm Occupation of auditor Professional designation
CPA FCPA
Designation registration number Make cheque payable to
Address (where cheque is sent) Unit Street Street name
City ProvinceTerritory Postal code
12
EC 20010 (052019)
SECTION D ndash Auditor ndash Privacy Notice and Declaration (Optional)
If appointing an auditor all fields marked with are mandatory
Privacy notice
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA) Any person at the returning office may examine the completed Nomination Paper during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information
Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
Auditor signature
I the undersigned hereby agree to act as the auditor for the candidate named in this Nomination Paper I further state that I am aware of the duties and responsibilities of this position under the Canada Elections Act and I am qualified to act as auditor under subsection 4773(1) and (2) of the Canada Elections Act
Auditor signature Date (YYYY-MM-DD)
13
EC 20010 (052019)
SECTION E ndash 6BCampaign Office (Optional)
Contact information to be made available on the Elections Canada website (optional)
Please note You may provide a telephone number andor a link to your website or social media platform of choice when filing your Nomination Paper with Elections Canada You do not have to provide this information but it is intended to help electors access campaign information Elections Canada may provide this information as part of the Voter Information Service Please include the full website address including prefix (http https)
Telephone number to be posted on electionsca
Website to be posted on electionsca (including prefix http https)
Campaign office address (optional)
Unit Street Street name
City ProvinceTerritory Postal code
14
SECTION F ndash 7BElectors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
15
8BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
16
9BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
17
10BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
18
11BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
19
12BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
20
13BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
21
14BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
22
15BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
23
16BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
24
17BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
25
18BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
26
19BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
27
20BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
28
21BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
29
22BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
30
EC 20010 (022019)
SECTION G ndash 23B Are You Ready to Submit Your Nomination
Have you completed the Nomination Paper (EC 20010)
bull Are all mandatory fields in sections AndashE complete
bull Have you collected the required number of signatures from qualified electors in section F
o For most electoral districts 100 electors must consent to your candidacy
o For electoral districts identified in Schedule 3 only 50 electors are required
o To ensure a smooth nomination process Elections Canada recommends collecting signatures from at least 150 electors
Do you have authorized proof of identify
bull For a list of authorized identification visit the Elections Canada website
bull If a campaign delegate is submitting on your behalf they must bring a copy of your identification documents signed by you
bull If you want an alternative name to appear on the ballot additional documentation is required visit electionsca for details
Are you endorsed by a political party
bull Make sure your party has submitted the required documentation to Elections Canada attesting your designated political affiliation
Have you made a nomination appointment
bull To facilitate the nomination process make an appointment with the returning officer to finalize the filing of the complete nomination package
bull The nomination period closes 21 days before election day at 200 pm local time
31
- Nomination Paperof a Candidate at a Federal General Election or By-election
- Table of Contents
- General Information
- SECTION A ndash Candidate Information (Mandatory)
- SECTION B ndash Campaign Delegate (Optional)
- SECTION C ndash Official Agent (Mandatory)
- SECTION D ndash Auditor (Optional)
- SECTION E ndash Campaign Office (Optional)
- SECTION F ndash Electors Consenting to Candidacy (Mandatory)
-
- Name of electoral district
- Political affiliation
- Telephone number to be posted on electionsca
- Website to be posted on electionsca including prefix http https
- Printed name of elector1
- Full residential address street numbernamecity1
- Postal code1
- Elector signature1
- Witness initials1
- Internal use only1
- Printed name of elector2
- Full residential address street numbernamecity2
- Postal code2
- Elector signature2
- Witness initials2
- Internal use only2
- Printed name of elector3
- Full residential address street numbernamecity3
- Postal code3
- Elector signature3
- Witness initials3
- Internal use only3
- Printed name of elector4
- Full residential address street numbernamecity4
- Postal code4
- Elector signature4
- Witness initials4
- Internal use only4
- Printed name of elector5
- Full residential address street numbernamecity5
- Postal code5
- Elector signature5
- Witness initials5
- Internal use only5
- Printed name of elector6
- Full residential address street numbernamecity6
- Postal code6
- Elector signature6
- Witness initials6
- Internal use only6
- Printed name of elector7
- Full residential address street numbernamecity7
- Postal code7
- Elector signature7
- Witness initials7
- Internal use only7
- Printed name of elector8
- Full residential address street numbernamecity8
- Postal code8
- Elector signature8
- Witness initials8
- Internal use only8
- Printed name of elector9
- Full residential address street numbernamecity9
- Postal code9
- Elector signature9
- Witness initials9
- Internal use only9
- Printed name of elector10
- Full residential address street numbernamecity10
- Postal code10
- Elector signature10
- Witness initials10
- Internal use only10
- Printed name of elector1_2
- Full residential address street numbernamecity1_2
- Postal code1_2
- Elector signature1_2
- Witness initials1_2
- Internal use only1_2
- Printed name of elector2_2
- Full residential address street numbernamecity2_2
- Postal code2_2
- Elector signature2_2
- Witness initials2_2
- Internal use only2_2
- Printed name of elector3_2
- Full residential address street numbernamecity3_2
- Postal code3_2
- Elector signature3_2
- Witness initials3_2
- Internal use only3_2
- Printed name of elector4_2
- Full residential address street numbernamecity4_2
- Postal code4_2
- Elector signature4_2
- Witness initials4_2
- Internal use only4_2
- Printed name of elector5_2
- Full residential address street numbernamecity5_2
- Postal code5_2
- Elector signature5_2
- Witness initials5_2
- Internal use only5_2
- Printed name of elector6_2
- Full residential address street numbernamecity6_2
- Postal code6_2
- Elector signature6_2
- Witness initials6_2
- Internal use only6_2
- Printed name of elector7_2
- Full residential address street numbernamecity7_2
- Postal code7_2
- Elector signature7_2
- Witness initials7_2
- Internal use only7_2
- Printed name of elector8_2
- Full residential address street numbernamecity8_2
- Postal code8_2
- Elector signature8_2
- Witness initials8_2
- Internal use only8_2
- Printed name of elector9_2
- Full residential address street numbernamecity9_2
- Postal code9_2
- Elector signature9_2
- Witness initials9_2
- Internal use only9_2
- Printed name of elector10_2
- Full residential address street numbernamecity10_2
- Postal code10_2
- Elector signature10_2
- Witness initials10_2
- Internal use only10_2
- Printed name of elector1_3
- Full residential address street numbernamecity1_3
- Postal code1_3
- Elector signature1_3
- Witness initials1_3
- Internal use only1_3
- Printed name of elector2_3
- Full residential address street numbernamecity2_3
- Postal code2_3
- Elector signature2_3
- Witness initials2_3
- Internal use only2_3
- Printed name of elector3_3
- Full residential address street numbernamecity3_3
- Postal code3_3
- Elector signature3_3
- Witness initials3_3
- Internal use only3_3
- Printed name of elector4_3
- Full residential address street numbernamecity4_3
- Postal code4_3
- Elector signature4_3
- Witness initials4_3
- Internal use only4_3
- Printed name of elector5_3
- Full residential address street numbernamecity5_3
- Postal code5_3
- Elector signature5_3
- Witness initials5_3
- Internal use only5_3
- Printed name of elector6_3
- Full residential address street numbernamecity6_3
- Postal code6_3
- Elector signature6_3
- Witness initials6_3
- Internal use only6_3
- Printed name of elector7_3
- Full residential address street numbernamecity7_3
- Postal code7_3
- Elector signature7_3
- Witness initials7_3
- Internal use only7_3
- Printed name of elector8_3
- Full residential address street numbernamecity8_3
- Postal code8_3
- Elector signature8_3
- Witness initials8_3
- Internal use only8_3
- Printed name of elector9_3
- Full residential address street numbernamecity9_3
- Postal code9_3
- Elector signature9_3
- Witness initials9_3
- Internal use only9_3
- Printed name of elector10_3
- Full residential address street numbernamecity10_3
- Postal code10_3
- Elector signature10_3
- Witness initials10_3
- Internal use only10_3
- Printed name of elector1_4
- Full residential address street numbernamecity1_4
- Postal code1_4
- Elector signature1_4
- Witness initials1_4
- Internal use only1_4
- Printed name of elector2_4
- Full residential address street numbernamecity2_4
- Postal code2_4
- Elector signature2_4
- Witness initials2_4
- Internal use only2_4
- Printed name of elector3_4
- Full residential address street numbernamecity3_4
- Postal code3_4
- Elector signature3_4
- Witness initials3_4
- Internal use only3_4
- Printed name of elector4_4
- Full residential address street numbernamecity4_4
- Postal code4_4
- Elector signature4_4
- Witness initials4_4
- Internal use only4_4
- Printed name of elector5_4
- Full residential address street numbernamecity5_4
- Postal code5_4
- Elector signature5_4
- Witness initials5_4
- Internal use only5_4
- Printed name of elector6_4
- Full residential address street numbernamecity6_4
- Postal code6_4
- Elector signature6_4
- Witness initials6_4
- Internal use only6_4
- Printed name of elector7_4
- Full residential address street numbernamecity7_4
- Postal code7_4
- Elector signature7_4
- Witness initials7_4
- Internal use only7_4
- Printed name of elector8_4
- Full residential address street numbernamecity8_4
- Postal code8_4
- Elector signature8_4
- Witness initials8_4
- Internal use only8_4
- Printed name of elector9_4
- Full residential address street numbernamecity9_4
- Postal code9_4
- Elector signature9_4
- Witness initials9_4
- Internal use only9_4
- Printed name of elector10_4
- Full residential address street numbernamecity10_4
- Postal code10_4
- Elector signature10_4
- Witness initials10_4
- Internal use only10_4
- Printed name of elector1_5
- Full residential address street numbernamecity1_5
- Postal code1_5
- Elector signature1_5
- Witness initials1_5
- Internal use only1_5
- Printed name of elector2_5
- Full residential address street numbernamecity2_5
- Postal code2_5
- Elector signature2_5
- Witness initials2_5
- Internal use only2_5
- Printed name of elector3_5
- Full residential address street numbernamecity3_5
- Postal code3_5
- Elector signature3_5
- Witness initials3_5
- Internal use only3_5
- Printed name of elector4_5
- Full residential address street numbernamecity4_5
- Postal code4_5
- Elector signature4_5
- Witness initials4_5
- Internal use only4_5
- Printed name of elector5_5
- Full residential address street numbernamecity5_5
- Postal code5_5
- Elector signature5_5
- Witness initials5_5
- Internal use only5_5
- Printed name of elector6_5
- Full residential address street numbernamecity6_5
- Postal code6_5
- Elector signature6_5
- Witness initials6_5
- Internal use only6_5
- Printed name of elector7_5
- Full residential address street numbernamecity7_5
- Postal code7_5
- Elector signature7_5
- Witness initials7_5
- Internal use only7_5
- Printed name of elector8_5
- Full residential address street numbernamecity8_5
- Postal code8_5
- Elector signature8_5
- Witness initials8_5
- Internal use only8_5
- Printed name of elector9_5
- Full residential address street numbernamecity9_5
- Postal code9_5
- Elector signature9_5
- Witness initials9_5
- Internal use only9_5
- Printed name of elector10_5
- Full residential address street numbernamecity10_5
- Postal code10_5
- Elector signature10_5
- Witness initials10_5
- Internal use only10_5
- Printed name of elector1_6
- Full residential address street numbernamecity1_6
- Postal code1_6
- Elector signature1_6
- Witness initials1_6
- Internal use only1_6
- Printed name of elector2_6
- Full residential address street numbernamecity2_6
- Postal code2_6
- Elector signature2_6
- Witness initials2_6
- Internal use only2_6
- Printed name of elector3_6
- Full residential address street numbernamecity3_6
- Postal code3_6
- Elector signature3_6
- Witness initials3_6
- Internal use only3_6
- Printed name of elector4_6
- Full residential address street numbernamecity4_6
- Postal code4_6
- Elector signature4_6
- Witness initials4_6
- Internal use only4_6
- Printed name of elector5_6
- Full residential address street numbernamecity5_6
- Postal code5_6
- Elector signature5_6
- Witness initials5_6
- Internal use only5_6
- Printed name of elector6_6
- Full residential address street numbernamecity6_6
- Postal code6_6
- Elector signature6_6
- Witness initials6_6
- Internal use only6_6
- Printed name of elector7_6
- Full residential address street numbernamecity7_6
- Postal code7_6
- Elector signature7_6
- Witness initials7_6
- Internal use only7_6
- Printed name of elector8_6
- Full residential address street numbernamecity8_6
- Postal code8_6
- Elector signature8_6
- Witness initials8_6
- Internal use only8_6
- Printed name of elector9_6
- Full residential address street numbernamecity9_6
- Postal code9_6
- Elector signature9_6
- Witness initials9_6
- Internal use only9_6
- Printed name of elector10_6
- Full residential address street numbernamecity10_6
- Postal code10_6
- Elector signature10_6
- Witness initials10_6
- Internal use only10_6
- Printed name of elector1_7
- Full residential address street numbernamecity1_7
- Postal code1_7
- Elector signature1_7
- Witness initials1_7
- Internal use only1_7
- Printed name of elector2_7
- Full residential address street numbernamecity2_7
- Postal code2_7
- Elector signature2_7
- Witness initials2_7
- Internal use only2_7
- Printed name of elector3_7
- Full residential address street numbernamecity3_7
- Postal code3_7
- Elector signature3_7
- Witness initials3_7
- Internal use only3_7
- Printed name of elector4_7
- Full residential address street numbernamecity4_7
- Postal code4_7
- Elector signature4_7
- Witness initials4_7
- Internal use only4_7
- Printed name of elector5_7
- Full residential address street numbernamecity5_7
- Postal code5_7
- Elector signature5_7
- Witness initials5_7
- Internal use only5_7
- Printed name of elector6_7
- Full residential address street numbernamecity6_7
- Postal code6_7
- Elector signature6_7
- Witness initials6_7
- Internal use only6_7
- Printed name of elector7_7
- Full residential address street numbernamecity7_7
- Postal code7_7
- Elector signature7_7
- Witness initials7_7
- Internal use only7_7
- Printed name of elector8_7
- Full residential address street numbernamecity8_7
- Postal code8_7
- Elector signature8_7
- Witness initials8_7
- Internal use only8_7
- Printed name of elector9_7
- Full residential address street numbernamecity9_7
- Postal code9_7
- Elector signature9_7
- Witness initials9_7
- Internal use only9_7
- Printed name of elector10_7
- Full residential address street numbernamecity10_7
- Postal code10_7
- Elector signature10_7
- Witness initials10_7
- Internal use only10_7
- Printed name of elector1_8
- Full residential address street numbernamecity1_8
- Postal code1_8
- Elector signature1_8
- Witness initials1_8
- Internal use only1_8
- Printed name of elector2_8
- Full residential address street numbernamecity2_8
- Postal code2_8
- Elector signature2_8
- Witness initials2_8
- Internal use only2_8
- Printed name of elector3_8
- Full residential address street numbernamecity3_8
- Postal code3_8
- Elector signature3_8
- Witness initials3_8
- Internal use only3_8
- Printed name of elector4_8
- Full residential address street numbernamecity4_8
- Postal code4_8
- Elector signature4_8
- Witness initials4_8
- Internal use only4_8
- Printed name of elector5_8
- Full residential address street numbernamecity5_8
- Postal code5_8
- Elector signature5_8
- Witness initials5_8
- Internal use only5_8
- Printed name of elector6_8
- Full residential address street numbernamecity6_8
- Postal code6_8
- Elector signature6_8
- Witness initials6_8
- Internal use only6_8
- Printed name of elector7_8
- Full residential address street numbernamecity7_8
- Postal code7_8
- Elector signature7_8
- Witness initials7_8
- Internal use only7_8
- Printed name of elector8_8
- Full residential address street numbernamecity8_8
- Postal code8_8
- Elector signature8_8
- Witness initials8_8
- Internal use only8_8
- Printed name of elector9_8
- Full residential address street numbernamecity9_8
- Postal code9_8
- Elector signature9_8
- Witness initials9_8
- Internal use only9_8
- Printed name of elector10_8
- Full residential address street numbernamecity10_8
- Postal code10_8
- Elector signature10_8
- Witness initials10_8
- Internal use only10_8
- Printed name of elector1_9
- Full residential address street numbernamecity1_9
- Postal code1_9
- Elector signature1_9
- Witness initials1_9
- Internal use only1_9
- Printed name of elector2_9
- Full residential address street numbernamecity2_9
- Postal code2_9
- Elector signature2_9
- Witness initials2_9
- Internal use only2_9
- Printed name of elector3_9
- Full residential address street numbernamecity3_9
- Postal code3_9
- Elector signature3_9
- Witness initials3_9
- Internal use only3_9
- Printed name of elector4_9
- Full residential address street numbernamecity4_9
- Postal code4_9
- Elector signature4_9
- Witness initials4_9
- Internal use only4_9
- Printed name of elector5_9
- Full residential address street numbernamecity5_9
- Postal code5_9
- Elector signature5_9
- Witness initials5_9
- Internal use only5_9
- Printed name of elector6_9
- Full residential address street numbernamecity6_9
- Postal code6_9
- Elector signature6_9
- Witness initials6_9
- Internal use only6_9
- Printed name of elector7_9
- Full residential address street numbernamecity7_9
- Postal code7_9
- Elector signature7_9
- Witness initials7_9
- Internal use only7_9
- Printed name of elector8_9
- Full residential address street numbernamecity8_9
- Postal code8_9
- Elector signature8_9
- Witness initials8_9
- Internal use only8_9
- Printed name of elector9_9
- Full residential address street numbernamecity9_9
- Postal code9_9
- Elector signature9_9
- Witness initials9_9
- Internal use only9_9
- Printed name of elector10_9
- Full residential address street numbernamecity10_9
- Postal code10_9
- Elector signature10_9
- Witness initials10_9
- Internal use only10_9
- Printed name of elector1_10
- Full residential address street numbernamecity1_10
- Postal code1_10
- Elector signature1_10
- Witness initials1_10
- Internal use only1_10
- Printed name of elector2_10
- Full residential address street numbernamecity2_10
- Postal code2_10
- Elector signature2_10
- Witness initials2_10
- Internal use only2_10
- Printed name of elector3_10
- Full residential address street numbernamecity3_10
- Postal code3_10
- Elector signature3_10
- Witness initials3_10
- Internal use only3_10
- Printed name of elector4_10
- Full residential address street numbernamecity4_10
- Postal code4_10
- Elector signature4_10
- Witness initials4_10
- Internal use only4_10
- Printed name of elector5_10
- Full residential address street numbernamecity5_10
- Postal code5_10
- Elector signature5_10
- Witness initials5_10
- Internal use only5_10
- Printed name of elector6_10
- Full residential address street numbernamecity6_10
- Postal code6_10
- Elector signature6_10
- Witness initials6_10
- Internal use only6_10
- Printed name of elector7_10
- Full residential address street numbernamecity7_10
- Postal code7_10
- Elector signature7_10
- Witness initials7_10
- Internal use only7_10
- Printed name of elector8_10
- Full residential address street numbernamecity8_10
- Postal code8_10
- Elector signature8_10
- Witness initials8_10
- Internal use only8_10
- Printed name of elector9_10
- Full residential address street numbernamecity9_10
- Postal code9_10
- Elector signature9_10
- Witness initials9_10
- Internal use only9_10
- Printed name of elector10_10
- Full residential address street numbernamecity10_10
- Postal code10_10
- Elector signature10_10
- Witness initials10_10
- Internal use only10_10
- Printed name of elector1_11
- Full residential address street numbernamecity1_11
- Postal code1_11
- Elector signature1_11
- Witness initials1_11
- Internal use only1_11
- Printed name of elector2_11
- Full residential address street numbernamecity2_11
- Postal code2_11
- Elector signature2_11
- Witness initials2_11
- Internal use only2_11
- Printed name of elector3_11
- Full residential address street numbernamecity3_11
- Postal code3_11
- Elector signature3_11
- Witness initials3_11
- Internal use only3_11
- Printed name of elector4_11
- Full residential address street numbernamecity4_11
- Postal code4_11
- Elector signature4_11
- Witness initials4_11
- Internal use only4_11
- Printed name of elector5_11
- Full residential address street numbernamecity5_11
- Postal code5_11
- Elector signature5_11
- Witness initials5_11
- Internal use only5_11
- Printed name of elector6_11
- Full residential address street numbernamecity6_11
- Postal code6_11
- Elector signature6_11
- Witness initials6_11
- Internal use only6_11
- Printed name of elector7_11
- Full residential address street numbernamecity7_11
- Postal code7_11
- Elector signature7_11
- Witness initials7_11
- Internal use only7_11
- Printed name of elector8_11
- Full residential address street numbernamecity8_11
- Postal code8_11
- Elector signature8_11
- Witness initials8_11
- Internal use only8_11
- Printed name of elector9_11
- Full residential address street numbernamecity9_11
- Postal code9_11
- Elector signature9_11
- Witness initials9_11
- Internal use only9_11
- Printed name of elector10_11
- Full residential address street numbernamecity10_11
- Postal code10_11
- Elector signature10_11
- Witness initials10_11
- Internal use only10_11
- Printed name of elector1_12
- Full residential address street numbernamecity1_12
- Postal code1_12
- Elector signature1_12
- Witness initials1_12
- Internal use only1_12
- Printed name of elector2_12
- Full residential address street numbernamecity2_12
- Postal code2_12
- Elector signature2_12
- Witness initials2_12
- Internal use only2_12
- Printed name of elector3_12
- Full residential address street numbernamecity3_12
- Postal code3_12
- Elector signature3_12
- Witness initials3_12
- Internal use only3_12
- Printed name of elector4_12
- Full residential address street numbernamecity4_12
- Postal code4_12
- Elector signature4_12
- Witness initials4_12
- Internal use only4_12
- Printed name of elector5_12
- Full residential address street numbernamecity5_12
- Postal code5_12
- Elector signature5_12
- Witness initials5_12
- Internal use only5_12
- Printed name of elector6_12
- Full residential address street numbernamecity6_12
- Postal code6_12
- Elector signature6_12
- Witness initials6_12
- Internal use only6_12
- Printed name of elector7_12
- Full residential address street numbernamecity7_12
- Postal code7_12
- Elector signature7_12
- Witness initials7_12
- Internal use only7_12
- Printed name of elector8_12
- Full residential address street numbernamecity8_12
- Postal code8_12
- Elector signature8_12
- Witness initials8_12
- Internal use only8_12
- Printed name of elector9_12
- Full residential address street numbernamecity9_12
- Postal code9_12
- Elector signature9_12
- Witness initials9_12
- Internal use only9_12
- Printed name of elector10_12
- Full residential address street numbernamecity10_12
- Postal code10_12
- Elector signature10_12
- Witness initials10_12
- Internal use only10_12
- Printed name of elector1_13
- Full residential address street numbernamecity1_13
- Postal code1_13
- Elector signature1_13
- Witness initials1_13
- Internal use only1_13
- Printed name of elector2_13
- Full residential address street numbernamecity2_13
- Postal code2_13
- Elector signature2_13
- Witness initials2_13
- Internal use only2_13
- Printed name of elector3_13
- Full residential address street numbernamecity3_13
- Postal code3_13
- Elector signature3_13
- Witness initials3_13
- Internal use only3_13
- Printed name of elector4_13
- Full residential address street numbernamecity4_13
- Postal code4_13
- Elector signature4_13
- Witness initials4_13
- Internal use only4_13
- Printed name of elector5_13
- Full residential address street numbernamecity5_13
- Postal code5_13
- Elector signature5_13
- Witness initials5_13
- Internal use only5_13
- Printed name of elector6_13
- Full residential address street numbernamecity6_13
- Postal code6_13
- Elector signature6_13
- Witness initials6_13
- Internal use only6_13
- Printed name of elector7_13
- Full residential address street numbernamecity7_13
- Postal code7_13
- Elector signature7_13
- Witness initials7_13
- Internal use only7_13
- Printed name of elector8_13
- Full residential address street numbernamecity8_13
- Postal code8_13
- Elector signature8_13
- Witness initials8_13
- Internal use only8_13
- Printed name of elector9_13
- Full residential address street numbernamecity9_13
- Postal code9_13
- Elector signature9_13
- Witness initials9_13
- Internal use only9_13
- Printed name of elector10_13
- Full residential address street numbernamecity10_13
- Postal code10_13
- Elector signature10_13
- Witness initials10_13
- Internal use only10_13
- Printed name of elector1_14
- Full residential address street numbernamecity1_14
- Postal code1_14
- Elector signature1_14
- Witness initials1_14
- Internal use only1_14
- Printed name of elector2_14
- Full residential address street numbernamecity2_14
- Postal code2_14
- Elector signature2_14
- Witness initials2_14
- Internal use only2_14
- Printed name of elector3_14
- Full residential address street numbernamecity3_14
- Postal code3_14
- Elector signature3_14
- Witness initials3_14
- Internal use only3_14
- Printed name of elector4_14
- Full residential address street numbernamecity4_14
- Postal code4_14
- Elector signature4_14
- Witness initials4_14
- Internal use only4_14
- Printed name of elector5_14
- Full residential address street numbernamecity5_14
- Postal code5_14
- Elector signature5_14
- Witness initials5_14
- Internal use only5_14
- Printed name of elector6_14
- Full residential address street numbernamecity6_14
- Postal code6_14
- Elector signature6_14
- Witness initials6_14
- Internal use only6_14
- Printed name of elector7_14
- Full residential address street numbernamecity7_14
- Postal code7_14
- Elector signature7_14
- Witness initials7_14
- Internal use only7_14
- Printed name of elector8_14
- Full residential address street numbernamecity8_14
- Postal code8_14
- Elector signature8_14
- Witness initials8_14
- Internal use only8_14
- Printed name of elector9_14
- Full residential address street numbernamecity9_14
- Postal code9_14
- Elector signature9_14
- Witness initials9_14
- Internal use only9_14
- Printed name of elector10_14
- Full residential address street numbernamecity10_14
- Postal code10_14
- Elector signature10_14
- Witness initials10_14
- Internal use only10_14
- Printed name of elector1_15
- Full residential address street numbernamecity1_15
- Postal code1_15
- Elector signature1_15
- Witness initials1_15
- Internal use only1_15
- Printed name of elector2_15
- Full residential address street numbernamecity2_15
- Postal code2_15
- Elector signature2_15
- Witness initials2_15
- Internal use only2_15
- Printed name of elector3_15
- Full residential address street numbernamecity3_15
- Postal code3_15
- Elector signature3_15
- Witness initials3_15
- Internal use only3_15
- Printed name of elector4_15
- Full residential address street numbernamecity4_15
- Postal code4_15
- Elector signature4_15
- Witness initials4_15
- Internal use only4_15
- Printed name of elector5_15
- Full residential address street numbernamecity5_15
- Postal code5_15
- Elector signature5_15
- Witness initials5_15
- Internal use only5_15
- Printed name of elector6_15
- Full residential address street numbernamecity6_15
- Postal code6_15
- Elector signature6_15
- Witness initials6_15
- Internal use only6_15
- Printed name of elector7_15
- Full residential address street numbernamecity7_15
- Postal code7_15
- Elector signature7_15
- Witness initials7_15
- Internal use only7_15
- Printed name of elector8_15
- Full residential address street numbernamecity8_15
- Postal code8_15
- Elector signature8_15
- Witness initials8_15
- Internal use only8_15
- Printed name of elector9_15
- Full residential address street numbernamecity9_15
- Postal code9_15
- Elector signature9_15
- Witness initials9_15
- Internal use only9_15
- Printed name of elector10_15
- Full residential address street numbernamecity10_15
- Postal code10_15
- Elector signature10_15
- Witness initials10_15
- Internal use only10_15
- Printed name of elector1_16
- Full residential address street numbernamecity1_16
- Postal code1_16
- Elector signature1_16
- Witness initials1_16
- Internal use only1_16
- Printed name of elector2_16
- Full residential address street numbernamecity2_16
- Postal code2_16
- Elector signature2_16
- Witness initials2_16
- Internal use only2_16
- Printed name of elector3_16
- Full residential address street numbernamecity3_16
- Postal code3_16
- Elector signature3_16
- Witness initials3_16
- Internal use only3_16
- Printed name of elector4_16
- Full residential address street numbernamecity4_16
- Postal code4_16
- Elector signature4_16
- Witness initials4_16
- Internal use only4_16
- Printed name of elector5_16
- Full residential address street numbernamecity5_16
- Postal code5_16
- Elector signature5_16
- Witness initials5_16
- Internal use only5_16
- Printed name of elector6_16
- Full residential address street numbernamecity6_16
- Postal code6_16
- Elector signature6_16
- Witness initials6_16
- Internal use only6_16
- Printed name of elector7_16
- Full residential address street numbernamecity7_16
- Postal code7_16
- Elector signature7_16
- Witness initials7_16
- Internal use only7_16
- Printed name of elector8_16
- Full residential address street numbernamecity8_16
- Postal code8_16
- Elector signature8_16
- Witness initials8_16
- Internal use only8_16
- Printed name of elector9_16
- Full residential address street numbernamecity9_16
- Postal code9_16
- Elector signature9_16
- Witness initials9_16
- Internal use only9_16
- Printed name of elector10_16
- Full residential address street numbernamecity10_16
- Postal code10_16
- Elector signature10_16
- Witness initials10_16
- Internal use only10_16
- Have you completed the Nomination Paper EC 20010 Off
- Do you have authorized proof of identify Off
- Are you endorsed by a political party Off
- Have you made a nomination appointment Off
- Last name - Candidate Name
- First name - Candidate Name
- Name of electoral district- Candidate Information
- First name - Candidate Information
- Last name - Candidate Information
- Ballot Name Off
- Ballot First name(s)
- Ballot Last name(s)
- Gender -Candidate information
- Date of birth (YYY-MM-DD) - Gender -Candidate information
- language of correspondence - Candidate information Off
- Email -Contact information
- Primary phone number - Contact information
- Ext - Primary phone number
- Alternate phone number - Contact information
- Ext - Alternate phone number
- Fax number- Alternate phone number
- Unit -Residential address
- Street -Residential address
- Street name -Residential address
- City -Residential address
- ProvinceTerritory -Residential address
- Postal code - -Residential address
- Mailing address - same as residential address Off
- Occupation- Candidate occupation
- Sharing of information with the Conflict of Interest and Ethics Commissioner and the House of Commons including the Library of Parliament Off
- where applicable if the returning officer is unable to verify that I have been endorsed by the political party identified in section A of this Nomination Paper I wish to Off
- Date of Signature (YYYY-MM-DD) - Candidate signature
- Date of Signature (YYYY-MM-DD) -Signature of person receiving the solemn declaration
- Campaign delegate information
- First name - Campaign delegate information
- Last name - Campaign delegate information
- Language of correspondence - Campaign delegate information Off
- Email - Contact information -Campaign Delegate
- Primary phone number - Contact information -Campaign Delegate
- Primary phone number EXT - Contact information -Campaign Delegate
- Alternate phone number - Contact information -Campaign Delegate
- Alternate phone number EXT - Contact information -Campaign Delegate
- Fax nmuber- Contact information -Campaign Delegate
- Street - Residential address -Campaign delegate
- Street name - Residential address -Campaign delegate
- City - Residential address -Campaign delegate
- ProvinceTerritory - Residential address -Campaign delegate
- Postal Code - Residential address -Campaign delegate
- Campaign delegate - Mailing address ndash Same as residential address Off
- Unit - Residential address -Campaign delegate
- Date (YYYY-MM-DD) - Candidate authorization Signature
- Date (YYYY-MM-DD) - Candidate campaign Signature
- First name - Official agent information
- Last name - Official agent information
- Language of correspondence - Official agent information Off
- Email - Official agent information
- Primary phone number - Official agent information
- Primary phone number EXT - Official agent information
- Alternate phone number EXT - Official agent information
- Alternate phone number - Official agent information
- Fax number - Official agent information
- Unit -Residential address - Official Agent
- Street name -Residential address - Official Agent
- City -Residential address - Official Agent
- Street -Residential address - Official Agent
- ProvinceTerritory -Residential address - Official Agent
- Postal code-Residential address - Official Agent
- Mailing address ndash Same as residential address- Official Agent Off
- Date (YYYY-MM-DD) - Official agent signature
- First name - Auditor information
- Last name - Auditor information
- Language of correspondence - Auditor information Off
- Email - Auditor information
- Primary phone number - Auditor information
- Primary phone number EXT- Auditor information
- Alternate phone number - Auditor information
- Alternate phone number EXT- Auditor information
- Fax number - Auditor information
- Name of firm- Auditor organizational information
- Occupation of auditor - Auditor organizational information
- Professional designation - Auditor organizational information Off
- Designation registration number
- Make cheque payable to
- Unit - Address (where cheque is sent)
- Street - Address (where cheque is sent)
- Street name - Address (where cheque is sent)
- City - Address (where cheque is sent)
- ProvinceTerritory - Address (where cheque is sent)
- Postal code - Address (where cheque is sent)
- Date (YYY-MM-DD) - Auditor signature
- Unit - Campaign office address (optional)
- Street - Campaign office address (optional)
- Street name - Campaign office address (optional)
- City - Campaign office address (optional)
- ProvinceTerritory- Campaign office address (optional)
- Postal code - Campaign office address (optional)
- Name of witness
- Full address of witness
- Name of candidate
- Electoral district
- Year
- Name of candidate2
- Electoral district2
- Year2
- Name of witness2
- Full address of witness2
- Name of candidate3
- Electoral district3
- Year3
- Full address of witness3
- Name of witness3
- Name of candidate 4
- Electoral district4
- Year4
- Full address of witness 4
- Name of witness 4
- Name of candidate5
- Electoral district5
- Year5
- Full address of witness5
- Name of witness5
- Name of candidate6
- Electoral district6
- Year6
- Name of witness6
- Full address of witness6
- Name of candidate7
- Electoral district7
- Year7
- Full address of witness7
- Name of witness7
- Name of candidate8
- Electoral district8
- Year8
- Full address of witness8
- Name of witness8
- Name of candidate9
- Electoral district9
- Year9
- Full address of witness 9
- Name of witness 9
- Name of candidate10
- Electoral district10
- Year10
- Full address of witness10
- Name of witness10
- Name of candidate11
- Electoral district11
- Year11
- Full address of witness11
- Name of witness11
- Name of candidate12
- Electoral district12
- Year12
- Full address of witness12
- Name of witness12
- Name of candidate13
- Electoral district13
- Year13
- Full address of witness13
- Name of witness13
- Name of candidate14
- Electoral district14
- Year14
- Name of witness14
- Full address of witness14
- Name of candidate1
- Electoral district1
- Year1
- Name of witness1
- Full address of witness1
- Name of candidate15
- Electoral district15
- Year15
- Name of witness15
- Full address of witness15
- unit -Mailing address
- Street -Mailing address
- Street name -Mailing address
- City -Mailing address
- ProvinceTerritory -Mailing address
- Postal code -Mailing address
- Unit - Mailing address -Campaign delegate
- Street - Mailing address -Campaign delegate
- Street name - Mailing address -Campaign delegate
- City - Mailing address -Campaign delegate
- ProvinceTerritory- Mailing address -Campaign delegate
- Postal code- Mailing address -Campaign delegate
- Unit -Mailing address - Official Agent
- Street -Mailing address - Official Agent
- Street name -Mailing address - Official Agent
- city -Mailing address - Official Agent
- ProvinceTerritory-Mailing address - Official Agent
- Postal code-Mailing address - Official Agent
EC 20010 (052019)
SECTION D ndash 5B Auditor (Optional)
If appointing an auditor all fields marked with are mandatory
Auditor information An auditor must be appointed if bull the candidatersquos campaign accepts contributions of $10000 or more bull the candidatersquos campaign incurs expenses of $10000 or more or bull the candidate receives 10 or more of votes cast in the electoral district If at the time of filing the Nomination Paper none of the above applies you do not need to appoint an auditor though you may still choose to do so If the above requirements are later met you must appoint an auditor without delay A person or partnership who wants to act as a candidatersquos auditor must be or have every partner be recognized as a professional accountant under provincial or territorial legislation CEA 4773(1) For more information consult the Political Financing Handbook for Candidates and Official Agents
First name Last name Language of correspondence
English French
Contact information Upon confirmation of the nomination Elections Canada will send to the email address listed below an invitation to the Political Entities Service Centre (PESC) online portal
Primary phone number Ext Alternate phone number Ext Fax number
Auditor organizational information Name of firm Occupation of auditor Professional designation
CPA FCPA
Designation registration number Make cheque payable to
Address (where cheque is sent) Unit Street Street name
City ProvinceTerritory Postal code
12
EC 20010 (052019)
SECTION D ndash Auditor ndash Privacy Notice and Declaration (Optional)
If appointing an auditor all fields marked with are mandatory
Privacy notice
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA) Any person at the returning office may examine the completed Nomination Paper during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information
Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
Auditor signature
I the undersigned hereby agree to act as the auditor for the candidate named in this Nomination Paper I further state that I am aware of the duties and responsibilities of this position under the Canada Elections Act and I am qualified to act as auditor under subsection 4773(1) and (2) of the Canada Elections Act
Auditor signature Date (YYYY-MM-DD)
13
EC 20010 (052019)
SECTION E ndash 6BCampaign Office (Optional)
Contact information to be made available on the Elections Canada website (optional)
Please note You may provide a telephone number andor a link to your website or social media platform of choice when filing your Nomination Paper with Elections Canada You do not have to provide this information but it is intended to help electors access campaign information Elections Canada may provide this information as part of the Voter Information Service Please include the full website address including prefix (http https)
Telephone number to be posted on electionsca
Website to be posted on electionsca (including prefix http https)
Campaign office address (optional)
Unit Street Street name
City ProvinceTerritory Postal code
14
SECTION F ndash 7BElectors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
15
8BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
16
9BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
17
10BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
18
11BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
19
12BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
20
13BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
21
14BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
22
15BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
23
16BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
24
17BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
25
18BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
26
19BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
27
20BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
28
21BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
29
22BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
30
EC 20010 (022019)
SECTION G ndash 23B Are You Ready to Submit Your Nomination
Have you completed the Nomination Paper (EC 20010)
bull Are all mandatory fields in sections AndashE complete
bull Have you collected the required number of signatures from qualified electors in section F
o For most electoral districts 100 electors must consent to your candidacy
o For electoral districts identified in Schedule 3 only 50 electors are required
o To ensure a smooth nomination process Elections Canada recommends collecting signatures from at least 150 electors
Do you have authorized proof of identify
bull For a list of authorized identification visit the Elections Canada website
bull If a campaign delegate is submitting on your behalf they must bring a copy of your identification documents signed by you
bull If you want an alternative name to appear on the ballot additional documentation is required visit electionsca for details
Are you endorsed by a political party
bull Make sure your party has submitted the required documentation to Elections Canada attesting your designated political affiliation
Have you made a nomination appointment
bull To facilitate the nomination process make an appointment with the returning officer to finalize the filing of the complete nomination package
bull The nomination period closes 21 days before election day at 200 pm local time
31
- Nomination Paperof a Candidate at a Federal General Election or By-election
- Table of Contents
- General Information
- SECTION A ndash Candidate Information (Mandatory)
- SECTION B ndash Campaign Delegate (Optional)
- SECTION C ndash Official Agent (Mandatory)
- SECTION D ndash Auditor (Optional)
- SECTION E ndash Campaign Office (Optional)
- SECTION F ndash Electors Consenting to Candidacy (Mandatory)
-
- Name of electoral district
- Political affiliation
- Telephone number to be posted on electionsca
- Website to be posted on electionsca including prefix http https
- Printed name of elector1
- Full residential address street numbernamecity1
- Postal code1
- Elector signature1
- Witness initials1
- Internal use only1
- Printed name of elector2
- Full residential address street numbernamecity2
- Postal code2
- Elector signature2
- Witness initials2
- Internal use only2
- Printed name of elector3
- Full residential address street numbernamecity3
- Postal code3
- Elector signature3
- Witness initials3
- Internal use only3
- Printed name of elector4
- Full residential address street numbernamecity4
- Postal code4
- Elector signature4
- Witness initials4
- Internal use only4
- Printed name of elector5
- Full residential address street numbernamecity5
- Postal code5
- Elector signature5
- Witness initials5
- Internal use only5
- Printed name of elector6
- Full residential address street numbernamecity6
- Postal code6
- Elector signature6
- Witness initials6
- Internal use only6
- Printed name of elector7
- Full residential address street numbernamecity7
- Postal code7
- Elector signature7
- Witness initials7
- Internal use only7
- Printed name of elector8
- Full residential address street numbernamecity8
- Postal code8
- Elector signature8
- Witness initials8
- Internal use only8
- Printed name of elector9
- Full residential address street numbernamecity9
- Postal code9
- Elector signature9
- Witness initials9
- Internal use only9
- Printed name of elector10
- Full residential address street numbernamecity10
- Postal code10
- Elector signature10
- Witness initials10
- Internal use only10
- Printed name of elector1_2
- Full residential address street numbernamecity1_2
- Postal code1_2
- Elector signature1_2
- Witness initials1_2
- Internal use only1_2
- Printed name of elector2_2
- Full residential address street numbernamecity2_2
- Postal code2_2
- Elector signature2_2
- Witness initials2_2
- Internal use only2_2
- Printed name of elector3_2
- Full residential address street numbernamecity3_2
- Postal code3_2
- Elector signature3_2
- Witness initials3_2
- Internal use only3_2
- Printed name of elector4_2
- Full residential address street numbernamecity4_2
- Postal code4_2
- Elector signature4_2
- Witness initials4_2
- Internal use only4_2
- Printed name of elector5_2
- Full residential address street numbernamecity5_2
- Postal code5_2
- Elector signature5_2
- Witness initials5_2
- Internal use only5_2
- Printed name of elector6_2
- Full residential address street numbernamecity6_2
- Postal code6_2
- Elector signature6_2
- Witness initials6_2
- Internal use only6_2
- Printed name of elector7_2
- Full residential address street numbernamecity7_2
- Postal code7_2
- Elector signature7_2
- Witness initials7_2
- Internal use only7_2
- Printed name of elector8_2
- Full residential address street numbernamecity8_2
- Postal code8_2
- Elector signature8_2
- Witness initials8_2
- Internal use only8_2
- Printed name of elector9_2
- Full residential address street numbernamecity9_2
- Postal code9_2
- Elector signature9_2
- Witness initials9_2
- Internal use only9_2
- Printed name of elector10_2
- Full residential address street numbernamecity10_2
- Postal code10_2
- Elector signature10_2
- Witness initials10_2
- Internal use only10_2
- Printed name of elector1_3
- Full residential address street numbernamecity1_3
- Postal code1_3
- Elector signature1_3
- Witness initials1_3
- Internal use only1_3
- Printed name of elector2_3
- Full residential address street numbernamecity2_3
- Postal code2_3
- Elector signature2_3
- Witness initials2_3
- Internal use only2_3
- Printed name of elector3_3
- Full residential address street numbernamecity3_3
- Postal code3_3
- Elector signature3_3
- Witness initials3_3
- Internal use only3_3
- Printed name of elector4_3
- Full residential address street numbernamecity4_3
- Postal code4_3
- Elector signature4_3
- Witness initials4_3
- Internal use only4_3
- Printed name of elector5_3
- Full residential address street numbernamecity5_3
- Postal code5_3
- Elector signature5_3
- Witness initials5_3
- Internal use only5_3
- Printed name of elector6_3
- Full residential address street numbernamecity6_3
- Postal code6_3
- Elector signature6_3
- Witness initials6_3
- Internal use only6_3
- Printed name of elector7_3
- Full residential address street numbernamecity7_3
- Postal code7_3
- Elector signature7_3
- Witness initials7_3
- Internal use only7_3
- Printed name of elector8_3
- Full residential address street numbernamecity8_3
- Postal code8_3
- Elector signature8_3
- Witness initials8_3
- Internal use only8_3
- Printed name of elector9_3
- Full residential address street numbernamecity9_3
- Postal code9_3
- Elector signature9_3
- Witness initials9_3
- Internal use only9_3
- Printed name of elector10_3
- Full residential address street numbernamecity10_3
- Postal code10_3
- Elector signature10_3
- Witness initials10_3
- Internal use only10_3
- Printed name of elector1_4
- Full residential address street numbernamecity1_4
- Postal code1_4
- Elector signature1_4
- Witness initials1_4
- Internal use only1_4
- Printed name of elector2_4
- Full residential address street numbernamecity2_4
- Postal code2_4
- Elector signature2_4
- Witness initials2_4
- Internal use only2_4
- Printed name of elector3_4
- Full residential address street numbernamecity3_4
- Postal code3_4
- Elector signature3_4
- Witness initials3_4
- Internal use only3_4
- Printed name of elector4_4
- Full residential address street numbernamecity4_4
- Postal code4_4
- Elector signature4_4
- Witness initials4_4
- Internal use only4_4
- Printed name of elector5_4
- Full residential address street numbernamecity5_4
- Postal code5_4
- Elector signature5_4
- Witness initials5_4
- Internal use only5_4
- Printed name of elector6_4
- Full residential address street numbernamecity6_4
- Postal code6_4
- Elector signature6_4
- Witness initials6_4
- Internal use only6_4
- Printed name of elector7_4
- Full residential address street numbernamecity7_4
- Postal code7_4
- Elector signature7_4
- Witness initials7_4
- Internal use only7_4
- Printed name of elector8_4
- Full residential address street numbernamecity8_4
- Postal code8_4
- Elector signature8_4
- Witness initials8_4
- Internal use only8_4
- Printed name of elector9_4
- Full residential address street numbernamecity9_4
- Postal code9_4
- Elector signature9_4
- Witness initials9_4
- Internal use only9_4
- Printed name of elector10_4
- Full residential address street numbernamecity10_4
- Postal code10_4
- Elector signature10_4
- Witness initials10_4
- Internal use only10_4
- Printed name of elector1_5
- Full residential address street numbernamecity1_5
- Postal code1_5
- Elector signature1_5
- Witness initials1_5
- Internal use only1_5
- Printed name of elector2_5
- Full residential address street numbernamecity2_5
- Postal code2_5
- Elector signature2_5
- Witness initials2_5
- Internal use only2_5
- Printed name of elector3_5
- Full residential address street numbernamecity3_5
- Postal code3_5
- Elector signature3_5
- Witness initials3_5
- Internal use only3_5
- Printed name of elector4_5
- Full residential address street numbernamecity4_5
- Postal code4_5
- Elector signature4_5
- Witness initials4_5
- Internal use only4_5
- Printed name of elector5_5
- Full residential address street numbernamecity5_5
- Postal code5_5
- Elector signature5_5
- Witness initials5_5
- Internal use only5_5
- Printed name of elector6_5
- Full residential address street numbernamecity6_5
- Postal code6_5
- Elector signature6_5
- Witness initials6_5
- Internal use only6_5
- Printed name of elector7_5
- Full residential address street numbernamecity7_5
- Postal code7_5
- Elector signature7_5
- Witness initials7_5
- Internal use only7_5
- Printed name of elector8_5
- Full residential address street numbernamecity8_5
- Postal code8_5
- Elector signature8_5
- Witness initials8_5
- Internal use only8_5
- Printed name of elector9_5
- Full residential address street numbernamecity9_5
- Postal code9_5
- Elector signature9_5
- Witness initials9_5
- Internal use only9_5
- Printed name of elector10_5
- Full residential address street numbernamecity10_5
- Postal code10_5
- Elector signature10_5
- Witness initials10_5
- Internal use only10_5
- Printed name of elector1_6
- Full residential address street numbernamecity1_6
- Postal code1_6
- Elector signature1_6
- Witness initials1_6
- Internal use only1_6
- Printed name of elector2_6
- Full residential address street numbernamecity2_6
- Postal code2_6
- Elector signature2_6
- Witness initials2_6
- Internal use only2_6
- Printed name of elector3_6
- Full residential address street numbernamecity3_6
- Postal code3_6
- Elector signature3_6
- Witness initials3_6
- Internal use only3_6
- Printed name of elector4_6
- Full residential address street numbernamecity4_6
- Postal code4_6
- Elector signature4_6
- Witness initials4_6
- Internal use only4_6
- Printed name of elector5_6
- Full residential address street numbernamecity5_6
- Postal code5_6
- Elector signature5_6
- Witness initials5_6
- Internal use only5_6
- Printed name of elector6_6
- Full residential address street numbernamecity6_6
- Postal code6_6
- Elector signature6_6
- Witness initials6_6
- Internal use only6_6
- Printed name of elector7_6
- Full residential address street numbernamecity7_6
- Postal code7_6
- Elector signature7_6
- Witness initials7_6
- Internal use only7_6
- Printed name of elector8_6
- Full residential address street numbernamecity8_6
- Postal code8_6
- Elector signature8_6
- Witness initials8_6
- Internal use only8_6
- Printed name of elector9_6
- Full residential address street numbernamecity9_6
- Postal code9_6
- Elector signature9_6
- Witness initials9_6
- Internal use only9_6
- Printed name of elector10_6
- Full residential address street numbernamecity10_6
- Postal code10_6
- Elector signature10_6
- Witness initials10_6
- Internal use only10_6
- Printed name of elector1_7
- Full residential address street numbernamecity1_7
- Postal code1_7
- Elector signature1_7
- Witness initials1_7
- Internal use only1_7
- Printed name of elector2_7
- Full residential address street numbernamecity2_7
- Postal code2_7
- Elector signature2_7
- Witness initials2_7
- Internal use only2_7
- Printed name of elector3_7
- Full residential address street numbernamecity3_7
- Postal code3_7
- Elector signature3_7
- Witness initials3_7
- Internal use only3_7
- Printed name of elector4_7
- Full residential address street numbernamecity4_7
- Postal code4_7
- Elector signature4_7
- Witness initials4_7
- Internal use only4_7
- Printed name of elector5_7
- Full residential address street numbernamecity5_7
- Postal code5_7
- Elector signature5_7
- Witness initials5_7
- Internal use only5_7
- Printed name of elector6_7
- Full residential address street numbernamecity6_7
- Postal code6_7
- Elector signature6_7
- Witness initials6_7
- Internal use only6_7
- Printed name of elector7_7
- Full residential address street numbernamecity7_7
- Postal code7_7
- Elector signature7_7
- Witness initials7_7
- Internal use only7_7
- Printed name of elector8_7
- Full residential address street numbernamecity8_7
- Postal code8_7
- Elector signature8_7
- Witness initials8_7
- Internal use only8_7
- Printed name of elector9_7
- Full residential address street numbernamecity9_7
- Postal code9_7
- Elector signature9_7
- Witness initials9_7
- Internal use only9_7
- Printed name of elector10_7
- Full residential address street numbernamecity10_7
- Postal code10_7
- Elector signature10_7
- Witness initials10_7
- Internal use only10_7
- Printed name of elector1_8
- Full residential address street numbernamecity1_8
- Postal code1_8
- Elector signature1_8
- Witness initials1_8
- Internal use only1_8
- Printed name of elector2_8
- Full residential address street numbernamecity2_8
- Postal code2_8
- Elector signature2_8
- Witness initials2_8
- Internal use only2_8
- Printed name of elector3_8
- Full residential address street numbernamecity3_8
- Postal code3_8
- Elector signature3_8
- Witness initials3_8
- Internal use only3_8
- Printed name of elector4_8
- Full residential address street numbernamecity4_8
- Postal code4_8
- Elector signature4_8
- Witness initials4_8
- Internal use only4_8
- Printed name of elector5_8
- Full residential address street numbernamecity5_8
- Postal code5_8
- Elector signature5_8
- Witness initials5_8
- Internal use only5_8
- Printed name of elector6_8
- Full residential address street numbernamecity6_8
- Postal code6_8
- Elector signature6_8
- Witness initials6_8
- Internal use only6_8
- Printed name of elector7_8
- Full residential address street numbernamecity7_8
- Postal code7_8
- Elector signature7_8
- Witness initials7_8
- Internal use only7_8
- Printed name of elector8_8
- Full residential address street numbernamecity8_8
- Postal code8_8
- Elector signature8_8
- Witness initials8_8
- Internal use only8_8
- Printed name of elector9_8
- Full residential address street numbernamecity9_8
- Postal code9_8
- Elector signature9_8
- Witness initials9_8
- Internal use only9_8
- Printed name of elector10_8
- Full residential address street numbernamecity10_8
- Postal code10_8
- Elector signature10_8
- Witness initials10_8
- Internal use only10_8
- Printed name of elector1_9
- Full residential address street numbernamecity1_9
- Postal code1_9
- Elector signature1_9
- Witness initials1_9
- Internal use only1_9
- Printed name of elector2_9
- Full residential address street numbernamecity2_9
- Postal code2_9
- Elector signature2_9
- Witness initials2_9
- Internal use only2_9
- Printed name of elector3_9
- Full residential address street numbernamecity3_9
- Postal code3_9
- Elector signature3_9
- Witness initials3_9
- Internal use only3_9
- Printed name of elector4_9
- Full residential address street numbernamecity4_9
- Postal code4_9
- Elector signature4_9
- Witness initials4_9
- Internal use only4_9
- Printed name of elector5_9
- Full residential address street numbernamecity5_9
- Postal code5_9
- Elector signature5_9
- Witness initials5_9
- Internal use only5_9
- Printed name of elector6_9
- Full residential address street numbernamecity6_9
- Postal code6_9
- Elector signature6_9
- Witness initials6_9
- Internal use only6_9
- Printed name of elector7_9
- Full residential address street numbernamecity7_9
- Postal code7_9
- Elector signature7_9
- Witness initials7_9
- Internal use only7_9
- Printed name of elector8_9
- Full residential address street numbernamecity8_9
- Postal code8_9
- Elector signature8_9
- Witness initials8_9
- Internal use only8_9
- Printed name of elector9_9
- Full residential address street numbernamecity9_9
- Postal code9_9
- Elector signature9_9
- Witness initials9_9
- Internal use only9_9
- Printed name of elector10_9
- Full residential address street numbernamecity10_9
- Postal code10_9
- Elector signature10_9
- Witness initials10_9
- Internal use only10_9
- Printed name of elector1_10
- Full residential address street numbernamecity1_10
- Postal code1_10
- Elector signature1_10
- Witness initials1_10
- Internal use only1_10
- Printed name of elector2_10
- Full residential address street numbernamecity2_10
- Postal code2_10
- Elector signature2_10
- Witness initials2_10
- Internal use only2_10
- Printed name of elector3_10
- Full residential address street numbernamecity3_10
- Postal code3_10
- Elector signature3_10
- Witness initials3_10
- Internal use only3_10
- Printed name of elector4_10
- Full residential address street numbernamecity4_10
- Postal code4_10
- Elector signature4_10
- Witness initials4_10
- Internal use only4_10
- Printed name of elector5_10
- Full residential address street numbernamecity5_10
- Postal code5_10
- Elector signature5_10
- Witness initials5_10
- Internal use only5_10
- Printed name of elector6_10
- Full residential address street numbernamecity6_10
- Postal code6_10
- Elector signature6_10
- Witness initials6_10
- Internal use only6_10
- Printed name of elector7_10
- Full residential address street numbernamecity7_10
- Postal code7_10
- Elector signature7_10
- Witness initials7_10
- Internal use only7_10
- Printed name of elector8_10
- Full residential address street numbernamecity8_10
- Postal code8_10
- Elector signature8_10
- Witness initials8_10
- Internal use only8_10
- Printed name of elector9_10
- Full residential address street numbernamecity9_10
- Postal code9_10
- Elector signature9_10
- Witness initials9_10
- Internal use only9_10
- Printed name of elector10_10
- Full residential address street numbernamecity10_10
- Postal code10_10
- Elector signature10_10
- Witness initials10_10
- Internal use only10_10
- Printed name of elector1_11
- Full residential address street numbernamecity1_11
- Postal code1_11
- Elector signature1_11
- Witness initials1_11
- Internal use only1_11
- Printed name of elector2_11
- Full residential address street numbernamecity2_11
- Postal code2_11
- Elector signature2_11
- Witness initials2_11
- Internal use only2_11
- Printed name of elector3_11
- Full residential address street numbernamecity3_11
- Postal code3_11
- Elector signature3_11
- Witness initials3_11
- Internal use only3_11
- Printed name of elector4_11
- Full residential address street numbernamecity4_11
- Postal code4_11
- Elector signature4_11
- Witness initials4_11
- Internal use only4_11
- Printed name of elector5_11
- Full residential address street numbernamecity5_11
- Postal code5_11
- Elector signature5_11
- Witness initials5_11
- Internal use only5_11
- Printed name of elector6_11
- Full residential address street numbernamecity6_11
- Postal code6_11
- Elector signature6_11
- Witness initials6_11
- Internal use only6_11
- Printed name of elector7_11
- Full residential address street numbernamecity7_11
- Postal code7_11
- Elector signature7_11
- Witness initials7_11
- Internal use only7_11
- Printed name of elector8_11
- Full residential address street numbernamecity8_11
- Postal code8_11
- Elector signature8_11
- Witness initials8_11
- Internal use only8_11
- Printed name of elector9_11
- Full residential address street numbernamecity9_11
- Postal code9_11
- Elector signature9_11
- Witness initials9_11
- Internal use only9_11
- Printed name of elector10_11
- Full residential address street numbernamecity10_11
- Postal code10_11
- Elector signature10_11
- Witness initials10_11
- Internal use only10_11
- Printed name of elector1_12
- Full residential address street numbernamecity1_12
- Postal code1_12
- Elector signature1_12
- Witness initials1_12
- Internal use only1_12
- Printed name of elector2_12
- Full residential address street numbernamecity2_12
- Postal code2_12
- Elector signature2_12
- Witness initials2_12
- Internal use only2_12
- Printed name of elector3_12
- Full residential address street numbernamecity3_12
- Postal code3_12
- Elector signature3_12
- Witness initials3_12
- Internal use only3_12
- Printed name of elector4_12
- Full residential address street numbernamecity4_12
- Postal code4_12
- Elector signature4_12
- Witness initials4_12
- Internal use only4_12
- Printed name of elector5_12
- Full residential address street numbernamecity5_12
- Postal code5_12
- Elector signature5_12
- Witness initials5_12
- Internal use only5_12
- Printed name of elector6_12
- Full residential address street numbernamecity6_12
- Postal code6_12
- Elector signature6_12
- Witness initials6_12
- Internal use only6_12
- Printed name of elector7_12
- Full residential address street numbernamecity7_12
- Postal code7_12
- Elector signature7_12
- Witness initials7_12
- Internal use only7_12
- Printed name of elector8_12
- Full residential address street numbernamecity8_12
- Postal code8_12
- Elector signature8_12
- Witness initials8_12
- Internal use only8_12
- Printed name of elector9_12
- Full residential address street numbernamecity9_12
- Postal code9_12
- Elector signature9_12
- Witness initials9_12
- Internal use only9_12
- Printed name of elector10_12
- Full residential address street numbernamecity10_12
- Postal code10_12
- Elector signature10_12
- Witness initials10_12
- Internal use only10_12
- Printed name of elector1_13
- Full residential address street numbernamecity1_13
- Postal code1_13
- Elector signature1_13
- Witness initials1_13
- Internal use only1_13
- Printed name of elector2_13
- Full residential address street numbernamecity2_13
- Postal code2_13
- Elector signature2_13
- Witness initials2_13
- Internal use only2_13
- Printed name of elector3_13
- Full residential address street numbernamecity3_13
- Postal code3_13
- Elector signature3_13
- Witness initials3_13
- Internal use only3_13
- Printed name of elector4_13
- Full residential address street numbernamecity4_13
- Postal code4_13
- Elector signature4_13
- Witness initials4_13
- Internal use only4_13
- Printed name of elector5_13
- Full residential address street numbernamecity5_13
- Postal code5_13
- Elector signature5_13
- Witness initials5_13
- Internal use only5_13
- Printed name of elector6_13
- Full residential address street numbernamecity6_13
- Postal code6_13
- Elector signature6_13
- Witness initials6_13
- Internal use only6_13
- Printed name of elector7_13
- Full residential address street numbernamecity7_13
- Postal code7_13
- Elector signature7_13
- Witness initials7_13
- Internal use only7_13
- Printed name of elector8_13
- Full residential address street numbernamecity8_13
- Postal code8_13
- Elector signature8_13
- Witness initials8_13
- Internal use only8_13
- Printed name of elector9_13
- Full residential address street numbernamecity9_13
- Postal code9_13
- Elector signature9_13
- Witness initials9_13
- Internal use only9_13
- Printed name of elector10_13
- Full residential address street numbernamecity10_13
- Postal code10_13
- Elector signature10_13
- Witness initials10_13
- Internal use only10_13
- Printed name of elector1_14
- Full residential address street numbernamecity1_14
- Postal code1_14
- Elector signature1_14
- Witness initials1_14
- Internal use only1_14
- Printed name of elector2_14
- Full residential address street numbernamecity2_14
- Postal code2_14
- Elector signature2_14
- Witness initials2_14
- Internal use only2_14
- Printed name of elector3_14
- Full residential address street numbernamecity3_14
- Postal code3_14
- Elector signature3_14
- Witness initials3_14
- Internal use only3_14
- Printed name of elector4_14
- Full residential address street numbernamecity4_14
- Postal code4_14
- Elector signature4_14
- Witness initials4_14
- Internal use only4_14
- Printed name of elector5_14
- Full residential address street numbernamecity5_14
- Postal code5_14
- Elector signature5_14
- Witness initials5_14
- Internal use only5_14
- Printed name of elector6_14
- Full residential address street numbernamecity6_14
- Postal code6_14
- Elector signature6_14
- Witness initials6_14
- Internal use only6_14
- Printed name of elector7_14
- Full residential address street numbernamecity7_14
- Postal code7_14
- Elector signature7_14
- Witness initials7_14
- Internal use only7_14
- Printed name of elector8_14
- Full residential address street numbernamecity8_14
- Postal code8_14
- Elector signature8_14
- Witness initials8_14
- Internal use only8_14
- Printed name of elector9_14
- Full residential address street numbernamecity9_14
- Postal code9_14
- Elector signature9_14
- Witness initials9_14
- Internal use only9_14
- Printed name of elector10_14
- Full residential address street numbernamecity10_14
- Postal code10_14
- Elector signature10_14
- Witness initials10_14
- Internal use only10_14
- Printed name of elector1_15
- Full residential address street numbernamecity1_15
- Postal code1_15
- Elector signature1_15
- Witness initials1_15
- Internal use only1_15
- Printed name of elector2_15
- Full residential address street numbernamecity2_15
- Postal code2_15
- Elector signature2_15
- Witness initials2_15
- Internal use only2_15
- Printed name of elector3_15
- Full residential address street numbernamecity3_15
- Postal code3_15
- Elector signature3_15
- Witness initials3_15
- Internal use only3_15
- Printed name of elector4_15
- Full residential address street numbernamecity4_15
- Postal code4_15
- Elector signature4_15
- Witness initials4_15
- Internal use only4_15
- Printed name of elector5_15
- Full residential address street numbernamecity5_15
- Postal code5_15
- Elector signature5_15
- Witness initials5_15
- Internal use only5_15
- Printed name of elector6_15
- Full residential address street numbernamecity6_15
- Postal code6_15
- Elector signature6_15
- Witness initials6_15
- Internal use only6_15
- Printed name of elector7_15
- Full residential address street numbernamecity7_15
- Postal code7_15
- Elector signature7_15
- Witness initials7_15
- Internal use only7_15
- Printed name of elector8_15
- Full residential address street numbernamecity8_15
- Postal code8_15
- Elector signature8_15
- Witness initials8_15
- Internal use only8_15
- Printed name of elector9_15
- Full residential address street numbernamecity9_15
- Postal code9_15
- Elector signature9_15
- Witness initials9_15
- Internal use only9_15
- Printed name of elector10_15
- Full residential address street numbernamecity10_15
- Postal code10_15
- Elector signature10_15
- Witness initials10_15
- Internal use only10_15
- Printed name of elector1_16
- Full residential address street numbernamecity1_16
- Postal code1_16
- Elector signature1_16
- Witness initials1_16
- Internal use only1_16
- Printed name of elector2_16
- Full residential address street numbernamecity2_16
- Postal code2_16
- Elector signature2_16
- Witness initials2_16
- Internal use only2_16
- Printed name of elector3_16
- Full residential address street numbernamecity3_16
- Postal code3_16
- Elector signature3_16
- Witness initials3_16
- Internal use only3_16
- Printed name of elector4_16
- Full residential address street numbernamecity4_16
- Postal code4_16
- Elector signature4_16
- Witness initials4_16
- Internal use only4_16
- Printed name of elector5_16
- Full residential address street numbernamecity5_16
- Postal code5_16
- Elector signature5_16
- Witness initials5_16
- Internal use only5_16
- Printed name of elector6_16
- Full residential address street numbernamecity6_16
- Postal code6_16
- Elector signature6_16
- Witness initials6_16
- Internal use only6_16
- Printed name of elector7_16
- Full residential address street numbernamecity7_16
- Postal code7_16
- Elector signature7_16
- Witness initials7_16
- Internal use only7_16
- Printed name of elector8_16
- Full residential address street numbernamecity8_16
- Postal code8_16
- Elector signature8_16
- Witness initials8_16
- Internal use only8_16
- Printed name of elector9_16
- Full residential address street numbernamecity9_16
- Postal code9_16
- Elector signature9_16
- Witness initials9_16
- Internal use only9_16
- Printed name of elector10_16
- Full residential address street numbernamecity10_16
- Postal code10_16
- Elector signature10_16
- Witness initials10_16
- Internal use only10_16
- Have you completed the Nomination Paper EC 20010 Off
- Do you have authorized proof of identify Off
- Are you endorsed by a political party Off
- Have you made a nomination appointment Off
- Last name - Candidate Name
- First name - Candidate Name
- Name of electoral district- Candidate Information
- First name - Candidate Information
- Last name - Candidate Information
- Ballot Name Off
- Ballot First name(s)
- Ballot Last name(s)
- Gender -Candidate information
- Date of birth (YYY-MM-DD) - Gender -Candidate information
- language of correspondence - Candidate information Off
- Email -Contact information
- Primary phone number - Contact information
- Ext - Primary phone number
- Alternate phone number - Contact information
- Ext - Alternate phone number
- Fax number- Alternate phone number
- Unit -Residential address
- Street -Residential address
- Street name -Residential address
- City -Residential address
- ProvinceTerritory -Residential address
- Postal code - -Residential address
- Mailing address - same as residential address Off
- Occupation- Candidate occupation
- Sharing of information with the Conflict of Interest and Ethics Commissioner and the House of Commons including the Library of Parliament Off
- where applicable if the returning officer is unable to verify that I have been endorsed by the political party identified in section A of this Nomination Paper I wish to Off
- Date of Signature (YYYY-MM-DD) - Candidate signature
- Date of Signature (YYYY-MM-DD) -Signature of person receiving the solemn declaration
- Campaign delegate information
- First name - Campaign delegate information
- Last name - Campaign delegate information
- Language of correspondence - Campaign delegate information Off
- Email - Contact information -Campaign Delegate
- Primary phone number - Contact information -Campaign Delegate
- Primary phone number EXT - Contact information -Campaign Delegate
- Alternate phone number - Contact information -Campaign Delegate
- Alternate phone number EXT - Contact information -Campaign Delegate
- Fax nmuber- Contact information -Campaign Delegate
- Street - Residential address -Campaign delegate
- Street name - Residential address -Campaign delegate
- City - Residential address -Campaign delegate
- ProvinceTerritory - Residential address -Campaign delegate
- Postal Code - Residential address -Campaign delegate
- Campaign delegate - Mailing address ndash Same as residential address Off
- Unit - Residential address -Campaign delegate
- Date (YYYY-MM-DD) - Candidate authorization Signature
- Date (YYYY-MM-DD) - Candidate campaign Signature
- First name - Official agent information
- Last name - Official agent information
- Language of correspondence - Official agent information Off
- Email - Official agent information
- Primary phone number - Official agent information
- Primary phone number EXT - Official agent information
- Alternate phone number EXT - Official agent information
- Alternate phone number - Official agent information
- Fax number - Official agent information
- Unit -Residential address - Official Agent
- Street name -Residential address - Official Agent
- City -Residential address - Official Agent
- Street -Residential address - Official Agent
- ProvinceTerritory -Residential address - Official Agent
- Postal code-Residential address - Official Agent
- Mailing address ndash Same as residential address- Official Agent Off
- Date (YYYY-MM-DD) - Official agent signature
- First name - Auditor information
- Last name - Auditor information
- Language of correspondence - Auditor information Off
- Email - Auditor information
- Primary phone number - Auditor information
- Primary phone number EXT- Auditor information
- Alternate phone number - Auditor information
- Alternate phone number EXT- Auditor information
- Fax number - Auditor information
- Name of firm- Auditor organizational information
- Occupation of auditor - Auditor organizational information
- Professional designation - Auditor organizational information Off
- Designation registration number
- Make cheque payable to
- Unit - Address (where cheque is sent)
- Street - Address (where cheque is sent)
- Street name - Address (where cheque is sent)
- City - Address (where cheque is sent)
- ProvinceTerritory - Address (where cheque is sent)
- Postal code - Address (where cheque is sent)
- Date (YYY-MM-DD) - Auditor signature
- Unit - Campaign office address (optional)
- Street - Campaign office address (optional)
- Street name - Campaign office address (optional)
- City - Campaign office address (optional)
- ProvinceTerritory- Campaign office address (optional)
- Postal code - Campaign office address (optional)
- Name of witness
- Full address of witness
- Name of candidate
- Electoral district
- Year
- Name of candidate2
- Electoral district2
- Year2
- Name of witness2
- Full address of witness2
- Name of candidate3
- Electoral district3
- Year3
- Full address of witness3
- Name of witness3
- Name of candidate 4
- Electoral district4
- Year4
- Full address of witness 4
- Name of witness 4
- Name of candidate5
- Electoral district5
- Year5
- Full address of witness5
- Name of witness5
- Name of candidate6
- Electoral district6
- Year6
- Name of witness6
- Full address of witness6
- Name of candidate7
- Electoral district7
- Year7
- Full address of witness7
- Name of witness7
- Name of candidate8
- Electoral district8
- Year8
- Full address of witness8
- Name of witness8
- Name of candidate9
- Electoral district9
- Year9
- Full address of witness 9
- Name of witness 9
- Name of candidate10
- Electoral district10
- Year10
- Full address of witness10
- Name of witness10
- Name of candidate11
- Electoral district11
- Year11
- Full address of witness11
- Name of witness11
- Name of candidate12
- Electoral district12
- Year12
- Full address of witness12
- Name of witness12
- Name of candidate13
- Electoral district13
- Year13
- Full address of witness13
- Name of witness13
- Name of candidate14
- Electoral district14
- Year14
- Name of witness14
- Full address of witness14
- Name of candidate1
- Electoral district1
- Year1
- Name of witness1
- Full address of witness1
- Name of candidate15
- Electoral district15
- Year15
- Name of witness15
- Full address of witness15
- unit -Mailing address
- Street -Mailing address
- Street name -Mailing address
- City -Mailing address
- ProvinceTerritory -Mailing address
- Postal code -Mailing address
- Unit - Mailing address -Campaign delegate
- Street - Mailing address -Campaign delegate
- Street name - Mailing address -Campaign delegate
- City - Mailing address -Campaign delegate
- ProvinceTerritory- Mailing address -Campaign delegate
- Postal code- Mailing address -Campaign delegate
- Unit -Mailing address - Official Agent
- Street -Mailing address - Official Agent
- Street name -Mailing address - Official Agent
- city -Mailing address - Official Agent
- ProvinceTerritory-Mailing address - Official Agent
- Postal code-Mailing address - Official Agent
EC 20010 (052019)
SECTION D ndash Auditor ndash Privacy Notice and Declaration (Optional)
If appointing an auditor all fields marked with are mandatory
Privacy notice
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA) Any person at the returning office may examine the completed Nomination Paper during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information
Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
Auditor signature
I the undersigned hereby agree to act as the auditor for the candidate named in this Nomination Paper I further state that I am aware of the duties and responsibilities of this position under the Canada Elections Act and I am qualified to act as auditor under subsection 4773(1) and (2) of the Canada Elections Act
Auditor signature Date (YYYY-MM-DD)
13
EC 20010 (052019)
SECTION E ndash 6BCampaign Office (Optional)
Contact information to be made available on the Elections Canada website (optional)
Please note You may provide a telephone number andor a link to your website or social media platform of choice when filing your Nomination Paper with Elections Canada You do not have to provide this information but it is intended to help electors access campaign information Elections Canada may provide this information as part of the Voter Information Service Please include the full website address including prefix (http https)
Telephone number to be posted on electionsca
Website to be posted on electionsca (including prefix http https)
Campaign office address (optional)
Unit Street Street name
City ProvinceTerritory Postal code
14
SECTION F ndash 7BElectors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
15
8BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
16
9BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
17
10BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
18
11BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
19
12BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
20
13BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
21
14BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
22
15BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
23
16BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
24
17BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
25
18BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
26
19BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
27
20BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
28
21BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
29
22BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
30
EC 20010 (022019)
SECTION G ndash 23B Are You Ready to Submit Your Nomination
Have you completed the Nomination Paper (EC 20010)
bull Are all mandatory fields in sections AndashE complete
bull Have you collected the required number of signatures from qualified electors in section F
o For most electoral districts 100 electors must consent to your candidacy
o For electoral districts identified in Schedule 3 only 50 electors are required
o To ensure a smooth nomination process Elections Canada recommends collecting signatures from at least 150 electors
Do you have authorized proof of identify
bull For a list of authorized identification visit the Elections Canada website
bull If a campaign delegate is submitting on your behalf they must bring a copy of your identification documents signed by you
bull If you want an alternative name to appear on the ballot additional documentation is required visit electionsca for details
Are you endorsed by a political party
bull Make sure your party has submitted the required documentation to Elections Canada attesting your designated political affiliation
Have you made a nomination appointment
bull To facilitate the nomination process make an appointment with the returning officer to finalize the filing of the complete nomination package
bull The nomination period closes 21 days before election day at 200 pm local time
31
- Nomination Paperof a Candidate at a Federal General Election or By-election
- Table of Contents
- General Information
- SECTION A ndash Candidate Information (Mandatory)
- SECTION B ndash Campaign Delegate (Optional)
- SECTION C ndash Official Agent (Mandatory)
- SECTION D ndash Auditor (Optional)
- SECTION E ndash Campaign Office (Optional)
- SECTION F ndash Electors Consenting to Candidacy (Mandatory)
-
- Name of electoral district
- Political affiliation
- Telephone number to be posted on electionsca
- Website to be posted on electionsca including prefix http https
- Printed name of elector1
- Full residential address street numbernamecity1
- Postal code1
- Elector signature1
- Witness initials1
- Internal use only1
- Printed name of elector2
- Full residential address street numbernamecity2
- Postal code2
- Elector signature2
- Witness initials2
- Internal use only2
- Printed name of elector3
- Full residential address street numbernamecity3
- Postal code3
- Elector signature3
- Witness initials3
- Internal use only3
- Printed name of elector4
- Full residential address street numbernamecity4
- Postal code4
- Elector signature4
- Witness initials4
- Internal use only4
- Printed name of elector5
- Full residential address street numbernamecity5
- Postal code5
- Elector signature5
- Witness initials5
- Internal use only5
- Printed name of elector6
- Full residential address street numbernamecity6
- Postal code6
- Elector signature6
- Witness initials6
- Internal use only6
- Printed name of elector7
- Full residential address street numbernamecity7
- Postal code7
- Elector signature7
- Witness initials7
- Internal use only7
- Printed name of elector8
- Full residential address street numbernamecity8
- Postal code8
- Elector signature8
- Witness initials8
- Internal use only8
- Printed name of elector9
- Full residential address street numbernamecity9
- Postal code9
- Elector signature9
- Witness initials9
- Internal use only9
- Printed name of elector10
- Full residential address street numbernamecity10
- Postal code10
- Elector signature10
- Witness initials10
- Internal use only10
- Printed name of elector1_2
- Full residential address street numbernamecity1_2
- Postal code1_2
- Elector signature1_2
- Witness initials1_2
- Internal use only1_2
- Printed name of elector2_2
- Full residential address street numbernamecity2_2
- Postal code2_2
- Elector signature2_2
- Witness initials2_2
- Internal use only2_2
- Printed name of elector3_2
- Full residential address street numbernamecity3_2
- Postal code3_2
- Elector signature3_2
- Witness initials3_2
- Internal use only3_2
- Printed name of elector4_2
- Full residential address street numbernamecity4_2
- Postal code4_2
- Elector signature4_2
- Witness initials4_2
- Internal use only4_2
- Printed name of elector5_2
- Full residential address street numbernamecity5_2
- Postal code5_2
- Elector signature5_2
- Witness initials5_2
- Internal use only5_2
- Printed name of elector6_2
- Full residential address street numbernamecity6_2
- Postal code6_2
- Elector signature6_2
- Witness initials6_2
- Internal use only6_2
- Printed name of elector7_2
- Full residential address street numbernamecity7_2
- Postal code7_2
- Elector signature7_2
- Witness initials7_2
- Internal use only7_2
- Printed name of elector8_2
- Full residential address street numbernamecity8_2
- Postal code8_2
- Elector signature8_2
- Witness initials8_2
- Internal use only8_2
- Printed name of elector9_2
- Full residential address street numbernamecity9_2
- Postal code9_2
- Elector signature9_2
- Witness initials9_2
- Internal use only9_2
- Printed name of elector10_2
- Full residential address street numbernamecity10_2
- Postal code10_2
- Elector signature10_2
- Witness initials10_2
- Internal use only10_2
- Printed name of elector1_3
- Full residential address street numbernamecity1_3
- Postal code1_3
- Elector signature1_3
- Witness initials1_3
- Internal use only1_3
- Printed name of elector2_3
- Full residential address street numbernamecity2_3
- Postal code2_3
- Elector signature2_3
- Witness initials2_3
- Internal use only2_3
- Printed name of elector3_3
- Full residential address street numbernamecity3_3
- Postal code3_3
- Elector signature3_3
- Witness initials3_3
- Internal use only3_3
- Printed name of elector4_3
- Full residential address street numbernamecity4_3
- Postal code4_3
- Elector signature4_3
- Witness initials4_3
- Internal use only4_3
- Printed name of elector5_3
- Full residential address street numbernamecity5_3
- Postal code5_3
- Elector signature5_3
- Witness initials5_3
- Internal use only5_3
- Printed name of elector6_3
- Full residential address street numbernamecity6_3
- Postal code6_3
- Elector signature6_3
- Witness initials6_3
- Internal use only6_3
- Printed name of elector7_3
- Full residential address street numbernamecity7_3
- Postal code7_3
- Elector signature7_3
- Witness initials7_3
- Internal use only7_3
- Printed name of elector8_3
- Full residential address street numbernamecity8_3
- Postal code8_3
- Elector signature8_3
- Witness initials8_3
- Internal use only8_3
- Printed name of elector9_3
- Full residential address street numbernamecity9_3
- Postal code9_3
- Elector signature9_3
- Witness initials9_3
- Internal use only9_3
- Printed name of elector10_3
- Full residential address street numbernamecity10_3
- Postal code10_3
- Elector signature10_3
- Witness initials10_3
- Internal use only10_3
- Printed name of elector1_4
- Full residential address street numbernamecity1_4
- Postal code1_4
- Elector signature1_4
- Witness initials1_4
- Internal use only1_4
- Printed name of elector2_4
- Full residential address street numbernamecity2_4
- Postal code2_4
- Elector signature2_4
- Witness initials2_4
- Internal use only2_4
- Printed name of elector3_4
- Full residential address street numbernamecity3_4
- Postal code3_4
- Elector signature3_4
- Witness initials3_4
- Internal use only3_4
- Printed name of elector4_4
- Full residential address street numbernamecity4_4
- Postal code4_4
- Elector signature4_4
- Witness initials4_4
- Internal use only4_4
- Printed name of elector5_4
- Full residential address street numbernamecity5_4
- Postal code5_4
- Elector signature5_4
- Witness initials5_4
- Internal use only5_4
- Printed name of elector6_4
- Full residential address street numbernamecity6_4
- Postal code6_4
- Elector signature6_4
- Witness initials6_4
- Internal use only6_4
- Printed name of elector7_4
- Full residential address street numbernamecity7_4
- Postal code7_4
- Elector signature7_4
- Witness initials7_4
- Internal use only7_4
- Printed name of elector8_4
- Full residential address street numbernamecity8_4
- Postal code8_4
- Elector signature8_4
- Witness initials8_4
- Internal use only8_4
- Printed name of elector9_4
- Full residential address street numbernamecity9_4
- Postal code9_4
- Elector signature9_4
- Witness initials9_4
- Internal use only9_4
- Printed name of elector10_4
- Full residential address street numbernamecity10_4
- Postal code10_4
- Elector signature10_4
- Witness initials10_4
- Internal use only10_4
- Printed name of elector1_5
- Full residential address street numbernamecity1_5
- Postal code1_5
- Elector signature1_5
- Witness initials1_5
- Internal use only1_5
- Printed name of elector2_5
- Full residential address street numbernamecity2_5
- Postal code2_5
- Elector signature2_5
- Witness initials2_5
- Internal use only2_5
- Printed name of elector3_5
- Full residential address street numbernamecity3_5
- Postal code3_5
- Elector signature3_5
- Witness initials3_5
- Internal use only3_5
- Printed name of elector4_5
- Full residential address street numbernamecity4_5
- Postal code4_5
- Elector signature4_5
- Witness initials4_5
- Internal use only4_5
- Printed name of elector5_5
- Full residential address street numbernamecity5_5
- Postal code5_5
- Elector signature5_5
- Witness initials5_5
- Internal use only5_5
- Printed name of elector6_5
- Full residential address street numbernamecity6_5
- Postal code6_5
- Elector signature6_5
- Witness initials6_5
- Internal use only6_5
- Printed name of elector7_5
- Full residential address street numbernamecity7_5
- Postal code7_5
- Elector signature7_5
- Witness initials7_5
- Internal use only7_5
- Printed name of elector8_5
- Full residential address street numbernamecity8_5
- Postal code8_5
- Elector signature8_5
- Witness initials8_5
- Internal use only8_5
- Printed name of elector9_5
- Full residential address street numbernamecity9_5
- Postal code9_5
- Elector signature9_5
- Witness initials9_5
- Internal use only9_5
- Printed name of elector10_5
- Full residential address street numbernamecity10_5
- Postal code10_5
- Elector signature10_5
- Witness initials10_5
- Internal use only10_5
- Printed name of elector1_6
- Full residential address street numbernamecity1_6
- Postal code1_6
- Elector signature1_6
- Witness initials1_6
- Internal use only1_6
- Printed name of elector2_6
- Full residential address street numbernamecity2_6
- Postal code2_6
- Elector signature2_6
- Witness initials2_6
- Internal use only2_6
- Printed name of elector3_6
- Full residential address street numbernamecity3_6
- Postal code3_6
- Elector signature3_6
- Witness initials3_6
- Internal use only3_6
- Printed name of elector4_6
- Full residential address street numbernamecity4_6
- Postal code4_6
- Elector signature4_6
- Witness initials4_6
- Internal use only4_6
- Printed name of elector5_6
- Full residential address street numbernamecity5_6
- Postal code5_6
- Elector signature5_6
- Witness initials5_6
- Internal use only5_6
- Printed name of elector6_6
- Full residential address street numbernamecity6_6
- Postal code6_6
- Elector signature6_6
- Witness initials6_6
- Internal use only6_6
- Printed name of elector7_6
- Full residential address street numbernamecity7_6
- Postal code7_6
- Elector signature7_6
- Witness initials7_6
- Internal use only7_6
- Printed name of elector8_6
- Full residential address street numbernamecity8_6
- Postal code8_6
- Elector signature8_6
- Witness initials8_6
- Internal use only8_6
- Printed name of elector9_6
- Full residential address street numbernamecity9_6
- Postal code9_6
- Elector signature9_6
- Witness initials9_6
- Internal use only9_6
- Printed name of elector10_6
- Full residential address street numbernamecity10_6
- Postal code10_6
- Elector signature10_6
- Witness initials10_6
- Internal use only10_6
- Printed name of elector1_7
- Full residential address street numbernamecity1_7
- Postal code1_7
- Elector signature1_7
- Witness initials1_7
- Internal use only1_7
- Printed name of elector2_7
- Full residential address street numbernamecity2_7
- Postal code2_7
- Elector signature2_7
- Witness initials2_7
- Internal use only2_7
- Printed name of elector3_7
- Full residential address street numbernamecity3_7
- Postal code3_7
- Elector signature3_7
- Witness initials3_7
- Internal use only3_7
- Printed name of elector4_7
- Full residential address street numbernamecity4_7
- Postal code4_7
- Elector signature4_7
- Witness initials4_7
- Internal use only4_7
- Printed name of elector5_7
- Full residential address street numbernamecity5_7
- Postal code5_7
- Elector signature5_7
- Witness initials5_7
- Internal use only5_7
- Printed name of elector6_7
- Full residential address street numbernamecity6_7
- Postal code6_7
- Elector signature6_7
- Witness initials6_7
- Internal use only6_7
- Printed name of elector7_7
- Full residential address street numbernamecity7_7
- Postal code7_7
- Elector signature7_7
- Witness initials7_7
- Internal use only7_7
- Printed name of elector8_7
- Full residential address street numbernamecity8_7
- Postal code8_7
- Elector signature8_7
- Witness initials8_7
- Internal use only8_7
- Printed name of elector9_7
- Full residential address street numbernamecity9_7
- Postal code9_7
- Elector signature9_7
- Witness initials9_7
- Internal use only9_7
- Printed name of elector10_7
- Full residential address street numbernamecity10_7
- Postal code10_7
- Elector signature10_7
- Witness initials10_7
- Internal use only10_7
- Printed name of elector1_8
- Full residential address street numbernamecity1_8
- Postal code1_8
- Elector signature1_8
- Witness initials1_8
- Internal use only1_8
- Printed name of elector2_8
- Full residential address street numbernamecity2_8
- Postal code2_8
- Elector signature2_8
- Witness initials2_8
- Internal use only2_8
- Printed name of elector3_8
- Full residential address street numbernamecity3_8
- Postal code3_8
- Elector signature3_8
- Witness initials3_8
- Internal use only3_8
- Printed name of elector4_8
- Full residential address street numbernamecity4_8
- Postal code4_8
- Elector signature4_8
- Witness initials4_8
- Internal use only4_8
- Printed name of elector5_8
- Full residential address street numbernamecity5_8
- Postal code5_8
- Elector signature5_8
- Witness initials5_8
- Internal use only5_8
- Printed name of elector6_8
- Full residential address street numbernamecity6_8
- Postal code6_8
- Elector signature6_8
- Witness initials6_8
- Internal use only6_8
- Printed name of elector7_8
- Full residential address street numbernamecity7_8
- Postal code7_8
- Elector signature7_8
- Witness initials7_8
- Internal use only7_8
- Printed name of elector8_8
- Full residential address street numbernamecity8_8
- Postal code8_8
- Elector signature8_8
- Witness initials8_8
- Internal use only8_8
- Printed name of elector9_8
- Full residential address street numbernamecity9_8
- Postal code9_8
- Elector signature9_8
- Witness initials9_8
- Internal use only9_8
- Printed name of elector10_8
- Full residential address street numbernamecity10_8
- Postal code10_8
- Elector signature10_8
- Witness initials10_8
- Internal use only10_8
- Printed name of elector1_9
- Full residential address street numbernamecity1_9
- Postal code1_9
- Elector signature1_9
- Witness initials1_9
- Internal use only1_9
- Printed name of elector2_9
- Full residential address street numbernamecity2_9
- Postal code2_9
- Elector signature2_9
- Witness initials2_9
- Internal use only2_9
- Printed name of elector3_9
- Full residential address street numbernamecity3_9
- Postal code3_9
- Elector signature3_9
- Witness initials3_9
- Internal use only3_9
- Printed name of elector4_9
- Full residential address street numbernamecity4_9
- Postal code4_9
- Elector signature4_9
- Witness initials4_9
- Internal use only4_9
- Printed name of elector5_9
- Full residential address street numbernamecity5_9
- Postal code5_9
- Elector signature5_9
- Witness initials5_9
- Internal use only5_9
- Printed name of elector6_9
- Full residential address street numbernamecity6_9
- Postal code6_9
- Elector signature6_9
- Witness initials6_9
- Internal use only6_9
- Printed name of elector7_9
- Full residential address street numbernamecity7_9
- Postal code7_9
- Elector signature7_9
- Witness initials7_9
- Internal use only7_9
- Printed name of elector8_9
- Full residential address street numbernamecity8_9
- Postal code8_9
- Elector signature8_9
- Witness initials8_9
- Internal use only8_9
- Printed name of elector9_9
- Full residential address street numbernamecity9_9
- Postal code9_9
- Elector signature9_9
- Witness initials9_9
- Internal use only9_9
- Printed name of elector10_9
- Full residential address street numbernamecity10_9
- Postal code10_9
- Elector signature10_9
- Witness initials10_9
- Internal use only10_9
- Printed name of elector1_10
- Full residential address street numbernamecity1_10
- Postal code1_10
- Elector signature1_10
- Witness initials1_10
- Internal use only1_10
- Printed name of elector2_10
- Full residential address street numbernamecity2_10
- Postal code2_10
- Elector signature2_10
- Witness initials2_10
- Internal use only2_10
- Printed name of elector3_10
- Full residential address street numbernamecity3_10
- Postal code3_10
- Elector signature3_10
- Witness initials3_10
- Internal use only3_10
- Printed name of elector4_10
- Full residential address street numbernamecity4_10
- Postal code4_10
- Elector signature4_10
- Witness initials4_10
- Internal use only4_10
- Printed name of elector5_10
- Full residential address street numbernamecity5_10
- Postal code5_10
- Elector signature5_10
- Witness initials5_10
- Internal use only5_10
- Printed name of elector6_10
- Full residential address street numbernamecity6_10
- Postal code6_10
- Elector signature6_10
- Witness initials6_10
- Internal use only6_10
- Printed name of elector7_10
- Full residential address street numbernamecity7_10
- Postal code7_10
- Elector signature7_10
- Witness initials7_10
- Internal use only7_10
- Printed name of elector8_10
- Full residential address street numbernamecity8_10
- Postal code8_10
- Elector signature8_10
- Witness initials8_10
- Internal use only8_10
- Printed name of elector9_10
- Full residential address street numbernamecity9_10
- Postal code9_10
- Elector signature9_10
- Witness initials9_10
- Internal use only9_10
- Printed name of elector10_10
- Full residential address street numbernamecity10_10
- Postal code10_10
- Elector signature10_10
- Witness initials10_10
- Internal use only10_10
- Printed name of elector1_11
- Full residential address street numbernamecity1_11
- Postal code1_11
- Elector signature1_11
- Witness initials1_11
- Internal use only1_11
- Printed name of elector2_11
- Full residential address street numbernamecity2_11
- Postal code2_11
- Elector signature2_11
- Witness initials2_11
- Internal use only2_11
- Printed name of elector3_11
- Full residential address street numbernamecity3_11
- Postal code3_11
- Elector signature3_11
- Witness initials3_11
- Internal use only3_11
- Printed name of elector4_11
- Full residential address street numbernamecity4_11
- Postal code4_11
- Elector signature4_11
- Witness initials4_11
- Internal use only4_11
- Printed name of elector5_11
- Full residential address street numbernamecity5_11
- Postal code5_11
- Elector signature5_11
- Witness initials5_11
- Internal use only5_11
- Printed name of elector6_11
- Full residential address street numbernamecity6_11
- Postal code6_11
- Elector signature6_11
- Witness initials6_11
- Internal use only6_11
- Printed name of elector7_11
- Full residential address street numbernamecity7_11
- Postal code7_11
- Elector signature7_11
- Witness initials7_11
- Internal use only7_11
- Printed name of elector8_11
- Full residential address street numbernamecity8_11
- Postal code8_11
- Elector signature8_11
- Witness initials8_11
- Internal use only8_11
- Printed name of elector9_11
- Full residential address street numbernamecity9_11
- Postal code9_11
- Elector signature9_11
- Witness initials9_11
- Internal use only9_11
- Printed name of elector10_11
- Full residential address street numbernamecity10_11
- Postal code10_11
- Elector signature10_11
- Witness initials10_11
- Internal use only10_11
- Printed name of elector1_12
- Full residential address street numbernamecity1_12
- Postal code1_12
- Elector signature1_12
- Witness initials1_12
- Internal use only1_12
- Printed name of elector2_12
- Full residential address street numbernamecity2_12
- Postal code2_12
- Elector signature2_12
- Witness initials2_12
- Internal use only2_12
- Printed name of elector3_12
- Full residential address street numbernamecity3_12
- Postal code3_12
- Elector signature3_12
- Witness initials3_12
- Internal use only3_12
- Printed name of elector4_12
- Full residential address street numbernamecity4_12
- Postal code4_12
- Elector signature4_12
- Witness initials4_12
- Internal use only4_12
- Printed name of elector5_12
- Full residential address street numbernamecity5_12
- Postal code5_12
- Elector signature5_12
- Witness initials5_12
- Internal use only5_12
- Printed name of elector6_12
- Full residential address street numbernamecity6_12
- Postal code6_12
- Elector signature6_12
- Witness initials6_12
- Internal use only6_12
- Printed name of elector7_12
- Full residential address street numbernamecity7_12
- Postal code7_12
- Elector signature7_12
- Witness initials7_12
- Internal use only7_12
- Printed name of elector8_12
- Full residential address street numbernamecity8_12
- Postal code8_12
- Elector signature8_12
- Witness initials8_12
- Internal use only8_12
- Printed name of elector9_12
- Full residential address street numbernamecity9_12
- Postal code9_12
- Elector signature9_12
- Witness initials9_12
- Internal use only9_12
- Printed name of elector10_12
- Full residential address street numbernamecity10_12
- Postal code10_12
- Elector signature10_12
- Witness initials10_12
- Internal use only10_12
- Printed name of elector1_13
- Full residential address street numbernamecity1_13
- Postal code1_13
- Elector signature1_13
- Witness initials1_13
- Internal use only1_13
- Printed name of elector2_13
- Full residential address street numbernamecity2_13
- Postal code2_13
- Elector signature2_13
- Witness initials2_13
- Internal use only2_13
- Printed name of elector3_13
- Full residential address street numbernamecity3_13
- Postal code3_13
- Elector signature3_13
- Witness initials3_13
- Internal use only3_13
- Printed name of elector4_13
- Full residential address street numbernamecity4_13
- Postal code4_13
- Elector signature4_13
- Witness initials4_13
- Internal use only4_13
- Printed name of elector5_13
- Full residential address street numbernamecity5_13
- Postal code5_13
- Elector signature5_13
- Witness initials5_13
- Internal use only5_13
- Printed name of elector6_13
- Full residential address street numbernamecity6_13
- Postal code6_13
- Elector signature6_13
- Witness initials6_13
- Internal use only6_13
- Printed name of elector7_13
- Full residential address street numbernamecity7_13
- Postal code7_13
- Elector signature7_13
- Witness initials7_13
- Internal use only7_13
- Printed name of elector8_13
- Full residential address street numbernamecity8_13
- Postal code8_13
- Elector signature8_13
- Witness initials8_13
- Internal use only8_13
- Printed name of elector9_13
- Full residential address street numbernamecity9_13
- Postal code9_13
- Elector signature9_13
- Witness initials9_13
- Internal use only9_13
- Printed name of elector10_13
- Full residential address street numbernamecity10_13
- Postal code10_13
- Elector signature10_13
- Witness initials10_13
- Internal use only10_13
- Printed name of elector1_14
- Full residential address street numbernamecity1_14
- Postal code1_14
- Elector signature1_14
- Witness initials1_14
- Internal use only1_14
- Printed name of elector2_14
- Full residential address street numbernamecity2_14
- Postal code2_14
- Elector signature2_14
- Witness initials2_14
- Internal use only2_14
- Printed name of elector3_14
- Full residential address street numbernamecity3_14
- Postal code3_14
- Elector signature3_14
- Witness initials3_14
- Internal use only3_14
- Printed name of elector4_14
- Full residential address street numbernamecity4_14
- Postal code4_14
- Elector signature4_14
- Witness initials4_14
- Internal use only4_14
- Printed name of elector5_14
- Full residential address street numbernamecity5_14
- Postal code5_14
- Elector signature5_14
- Witness initials5_14
- Internal use only5_14
- Printed name of elector6_14
- Full residential address street numbernamecity6_14
- Postal code6_14
- Elector signature6_14
- Witness initials6_14
- Internal use only6_14
- Printed name of elector7_14
- Full residential address street numbernamecity7_14
- Postal code7_14
- Elector signature7_14
- Witness initials7_14
- Internal use only7_14
- Printed name of elector8_14
- Full residential address street numbernamecity8_14
- Postal code8_14
- Elector signature8_14
- Witness initials8_14
- Internal use only8_14
- Printed name of elector9_14
- Full residential address street numbernamecity9_14
- Postal code9_14
- Elector signature9_14
- Witness initials9_14
- Internal use only9_14
- Printed name of elector10_14
- Full residential address street numbernamecity10_14
- Postal code10_14
- Elector signature10_14
- Witness initials10_14
- Internal use only10_14
- Printed name of elector1_15
- Full residential address street numbernamecity1_15
- Postal code1_15
- Elector signature1_15
- Witness initials1_15
- Internal use only1_15
- Printed name of elector2_15
- Full residential address street numbernamecity2_15
- Postal code2_15
- Elector signature2_15
- Witness initials2_15
- Internal use only2_15
- Printed name of elector3_15
- Full residential address street numbernamecity3_15
- Postal code3_15
- Elector signature3_15
- Witness initials3_15
- Internal use only3_15
- Printed name of elector4_15
- Full residential address street numbernamecity4_15
- Postal code4_15
- Elector signature4_15
- Witness initials4_15
- Internal use only4_15
- Printed name of elector5_15
- Full residential address street numbernamecity5_15
- Postal code5_15
- Elector signature5_15
- Witness initials5_15
- Internal use only5_15
- Printed name of elector6_15
- Full residential address street numbernamecity6_15
- Postal code6_15
- Elector signature6_15
- Witness initials6_15
- Internal use only6_15
- Printed name of elector7_15
- Full residential address street numbernamecity7_15
- Postal code7_15
- Elector signature7_15
- Witness initials7_15
- Internal use only7_15
- Printed name of elector8_15
- Full residential address street numbernamecity8_15
- Postal code8_15
- Elector signature8_15
- Witness initials8_15
- Internal use only8_15
- Printed name of elector9_15
- Full residential address street numbernamecity9_15
- Postal code9_15
- Elector signature9_15
- Witness initials9_15
- Internal use only9_15
- Printed name of elector10_15
- Full residential address street numbernamecity10_15
- Postal code10_15
- Elector signature10_15
- Witness initials10_15
- Internal use only10_15
- Printed name of elector1_16
- Full residential address street numbernamecity1_16
- Postal code1_16
- Elector signature1_16
- Witness initials1_16
- Internal use only1_16
- Printed name of elector2_16
- Full residential address street numbernamecity2_16
- Postal code2_16
- Elector signature2_16
- Witness initials2_16
- Internal use only2_16
- Printed name of elector3_16
- Full residential address street numbernamecity3_16
- Postal code3_16
- Elector signature3_16
- Witness initials3_16
- Internal use only3_16
- Printed name of elector4_16
- Full residential address street numbernamecity4_16
- Postal code4_16
- Elector signature4_16
- Witness initials4_16
- Internal use only4_16
- Printed name of elector5_16
- Full residential address street numbernamecity5_16
- Postal code5_16
- Elector signature5_16
- Witness initials5_16
- Internal use only5_16
- Printed name of elector6_16
- Full residential address street numbernamecity6_16
- Postal code6_16
- Elector signature6_16
- Witness initials6_16
- Internal use only6_16
- Printed name of elector7_16
- Full residential address street numbernamecity7_16
- Postal code7_16
- Elector signature7_16
- Witness initials7_16
- Internal use only7_16
- Printed name of elector8_16
- Full residential address street numbernamecity8_16
- Postal code8_16
- Elector signature8_16
- Witness initials8_16
- Internal use only8_16
- Printed name of elector9_16
- Full residential address street numbernamecity9_16
- Postal code9_16
- Elector signature9_16
- Witness initials9_16
- Internal use only9_16
- Printed name of elector10_16
- Full residential address street numbernamecity10_16
- Postal code10_16
- Elector signature10_16
- Witness initials10_16
- Internal use only10_16
- Have you completed the Nomination Paper EC 20010 Off
- Do you have authorized proof of identify Off
- Are you endorsed by a political party Off
- Have you made a nomination appointment Off
- Last name - Candidate Name
- First name - Candidate Name
- Name of electoral district- Candidate Information
- First name - Candidate Information
- Last name - Candidate Information
- Ballot Name Off
- Ballot First name(s)
- Ballot Last name(s)
- Gender -Candidate information
- Date of birth (YYY-MM-DD) - Gender -Candidate information
- language of correspondence - Candidate information Off
- Email -Contact information
- Primary phone number - Contact information
- Ext - Primary phone number
- Alternate phone number - Contact information
- Ext - Alternate phone number
- Fax number- Alternate phone number
- Unit -Residential address
- Street -Residential address
- Street name -Residential address
- City -Residential address
- ProvinceTerritory -Residential address
- Postal code - -Residential address
- Mailing address - same as residential address Off
- Occupation- Candidate occupation
- Sharing of information with the Conflict of Interest and Ethics Commissioner and the House of Commons including the Library of Parliament Off
- where applicable if the returning officer is unable to verify that I have been endorsed by the political party identified in section A of this Nomination Paper I wish to Off
- Date of Signature (YYYY-MM-DD) - Candidate signature
- Date of Signature (YYYY-MM-DD) -Signature of person receiving the solemn declaration
- Campaign delegate information
- First name - Campaign delegate information
- Last name - Campaign delegate information
- Language of correspondence - Campaign delegate information Off
- Email - Contact information -Campaign Delegate
- Primary phone number - Contact information -Campaign Delegate
- Primary phone number EXT - Contact information -Campaign Delegate
- Alternate phone number - Contact information -Campaign Delegate
- Alternate phone number EXT - Contact information -Campaign Delegate
- Fax nmuber- Contact information -Campaign Delegate
- Street - Residential address -Campaign delegate
- Street name - Residential address -Campaign delegate
- City - Residential address -Campaign delegate
- ProvinceTerritory - Residential address -Campaign delegate
- Postal Code - Residential address -Campaign delegate
- Campaign delegate - Mailing address ndash Same as residential address Off
- Unit - Residential address -Campaign delegate
- Date (YYYY-MM-DD) - Candidate authorization Signature
- Date (YYYY-MM-DD) - Candidate campaign Signature
- First name - Official agent information
- Last name - Official agent information
- Language of correspondence - Official agent information Off
- Email - Official agent information
- Primary phone number - Official agent information
- Primary phone number EXT - Official agent information
- Alternate phone number EXT - Official agent information
- Alternate phone number - Official agent information
- Fax number - Official agent information
- Unit -Residential address - Official Agent
- Street name -Residential address - Official Agent
- City -Residential address - Official Agent
- Street -Residential address - Official Agent
- ProvinceTerritory -Residential address - Official Agent
- Postal code-Residential address - Official Agent
- Mailing address ndash Same as residential address- Official Agent Off
- Date (YYYY-MM-DD) - Official agent signature
- First name - Auditor information
- Last name - Auditor information
- Language of correspondence - Auditor information Off
- Email - Auditor information
- Primary phone number - Auditor information
- Primary phone number EXT- Auditor information
- Alternate phone number - Auditor information
- Alternate phone number EXT- Auditor information
- Fax number - Auditor information
- Name of firm- Auditor organizational information
- Occupation of auditor - Auditor organizational information
- Professional designation - Auditor organizational information Off
- Designation registration number
- Make cheque payable to
- Unit - Address (where cheque is sent)
- Street - Address (where cheque is sent)
- Street name - Address (where cheque is sent)
- City - Address (where cheque is sent)
- ProvinceTerritory - Address (where cheque is sent)
- Postal code - Address (where cheque is sent)
- Date (YYY-MM-DD) - Auditor signature
- Unit - Campaign office address (optional)
- Street - Campaign office address (optional)
- Street name - Campaign office address (optional)
- City - Campaign office address (optional)
- ProvinceTerritory- Campaign office address (optional)
- Postal code - Campaign office address (optional)
- Name of witness
- Full address of witness
- Name of candidate
- Electoral district
- Year
- Name of candidate2
- Electoral district2
- Year2
- Name of witness2
- Full address of witness2
- Name of candidate3
- Electoral district3
- Year3
- Full address of witness3
- Name of witness3
- Name of candidate 4
- Electoral district4
- Year4
- Full address of witness 4
- Name of witness 4
- Name of candidate5
- Electoral district5
- Year5
- Full address of witness5
- Name of witness5
- Name of candidate6
- Electoral district6
- Year6
- Name of witness6
- Full address of witness6
- Name of candidate7
- Electoral district7
- Year7
- Full address of witness7
- Name of witness7
- Name of candidate8
- Electoral district8
- Year8
- Full address of witness8
- Name of witness8
- Name of candidate9
- Electoral district9
- Year9
- Full address of witness 9
- Name of witness 9
- Name of candidate10
- Electoral district10
- Year10
- Full address of witness10
- Name of witness10
- Name of candidate11
- Electoral district11
- Year11
- Full address of witness11
- Name of witness11
- Name of candidate12
- Electoral district12
- Year12
- Full address of witness12
- Name of witness12
- Name of candidate13
- Electoral district13
- Year13
- Full address of witness13
- Name of witness13
- Name of candidate14
- Electoral district14
- Year14
- Name of witness14
- Full address of witness14
- Name of candidate1
- Electoral district1
- Year1
- Name of witness1
- Full address of witness1
- Name of candidate15
- Electoral district15
- Year15
- Name of witness15
- Full address of witness15
- unit -Mailing address
- Street -Mailing address
- Street name -Mailing address
- City -Mailing address
- ProvinceTerritory -Mailing address
- Postal code -Mailing address
- Unit - Mailing address -Campaign delegate
- Street - Mailing address -Campaign delegate
- Street name - Mailing address -Campaign delegate
- City - Mailing address -Campaign delegate
- ProvinceTerritory- Mailing address -Campaign delegate
- Postal code- Mailing address -Campaign delegate
- Unit -Mailing address - Official Agent
- Street -Mailing address - Official Agent
- Street name -Mailing address - Official Agent
- city -Mailing address - Official Agent
- ProvinceTerritory-Mailing address - Official Agent
- Postal code-Mailing address - Official Agent
EC 20010 (052019)
SECTION E ndash 6BCampaign Office (Optional)
Contact information to be made available on the Elections Canada website (optional)
Please note You may provide a telephone number andor a link to your website or social media platform of choice when filing your Nomination Paper with Elections Canada You do not have to provide this information but it is intended to help electors access campaign information Elections Canada may provide this information as part of the Voter Information Service Please include the full website address including prefix (http https)
Telephone number to be posted on electionsca
Website to be posted on electionsca (including prefix http https)
Campaign office address (optional)
Unit Street Street name
City ProvinceTerritory Postal code
14
SECTION F ndash 7BElectors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
15
8BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
16
9BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
17
10BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
18
11BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
19
12BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
20
13BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
21
14BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
22
15BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
23
16BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
24
17BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
25
18BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
26
19BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
27
20BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
28
21BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
29
22BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
30
EC 20010 (022019)
SECTION G ndash 23B Are You Ready to Submit Your Nomination
Have you completed the Nomination Paper (EC 20010)
bull Are all mandatory fields in sections AndashE complete
bull Have you collected the required number of signatures from qualified electors in section F
o For most electoral districts 100 electors must consent to your candidacy
o For electoral districts identified in Schedule 3 only 50 electors are required
o To ensure a smooth nomination process Elections Canada recommends collecting signatures from at least 150 electors
Do you have authorized proof of identify
bull For a list of authorized identification visit the Elections Canada website
bull If a campaign delegate is submitting on your behalf they must bring a copy of your identification documents signed by you
bull If you want an alternative name to appear on the ballot additional documentation is required visit electionsca for details
Are you endorsed by a political party
bull Make sure your party has submitted the required documentation to Elections Canada attesting your designated political affiliation
Have you made a nomination appointment
bull To facilitate the nomination process make an appointment with the returning officer to finalize the filing of the complete nomination package
bull The nomination period closes 21 days before election day at 200 pm local time
31
- Nomination Paperof a Candidate at a Federal General Election or By-election
- Table of Contents
- General Information
- SECTION A ndash Candidate Information (Mandatory)
- SECTION B ndash Campaign Delegate (Optional)
- SECTION C ndash Official Agent (Mandatory)
- SECTION D ndash Auditor (Optional)
- SECTION E ndash Campaign Office (Optional)
- SECTION F ndash Electors Consenting to Candidacy (Mandatory)
-
- Name of electoral district
- Political affiliation
- Telephone number to be posted on electionsca
- Website to be posted on electionsca including prefix http https
- Printed name of elector1
- Full residential address street numbernamecity1
- Postal code1
- Elector signature1
- Witness initials1
- Internal use only1
- Printed name of elector2
- Full residential address street numbernamecity2
- Postal code2
- Elector signature2
- Witness initials2
- Internal use only2
- Printed name of elector3
- Full residential address street numbernamecity3
- Postal code3
- Elector signature3
- Witness initials3
- Internal use only3
- Printed name of elector4
- Full residential address street numbernamecity4
- Postal code4
- Elector signature4
- Witness initials4
- Internal use only4
- Printed name of elector5
- Full residential address street numbernamecity5
- Postal code5
- Elector signature5
- Witness initials5
- Internal use only5
- Printed name of elector6
- Full residential address street numbernamecity6
- Postal code6
- Elector signature6
- Witness initials6
- Internal use only6
- Printed name of elector7
- Full residential address street numbernamecity7
- Postal code7
- Elector signature7
- Witness initials7
- Internal use only7
- Printed name of elector8
- Full residential address street numbernamecity8
- Postal code8
- Elector signature8
- Witness initials8
- Internal use only8
- Printed name of elector9
- Full residential address street numbernamecity9
- Postal code9
- Elector signature9
- Witness initials9
- Internal use only9
- Printed name of elector10
- Full residential address street numbernamecity10
- Postal code10
- Elector signature10
- Witness initials10
- Internal use only10
- Printed name of elector1_2
- Full residential address street numbernamecity1_2
- Postal code1_2
- Elector signature1_2
- Witness initials1_2
- Internal use only1_2
- Printed name of elector2_2
- Full residential address street numbernamecity2_2
- Postal code2_2
- Elector signature2_2
- Witness initials2_2
- Internal use only2_2
- Printed name of elector3_2
- Full residential address street numbernamecity3_2
- Postal code3_2
- Elector signature3_2
- Witness initials3_2
- Internal use only3_2
- Printed name of elector4_2
- Full residential address street numbernamecity4_2
- Postal code4_2
- Elector signature4_2
- Witness initials4_2
- Internal use only4_2
- Printed name of elector5_2
- Full residential address street numbernamecity5_2
- Postal code5_2
- Elector signature5_2
- Witness initials5_2
- Internal use only5_2
- Printed name of elector6_2
- Full residential address street numbernamecity6_2
- Postal code6_2
- Elector signature6_2
- Witness initials6_2
- Internal use only6_2
- Printed name of elector7_2
- Full residential address street numbernamecity7_2
- Postal code7_2
- Elector signature7_2
- Witness initials7_2
- Internal use only7_2
- Printed name of elector8_2
- Full residential address street numbernamecity8_2
- Postal code8_2
- Elector signature8_2
- Witness initials8_2
- Internal use only8_2
- Printed name of elector9_2
- Full residential address street numbernamecity9_2
- Postal code9_2
- Elector signature9_2
- Witness initials9_2
- Internal use only9_2
- Printed name of elector10_2
- Full residential address street numbernamecity10_2
- Postal code10_2
- Elector signature10_2
- Witness initials10_2
- Internal use only10_2
- Printed name of elector1_3
- Full residential address street numbernamecity1_3
- Postal code1_3
- Elector signature1_3
- Witness initials1_3
- Internal use only1_3
- Printed name of elector2_3
- Full residential address street numbernamecity2_3
- Postal code2_3
- Elector signature2_3
- Witness initials2_3
- Internal use only2_3
- Printed name of elector3_3
- Full residential address street numbernamecity3_3
- Postal code3_3
- Elector signature3_3
- Witness initials3_3
- Internal use only3_3
- Printed name of elector4_3
- Full residential address street numbernamecity4_3
- Postal code4_3
- Elector signature4_3
- Witness initials4_3
- Internal use only4_3
- Printed name of elector5_3
- Full residential address street numbernamecity5_3
- Postal code5_3
- Elector signature5_3
- Witness initials5_3
- Internal use only5_3
- Printed name of elector6_3
- Full residential address street numbernamecity6_3
- Postal code6_3
- Elector signature6_3
- Witness initials6_3
- Internal use only6_3
- Printed name of elector7_3
- Full residential address street numbernamecity7_3
- Postal code7_3
- Elector signature7_3
- Witness initials7_3
- Internal use only7_3
- Printed name of elector8_3
- Full residential address street numbernamecity8_3
- Postal code8_3
- Elector signature8_3
- Witness initials8_3
- Internal use only8_3
- Printed name of elector9_3
- Full residential address street numbernamecity9_3
- Postal code9_3
- Elector signature9_3
- Witness initials9_3
- Internal use only9_3
- Printed name of elector10_3
- Full residential address street numbernamecity10_3
- Postal code10_3
- Elector signature10_3
- Witness initials10_3
- Internal use only10_3
- Printed name of elector1_4
- Full residential address street numbernamecity1_4
- Postal code1_4
- Elector signature1_4
- Witness initials1_4
- Internal use only1_4
- Printed name of elector2_4
- Full residential address street numbernamecity2_4
- Postal code2_4
- Elector signature2_4
- Witness initials2_4
- Internal use only2_4
- Printed name of elector3_4
- Full residential address street numbernamecity3_4
- Postal code3_4
- Elector signature3_4
- Witness initials3_4
- Internal use only3_4
- Printed name of elector4_4
- Full residential address street numbernamecity4_4
- Postal code4_4
- Elector signature4_4
- Witness initials4_4
- Internal use only4_4
- Printed name of elector5_4
- Full residential address street numbernamecity5_4
- Postal code5_4
- Elector signature5_4
- Witness initials5_4
- Internal use only5_4
- Printed name of elector6_4
- Full residential address street numbernamecity6_4
- Postal code6_4
- Elector signature6_4
- Witness initials6_4
- Internal use only6_4
- Printed name of elector7_4
- Full residential address street numbernamecity7_4
- Postal code7_4
- Elector signature7_4
- Witness initials7_4
- Internal use only7_4
- Printed name of elector8_4
- Full residential address street numbernamecity8_4
- Postal code8_4
- Elector signature8_4
- Witness initials8_4
- Internal use only8_4
- Printed name of elector9_4
- Full residential address street numbernamecity9_4
- Postal code9_4
- Elector signature9_4
- Witness initials9_4
- Internal use only9_4
- Printed name of elector10_4
- Full residential address street numbernamecity10_4
- Postal code10_4
- Elector signature10_4
- Witness initials10_4
- Internal use only10_4
- Printed name of elector1_5
- Full residential address street numbernamecity1_5
- Postal code1_5
- Elector signature1_5
- Witness initials1_5
- Internal use only1_5
- Printed name of elector2_5
- Full residential address street numbernamecity2_5
- Postal code2_5
- Elector signature2_5
- Witness initials2_5
- Internal use only2_5
- Printed name of elector3_5
- Full residential address street numbernamecity3_5
- Postal code3_5
- Elector signature3_5
- Witness initials3_5
- Internal use only3_5
- Printed name of elector4_5
- Full residential address street numbernamecity4_5
- Postal code4_5
- Elector signature4_5
- Witness initials4_5
- Internal use only4_5
- Printed name of elector5_5
- Full residential address street numbernamecity5_5
- Postal code5_5
- Elector signature5_5
- Witness initials5_5
- Internal use only5_5
- Printed name of elector6_5
- Full residential address street numbernamecity6_5
- Postal code6_5
- Elector signature6_5
- Witness initials6_5
- Internal use only6_5
- Printed name of elector7_5
- Full residential address street numbernamecity7_5
- Postal code7_5
- Elector signature7_5
- Witness initials7_5
- Internal use only7_5
- Printed name of elector8_5
- Full residential address street numbernamecity8_5
- Postal code8_5
- Elector signature8_5
- Witness initials8_5
- Internal use only8_5
- Printed name of elector9_5
- Full residential address street numbernamecity9_5
- Postal code9_5
- Elector signature9_5
- Witness initials9_5
- Internal use only9_5
- Printed name of elector10_5
- Full residential address street numbernamecity10_5
- Postal code10_5
- Elector signature10_5
- Witness initials10_5
- Internal use only10_5
- Printed name of elector1_6
- Full residential address street numbernamecity1_6
- Postal code1_6
- Elector signature1_6
- Witness initials1_6
- Internal use only1_6
- Printed name of elector2_6
- Full residential address street numbernamecity2_6
- Postal code2_6
- Elector signature2_6
- Witness initials2_6
- Internal use only2_6
- Printed name of elector3_6
- Full residential address street numbernamecity3_6
- Postal code3_6
- Elector signature3_6
- Witness initials3_6
- Internal use only3_6
- Printed name of elector4_6
- Full residential address street numbernamecity4_6
- Postal code4_6
- Elector signature4_6
- Witness initials4_6
- Internal use only4_6
- Printed name of elector5_6
- Full residential address street numbernamecity5_6
- Postal code5_6
- Elector signature5_6
- Witness initials5_6
- Internal use only5_6
- Printed name of elector6_6
- Full residential address street numbernamecity6_6
- Postal code6_6
- Elector signature6_6
- Witness initials6_6
- Internal use only6_6
- Printed name of elector7_6
- Full residential address street numbernamecity7_6
- Postal code7_6
- Elector signature7_6
- Witness initials7_6
- Internal use only7_6
- Printed name of elector8_6
- Full residential address street numbernamecity8_6
- Postal code8_6
- Elector signature8_6
- Witness initials8_6
- Internal use only8_6
- Printed name of elector9_6
- Full residential address street numbernamecity9_6
- Postal code9_6
- Elector signature9_6
- Witness initials9_6
- Internal use only9_6
- Printed name of elector10_6
- Full residential address street numbernamecity10_6
- Postal code10_6
- Elector signature10_6
- Witness initials10_6
- Internal use only10_6
- Printed name of elector1_7
- Full residential address street numbernamecity1_7
- Postal code1_7
- Elector signature1_7
- Witness initials1_7
- Internal use only1_7
- Printed name of elector2_7
- Full residential address street numbernamecity2_7
- Postal code2_7
- Elector signature2_7
- Witness initials2_7
- Internal use only2_7
- Printed name of elector3_7
- Full residential address street numbernamecity3_7
- Postal code3_7
- Elector signature3_7
- Witness initials3_7
- Internal use only3_7
- Printed name of elector4_7
- Full residential address street numbernamecity4_7
- Postal code4_7
- Elector signature4_7
- Witness initials4_7
- Internal use only4_7
- Printed name of elector5_7
- Full residential address street numbernamecity5_7
- Postal code5_7
- Elector signature5_7
- Witness initials5_7
- Internal use only5_7
- Printed name of elector6_7
- Full residential address street numbernamecity6_7
- Postal code6_7
- Elector signature6_7
- Witness initials6_7
- Internal use only6_7
- Printed name of elector7_7
- Full residential address street numbernamecity7_7
- Postal code7_7
- Elector signature7_7
- Witness initials7_7
- Internal use only7_7
- Printed name of elector8_7
- Full residential address street numbernamecity8_7
- Postal code8_7
- Elector signature8_7
- Witness initials8_7
- Internal use only8_7
- Printed name of elector9_7
- Full residential address street numbernamecity9_7
- Postal code9_7
- Elector signature9_7
- Witness initials9_7
- Internal use only9_7
- Printed name of elector10_7
- Full residential address street numbernamecity10_7
- Postal code10_7
- Elector signature10_7
- Witness initials10_7
- Internal use only10_7
- Printed name of elector1_8
- Full residential address street numbernamecity1_8
- Postal code1_8
- Elector signature1_8
- Witness initials1_8
- Internal use only1_8
- Printed name of elector2_8
- Full residential address street numbernamecity2_8
- Postal code2_8
- Elector signature2_8
- Witness initials2_8
- Internal use only2_8
- Printed name of elector3_8
- Full residential address street numbernamecity3_8
- Postal code3_8
- Elector signature3_8
- Witness initials3_8
- Internal use only3_8
- Printed name of elector4_8
- Full residential address street numbernamecity4_8
- Postal code4_8
- Elector signature4_8
- Witness initials4_8
- Internal use only4_8
- Printed name of elector5_8
- Full residential address street numbernamecity5_8
- Postal code5_8
- Elector signature5_8
- Witness initials5_8
- Internal use only5_8
- Printed name of elector6_8
- Full residential address street numbernamecity6_8
- Postal code6_8
- Elector signature6_8
- Witness initials6_8
- Internal use only6_8
- Printed name of elector7_8
- Full residential address street numbernamecity7_8
- Postal code7_8
- Elector signature7_8
- Witness initials7_8
- Internal use only7_8
- Printed name of elector8_8
- Full residential address street numbernamecity8_8
- Postal code8_8
- Elector signature8_8
- Witness initials8_8
- Internal use only8_8
- Printed name of elector9_8
- Full residential address street numbernamecity9_8
- Postal code9_8
- Elector signature9_8
- Witness initials9_8
- Internal use only9_8
- Printed name of elector10_8
- Full residential address street numbernamecity10_8
- Postal code10_8
- Elector signature10_8
- Witness initials10_8
- Internal use only10_8
- Printed name of elector1_9
- Full residential address street numbernamecity1_9
- Postal code1_9
- Elector signature1_9
- Witness initials1_9
- Internal use only1_9
- Printed name of elector2_9
- Full residential address street numbernamecity2_9
- Postal code2_9
- Elector signature2_9
- Witness initials2_9
- Internal use only2_9
- Printed name of elector3_9
- Full residential address street numbernamecity3_9
- Postal code3_9
- Elector signature3_9
- Witness initials3_9
- Internal use only3_9
- Printed name of elector4_9
- Full residential address street numbernamecity4_9
- Postal code4_9
- Elector signature4_9
- Witness initials4_9
- Internal use only4_9
- Printed name of elector5_9
- Full residential address street numbernamecity5_9
- Postal code5_9
- Elector signature5_9
- Witness initials5_9
- Internal use only5_9
- Printed name of elector6_9
- Full residential address street numbernamecity6_9
- Postal code6_9
- Elector signature6_9
- Witness initials6_9
- Internal use only6_9
- Printed name of elector7_9
- Full residential address street numbernamecity7_9
- Postal code7_9
- Elector signature7_9
- Witness initials7_9
- Internal use only7_9
- Printed name of elector8_9
- Full residential address street numbernamecity8_9
- Postal code8_9
- Elector signature8_9
- Witness initials8_9
- Internal use only8_9
- Printed name of elector9_9
- Full residential address street numbernamecity9_9
- Postal code9_9
- Elector signature9_9
- Witness initials9_9
- Internal use only9_9
- Printed name of elector10_9
- Full residential address street numbernamecity10_9
- Postal code10_9
- Elector signature10_9
- Witness initials10_9
- Internal use only10_9
- Printed name of elector1_10
- Full residential address street numbernamecity1_10
- Postal code1_10
- Elector signature1_10
- Witness initials1_10
- Internal use only1_10
- Printed name of elector2_10
- Full residential address street numbernamecity2_10
- Postal code2_10
- Elector signature2_10
- Witness initials2_10
- Internal use only2_10
- Printed name of elector3_10
- Full residential address street numbernamecity3_10
- Postal code3_10
- Elector signature3_10
- Witness initials3_10
- Internal use only3_10
- Printed name of elector4_10
- Full residential address street numbernamecity4_10
- Postal code4_10
- Elector signature4_10
- Witness initials4_10
- Internal use only4_10
- Printed name of elector5_10
- Full residential address street numbernamecity5_10
- Postal code5_10
- Elector signature5_10
- Witness initials5_10
- Internal use only5_10
- Printed name of elector6_10
- Full residential address street numbernamecity6_10
- Postal code6_10
- Elector signature6_10
- Witness initials6_10
- Internal use only6_10
- Printed name of elector7_10
- Full residential address street numbernamecity7_10
- Postal code7_10
- Elector signature7_10
- Witness initials7_10
- Internal use only7_10
- Printed name of elector8_10
- Full residential address street numbernamecity8_10
- Postal code8_10
- Elector signature8_10
- Witness initials8_10
- Internal use only8_10
- Printed name of elector9_10
- Full residential address street numbernamecity9_10
- Postal code9_10
- Elector signature9_10
- Witness initials9_10
- Internal use only9_10
- Printed name of elector10_10
- Full residential address street numbernamecity10_10
- Postal code10_10
- Elector signature10_10
- Witness initials10_10
- Internal use only10_10
- Printed name of elector1_11
- Full residential address street numbernamecity1_11
- Postal code1_11
- Elector signature1_11
- Witness initials1_11
- Internal use only1_11
- Printed name of elector2_11
- Full residential address street numbernamecity2_11
- Postal code2_11
- Elector signature2_11
- Witness initials2_11
- Internal use only2_11
- Printed name of elector3_11
- Full residential address street numbernamecity3_11
- Postal code3_11
- Elector signature3_11
- Witness initials3_11
- Internal use only3_11
- Printed name of elector4_11
- Full residential address street numbernamecity4_11
- Postal code4_11
- Elector signature4_11
- Witness initials4_11
- Internal use only4_11
- Printed name of elector5_11
- Full residential address street numbernamecity5_11
- Postal code5_11
- Elector signature5_11
- Witness initials5_11
- Internal use only5_11
- Printed name of elector6_11
- Full residential address street numbernamecity6_11
- Postal code6_11
- Elector signature6_11
- Witness initials6_11
- Internal use only6_11
- Printed name of elector7_11
- Full residential address street numbernamecity7_11
- Postal code7_11
- Elector signature7_11
- Witness initials7_11
- Internal use only7_11
- Printed name of elector8_11
- Full residential address street numbernamecity8_11
- Postal code8_11
- Elector signature8_11
- Witness initials8_11
- Internal use only8_11
- Printed name of elector9_11
- Full residential address street numbernamecity9_11
- Postal code9_11
- Elector signature9_11
- Witness initials9_11
- Internal use only9_11
- Printed name of elector10_11
- Full residential address street numbernamecity10_11
- Postal code10_11
- Elector signature10_11
- Witness initials10_11
- Internal use only10_11
- Printed name of elector1_12
- Full residential address street numbernamecity1_12
- Postal code1_12
- Elector signature1_12
- Witness initials1_12
- Internal use only1_12
- Printed name of elector2_12
- Full residential address street numbernamecity2_12
- Postal code2_12
- Elector signature2_12
- Witness initials2_12
- Internal use only2_12
- Printed name of elector3_12
- Full residential address street numbernamecity3_12
- Postal code3_12
- Elector signature3_12
- Witness initials3_12
- Internal use only3_12
- Printed name of elector4_12
- Full residential address street numbernamecity4_12
- Postal code4_12
- Elector signature4_12
- Witness initials4_12
- Internal use only4_12
- Printed name of elector5_12
- Full residential address street numbernamecity5_12
- Postal code5_12
- Elector signature5_12
- Witness initials5_12
- Internal use only5_12
- Printed name of elector6_12
- Full residential address street numbernamecity6_12
- Postal code6_12
- Elector signature6_12
- Witness initials6_12
- Internal use only6_12
- Printed name of elector7_12
- Full residential address street numbernamecity7_12
- Postal code7_12
- Elector signature7_12
- Witness initials7_12
- Internal use only7_12
- Printed name of elector8_12
- Full residential address street numbernamecity8_12
- Postal code8_12
- Elector signature8_12
- Witness initials8_12
- Internal use only8_12
- Printed name of elector9_12
- Full residential address street numbernamecity9_12
- Postal code9_12
- Elector signature9_12
- Witness initials9_12
- Internal use only9_12
- Printed name of elector10_12
- Full residential address street numbernamecity10_12
- Postal code10_12
- Elector signature10_12
- Witness initials10_12
- Internal use only10_12
- Printed name of elector1_13
- Full residential address street numbernamecity1_13
- Postal code1_13
- Elector signature1_13
- Witness initials1_13
- Internal use only1_13
- Printed name of elector2_13
- Full residential address street numbernamecity2_13
- Postal code2_13
- Elector signature2_13
- Witness initials2_13
- Internal use only2_13
- Printed name of elector3_13
- Full residential address street numbernamecity3_13
- Postal code3_13
- Elector signature3_13
- Witness initials3_13
- Internal use only3_13
- Printed name of elector4_13
- Full residential address street numbernamecity4_13
- Postal code4_13
- Elector signature4_13
- Witness initials4_13
- Internal use only4_13
- Printed name of elector5_13
- Full residential address street numbernamecity5_13
- Postal code5_13
- Elector signature5_13
- Witness initials5_13
- Internal use only5_13
- Printed name of elector6_13
- Full residential address street numbernamecity6_13
- Postal code6_13
- Elector signature6_13
- Witness initials6_13
- Internal use only6_13
- Printed name of elector7_13
- Full residential address street numbernamecity7_13
- Postal code7_13
- Elector signature7_13
- Witness initials7_13
- Internal use only7_13
- Printed name of elector8_13
- Full residential address street numbernamecity8_13
- Postal code8_13
- Elector signature8_13
- Witness initials8_13
- Internal use only8_13
- Printed name of elector9_13
- Full residential address street numbernamecity9_13
- Postal code9_13
- Elector signature9_13
- Witness initials9_13
- Internal use only9_13
- Printed name of elector10_13
- Full residential address street numbernamecity10_13
- Postal code10_13
- Elector signature10_13
- Witness initials10_13
- Internal use only10_13
- Printed name of elector1_14
- Full residential address street numbernamecity1_14
- Postal code1_14
- Elector signature1_14
- Witness initials1_14
- Internal use only1_14
- Printed name of elector2_14
- Full residential address street numbernamecity2_14
- Postal code2_14
- Elector signature2_14
- Witness initials2_14
- Internal use only2_14
- Printed name of elector3_14
- Full residential address street numbernamecity3_14
- Postal code3_14
- Elector signature3_14
- Witness initials3_14
- Internal use only3_14
- Printed name of elector4_14
- Full residential address street numbernamecity4_14
- Postal code4_14
- Elector signature4_14
- Witness initials4_14
- Internal use only4_14
- Printed name of elector5_14
- Full residential address street numbernamecity5_14
- Postal code5_14
- Elector signature5_14
- Witness initials5_14
- Internal use only5_14
- Printed name of elector6_14
- Full residential address street numbernamecity6_14
- Postal code6_14
- Elector signature6_14
- Witness initials6_14
- Internal use only6_14
- Printed name of elector7_14
- Full residential address street numbernamecity7_14
- Postal code7_14
- Elector signature7_14
- Witness initials7_14
- Internal use only7_14
- Printed name of elector8_14
- Full residential address street numbernamecity8_14
- Postal code8_14
- Elector signature8_14
- Witness initials8_14
- Internal use only8_14
- Printed name of elector9_14
- Full residential address street numbernamecity9_14
- Postal code9_14
- Elector signature9_14
- Witness initials9_14
- Internal use only9_14
- Printed name of elector10_14
- Full residential address street numbernamecity10_14
- Postal code10_14
- Elector signature10_14
- Witness initials10_14
- Internal use only10_14
- Printed name of elector1_15
- Full residential address street numbernamecity1_15
- Postal code1_15
- Elector signature1_15
- Witness initials1_15
- Internal use only1_15
- Printed name of elector2_15
- Full residential address street numbernamecity2_15
- Postal code2_15
- Elector signature2_15
- Witness initials2_15
- Internal use only2_15
- Printed name of elector3_15
- Full residential address street numbernamecity3_15
- Postal code3_15
- Elector signature3_15
- Witness initials3_15
- Internal use only3_15
- Printed name of elector4_15
- Full residential address street numbernamecity4_15
- Postal code4_15
- Elector signature4_15
- Witness initials4_15
- Internal use only4_15
- Printed name of elector5_15
- Full residential address street numbernamecity5_15
- Postal code5_15
- Elector signature5_15
- Witness initials5_15
- Internal use only5_15
- Printed name of elector6_15
- Full residential address street numbernamecity6_15
- Postal code6_15
- Elector signature6_15
- Witness initials6_15
- Internal use only6_15
- Printed name of elector7_15
- Full residential address street numbernamecity7_15
- Postal code7_15
- Elector signature7_15
- Witness initials7_15
- Internal use only7_15
- Printed name of elector8_15
- Full residential address street numbernamecity8_15
- Postal code8_15
- Elector signature8_15
- Witness initials8_15
- Internal use only8_15
- Printed name of elector9_15
- Full residential address street numbernamecity9_15
- Postal code9_15
- Elector signature9_15
- Witness initials9_15
- Internal use only9_15
- Printed name of elector10_15
- Full residential address street numbernamecity10_15
- Postal code10_15
- Elector signature10_15
- Witness initials10_15
- Internal use only10_15
- Printed name of elector1_16
- Full residential address street numbernamecity1_16
- Postal code1_16
- Elector signature1_16
- Witness initials1_16
- Internal use only1_16
- Printed name of elector2_16
- Full residential address street numbernamecity2_16
- Postal code2_16
- Elector signature2_16
- Witness initials2_16
- Internal use only2_16
- Printed name of elector3_16
- Full residential address street numbernamecity3_16
- Postal code3_16
- Elector signature3_16
- Witness initials3_16
- Internal use only3_16
- Printed name of elector4_16
- Full residential address street numbernamecity4_16
- Postal code4_16
- Elector signature4_16
- Witness initials4_16
- Internal use only4_16
- Printed name of elector5_16
- Full residential address street numbernamecity5_16
- Postal code5_16
- Elector signature5_16
- Witness initials5_16
- Internal use only5_16
- Printed name of elector6_16
- Full residential address street numbernamecity6_16
- Postal code6_16
- Elector signature6_16
- Witness initials6_16
- Internal use only6_16
- Printed name of elector7_16
- Full residential address street numbernamecity7_16
- Postal code7_16
- Elector signature7_16
- Witness initials7_16
- Internal use only7_16
- Printed name of elector8_16
- Full residential address street numbernamecity8_16
- Postal code8_16
- Elector signature8_16
- Witness initials8_16
- Internal use only8_16
- Printed name of elector9_16
- Full residential address street numbernamecity9_16
- Postal code9_16
- Elector signature9_16
- Witness initials9_16
- Internal use only9_16
- Printed name of elector10_16
- Full residential address street numbernamecity10_16
- Postal code10_16
- Elector signature10_16
- Witness initials10_16
- Internal use only10_16
- Have you completed the Nomination Paper EC 20010 Off
- Do you have authorized proof of identify Off
- Are you endorsed by a political party Off
- Have you made a nomination appointment Off
- Last name - Candidate Name
- First name - Candidate Name
- Name of electoral district- Candidate Information
- First name - Candidate Information
- Last name - Candidate Information
- Ballot Name Off
- Ballot First name(s)
- Ballot Last name(s)
- Gender -Candidate information
- Date of birth (YYY-MM-DD) - Gender -Candidate information
- language of correspondence - Candidate information Off
- Email -Contact information
- Primary phone number - Contact information
- Ext - Primary phone number
- Alternate phone number - Contact information
- Ext - Alternate phone number
- Fax number- Alternate phone number
- Unit -Residential address
- Street -Residential address
- Street name -Residential address
- City -Residential address
- ProvinceTerritory -Residential address
- Postal code - -Residential address
- Mailing address - same as residential address Off
- Occupation- Candidate occupation
- Sharing of information with the Conflict of Interest and Ethics Commissioner and the House of Commons including the Library of Parliament Off
- where applicable if the returning officer is unable to verify that I have been endorsed by the political party identified in section A of this Nomination Paper I wish to Off
- Date of Signature (YYYY-MM-DD) - Candidate signature
- Date of Signature (YYYY-MM-DD) -Signature of person receiving the solemn declaration
- Campaign delegate information
- First name - Campaign delegate information
- Last name - Campaign delegate information
- Language of correspondence - Campaign delegate information Off
- Email - Contact information -Campaign Delegate
- Primary phone number - Contact information -Campaign Delegate
- Primary phone number EXT - Contact information -Campaign Delegate
- Alternate phone number - Contact information -Campaign Delegate
- Alternate phone number EXT - Contact information -Campaign Delegate
- Fax nmuber- Contact information -Campaign Delegate
- Street - Residential address -Campaign delegate
- Street name - Residential address -Campaign delegate
- City - Residential address -Campaign delegate
- ProvinceTerritory - Residential address -Campaign delegate
- Postal Code - Residential address -Campaign delegate
- Campaign delegate - Mailing address ndash Same as residential address Off
- Unit - Residential address -Campaign delegate
- Date (YYYY-MM-DD) - Candidate authorization Signature
- Date (YYYY-MM-DD) - Candidate campaign Signature
- First name - Official agent information
- Last name - Official agent information
- Language of correspondence - Official agent information Off
- Email - Official agent information
- Primary phone number - Official agent information
- Primary phone number EXT - Official agent information
- Alternate phone number EXT - Official agent information
- Alternate phone number - Official agent information
- Fax number - Official agent information
- Unit -Residential address - Official Agent
- Street name -Residential address - Official Agent
- City -Residential address - Official Agent
- Street -Residential address - Official Agent
- ProvinceTerritory -Residential address - Official Agent
- Postal code-Residential address - Official Agent
- Mailing address ndash Same as residential address- Official Agent Off
- Date (YYYY-MM-DD) - Official agent signature
- First name - Auditor information
- Last name - Auditor information
- Language of correspondence - Auditor information Off
- Email - Auditor information
- Primary phone number - Auditor information
- Primary phone number EXT- Auditor information
- Alternate phone number - Auditor information
- Alternate phone number EXT- Auditor information
- Fax number - Auditor information
- Name of firm- Auditor organizational information
- Occupation of auditor - Auditor organizational information
- Professional designation - Auditor organizational information Off
- Designation registration number
- Make cheque payable to
- Unit - Address (where cheque is sent)
- Street - Address (where cheque is sent)
- Street name - Address (where cheque is sent)
- City - Address (where cheque is sent)
- ProvinceTerritory - Address (where cheque is sent)
- Postal code - Address (where cheque is sent)
- Date (YYY-MM-DD) - Auditor signature
- Unit - Campaign office address (optional)
- Street - Campaign office address (optional)
- Street name - Campaign office address (optional)
- City - Campaign office address (optional)
- ProvinceTerritory- Campaign office address (optional)
- Postal code - Campaign office address (optional)
- Name of witness
- Full address of witness
- Name of candidate
- Electoral district
- Year
- Name of candidate2
- Electoral district2
- Year2
- Name of witness2
- Full address of witness2
- Name of candidate3
- Electoral district3
- Year3
- Full address of witness3
- Name of witness3
- Name of candidate 4
- Electoral district4
- Year4
- Full address of witness 4
- Name of witness 4
- Name of candidate5
- Electoral district5
- Year5
- Full address of witness5
- Name of witness5
- Name of candidate6
- Electoral district6
- Year6
- Name of witness6
- Full address of witness6
- Name of candidate7
- Electoral district7
- Year7
- Full address of witness7
- Name of witness7
- Name of candidate8
- Electoral district8
- Year8
- Full address of witness8
- Name of witness8
- Name of candidate9
- Electoral district9
- Year9
- Full address of witness 9
- Name of witness 9
- Name of candidate10
- Electoral district10
- Year10
- Full address of witness10
- Name of witness10
- Name of candidate11
- Electoral district11
- Year11
- Full address of witness11
- Name of witness11
- Name of candidate12
- Electoral district12
- Year12
- Full address of witness12
- Name of witness12
- Name of candidate13
- Electoral district13
- Year13
- Full address of witness13
- Name of witness13
- Name of candidate14
- Electoral district14
- Year14
- Name of witness14
- Full address of witness14
- Name of candidate1
- Electoral district1
- Year1
- Name of witness1
- Full address of witness1
- Name of candidate15
- Electoral district15
- Year15
- Name of witness15
- Full address of witness15
- unit -Mailing address
- Street -Mailing address
- Street name -Mailing address
- City -Mailing address
- ProvinceTerritory -Mailing address
- Postal code -Mailing address
- Unit - Mailing address -Campaign delegate
- Street - Mailing address -Campaign delegate
- Street name - Mailing address -Campaign delegate
- City - Mailing address -Campaign delegate
- ProvinceTerritory- Mailing address -Campaign delegate
- Postal code- Mailing address -Campaign delegate
- Unit -Mailing address - Official Agent
- Street -Mailing address - Official Agent
- Street name -Mailing address - Official Agent
- city -Mailing address - Official Agent
- ProvinceTerritory-Mailing address - Official Agent
- Postal code-Mailing address - Official Agent
SECTION F ndash 7BElectors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
15
8BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
16
9BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
17
10BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
18
11BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
19
12BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
20
13BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
21
14BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
22
15BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
23
16BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
24
17BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
25
18BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
26
19BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
27
20BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
28
21BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
29
22BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
30
EC 20010 (022019)
SECTION G ndash 23B Are You Ready to Submit Your Nomination
Have you completed the Nomination Paper (EC 20010)
bull Are all mandatory fields in sections AndashE complete
bull Have you collected the required number of signatures from qualified electors in section F
o For most electoral districts 100 electors must consent to your candidacy
o For electoral districts identified in Schedule 3 only 50 electors are required
o To ensure a smooth nomination process Elections Canada recommends collecting signatures from at least 150 electors
Do you have authorized proof of identify
bull For a list of authorized identification visit the Elections Canada website
bull If a campaign delegate is submitting on your behalf they must bring a copy of your identification documents signed by you
bull If you want an alternative name to appear on the ballot additional documentation is required visit electionsca for details
Are you endorsed by a political party
bull Make sure your party has submitted the required documentation to Elections Canada attesting your designated political affiliation
Have you made a nomination appointment
bull To facilitate the nomination process make an appointment with the returning officer to finalize the filing of the complete nomination package
bull The nomination period closes 21 days before election day at 200 pm local time
31
- Nomination Paperof a Candidate at a Federal General Election or By-election
- Table of Contents
- General Information
- SECTION A ndash Candidate Information (Mandatory)
- SECTION B ndash Campaign Delegate (Optional)
- SECTION C ndash Official Agent (Mandatory)
- SECTION D ndash Auditor (Optional)
- SECTION E ndash Campaign Office (Optional)
- SECTION F ndash Electors Consenting to Candidacy (Mandatory)
-
- Name of electoral district
- Political affiliation
- Telephone number to be posted on electionsca
- Website to be posted on electionsca including prefix http https
- Printed name of elector1
- Full residential address street numbernamecity1
- Postal code1
- Elector signature1
- Witness initials1
- Internal use only1
- Printed name of elector2
- Full residential address street numbernamecity2
- Postal code2
- Elector signature2
- Witness initials2
- Internal use only2
- Printed name of elector3
- Full residential address street numbernamecity3
- Postal code3
- Elector signature3
- Witness initials3
- Internal use only3
- Printed name of elector4
- Full residential address street numbernamecity4
- Postal code4
- Elector signature4
- Witness initials4
- Internal use only4
- Printed name of elector5
- Full residential address street numbernamecity5
- Postal code5
- Elector signature5
- Witness initials5
- Internal use only5
- Printed name of elector6
- Full residential address street numbernamecity6
- Postal code6
- Elector signature6
- Witness initials6
- Internal use only6
- Printed name of elector7
- Full residential address street numbernamecity7
- Postal code7
- Elector signature7
- Witness initials7
- Internal use only7
- Printed name of elector8
- Full residential address street numbernamecity8
- Postal code8
- Elector signature8
- Witness initials8
- Internal use only8
- Printed name of elector9
- Full residential address street numbernamecity9
- Postal code9
- Elector signature9
- Witness initials9
- Internal use only9
- Printed name of elector10
- Full residential address street numbernamecity10
- Postal code10
- Elector signature10
- Witness initials10
- Internal use only10
- Printed name of elector1_2
- Full residential address street numbernamecity1_2
- Postal code1_2
- Elector signature1_2
- Witness initials1_2
- Internal use only1_2
- Printed name of elector2_2
- Full residential address street numbernamecity2_2
- Postal code2_2
- Elector signature2_2
- Witness initials2_2
- Internal use only2_2
- Printed name of elector3_2
- Full residential address street numbernamecity3_2
- Postal code3_2
- Elector signature3_2
- Witness initials3_2
- Internal use only3_2
- Printed name of elector4_2
- Full residential address street numbernamecity4_2
- Postal code4_2
- Elector signature4_2
- Witness initials4_2
- Internal use only4_2
- Printed name of elector5_2
- Full residential address street numbernamecity5_2
- Postal code5_2
- Elector signature5_2
- Witness initials5_2
- Internal use only5_2
- Printed name of elector6_2
- Full residential address street numbernamecity6_2
- Postal code6_2
- Elector signature6_2
- Witness initials6_2
- Internal use only6_2
- Printed name of elector7_2
- Full residential address street numbernamecity7_2
- Postal code7_2
- Elector signature7_2
- Witness initials7_2
- Internal use only7_2
- Printed name of elector8_2
- Full residential address street numbernamecity8_2
- Postal code8_2
- Elector signature8_2
- Witness initials8_2
- Internal use only8_2
- Printed name of elector9_2
- Full residential address street numbernamecity9_2
- Postal code9_2
- Elector signature9_2
- Witness initials9_2
- Internal use only9_2
- Printed name of elector10_2
- Full residential address street numbernamecity10_2
- Postal code10_2
- Elector signature10_2
- Witness initials10_2
- Internal use only10_2
- Printed name of elector1_3
- Full residential address street numbernamecity1_3
- Postal code1_3
- Elector signature1_3
- Witness initials1_3
- Internal use only1_3
- Printed name of elector2_3
- Full residential address street numbernamecity2_3
- Postal code2_3
- Elector signature2_3
- Witness initials2_3
- Internal use only2_3
- Printed name of elector3_3
- Full residential address street numbernamecity3_3
- Postal code3_3
- Elector signature3_3
- Witness initials3_3
- Internal use only3_3
- Printed name of elector4_3
- Full residential address street numbernamecity4_3
- Postal code4_3
- Elector signature4_3
- Witness initials4_3
- Internal use only4_3
- Printed name of elector5_3
- Full residential address street numbernamecity5_3
- Postal code5_3
- Elector signature5_3
- Witness initials5_3
- Internal use only5_3
- Printed name of elector6_3
- Full residential address street numbernamecity6_3
- Postal code6_3
- Elector signature6_3
- Witness initials6_3
- Internal use only6_3
- Printed name of elector7_3
- Full residential address street numbernamecity7_3
- Postal code7_3
- Elector signature7_3
- Witness initials7_3
- Internal use only7_3
- Printed name of elector8_3
- Full residential address street numbernamecity8_3
- Postal code8_3
- Elector signature8_3
- Witness initials8_3
- Internal use only8_3
- Printed name of elector9_3
- Full residential address street numbernamecity9_3
- Postal code9_3
- Elector signature9_3
- Witness initials9_3
- Internal use only9_3
- Printed name of elector10_3
- Full residential address street numbernamecity10_3
- Postal code10_3
- Elector signature10_3
- Witness initials10_3
- Internal use only10_3
- Printed name of elector1_4
- Full residential address street numbernamecity1_4
- Postal code1_4
- Elector signature1_4
- Witness initials1_4
- Internal use only1_4
- Printed name of elector2_4
- Full residential address street numbernamecity2_4
- Postal code2_4
- Elector signature2_4
- Witness initials2_4
- Internal use only2_4
- Printed name of elector3_4
- Full residential address street numbernamecity3_4
- Postal code3_4
- Elector signature3_4
- Witness initials3_4
- Internal use only3_4
- Printed name of elector4_4
- Full residential address street numbernamecity4_4
- Postal code4_4
- Elector signature4_4
- Witness initials4_4
- Internal use only4_4
- Printed name of elector5_4
- Full residential address street numbernamecity5_4
- Postal code5_4
- Elector signature5_4
- Witness initials5_4
- Internal use only5_4
- Printed name of elector6_4
- Full residential address street numbernamecity6_4
- Postal code6_4
- Elector signature6_4
- Witness initials6_4
- Internal use only6_4
- Printed name of elector7_4
- Full residential address street numbernamecity7_4
- Postal code7_4
- Elector signature7_4
- Witness initials7_4
- Internal use only7_4
- Printed name of elector8_4
- Full residential address street numbernamecity8_4
- Postal code8_4
- Elector signature8_4
- Witness initials8_4
- Internal use only8_4
- Printed name of elector9_4
- Full residential address street numbernamecity9_4
- Postal code9_4
- Elector signature9_4
- Witness initials9_4
- Internal use only9_4
- Printed name of elector10_4
- Full residential address street numbernamecity10_4
- Postal code10_4
- Elector signature10_4
- Witness initials10_4
- Internal use only10_4
- Printed name of elector1_5
- Full residential address street numbernamecity1_5
- Postal code1_5
- Elector signature1_5
- Witness initials1_5
- Internal use only1_5
- Printed name of elector2_5
- Full residential address street numbernamecity2_5
- Postal code2_5
- Elector signature2_5
- Witness initials2_5
- Internal use only2_5
- Printed name of elector3_5
- Full residential address street numbernamecity3_5
- Postal code3_5
- Elector signature3_5
- Witness initials3_5
- Internal use only3_5
- Printed name of elector4_5
- Full residential address street numbernamecity4_5
- Postal code4_5
- Elector signature4_5
- Witness initials4_5
- Internal use only4_5
- Printed name of elector5_5
- Full residential address street numbernamecity5_5
- Postal code5_5
- Elector signature5_5
- Witness initials5_5
- Internal use only5_5
- Printed name of elector6_5
- Full residential address street numbernamecity6_5
- Postal code6_5
- Elector signature6_5
- Witness initials6_5
- Internal use only6_5
- Printed name of elector7_5
- Full residential address street numbernamecity7_5
- Postal code7_5
- Elector signature7_5
- Witness initials7_5
- Internal use only7_5
- Printed name of elector8_5
- Full residential address street numbernamecity8_5
- Postal code8_5
- Elector signature8_5
- Witness initials8_5
- Internal use only8_5
- Printed name of elector9_5
- Full residential address street numbernamecity9_5
- Postal code9_5
- Elector signature9_5
- Witness initials9_5
- Internal use only9_5
- Printed name of elector10_5
- Full residential address street numbernamecity10_5
- Postal code10_5
- Elector signature10_5
- Witness initials10_5
- Internal use only10_5
- Printed name of elector1_6
- Full residential address street numbernamecity1_6
- Postal code1_6
- Elector signature1_6
- Witness initials1_6
- Internal use only1_6
- Printed name of elector2_6
- Full residential address street numbernamecity2_6
- Postal code2_6
- Elector signature2_6
- Witness initials2_6
- Internal use only2_6
- Printed name of elector3_6
- Full residential address street numbernamecity3_6
- Postal code3_6
- Elector signature3_6
- Witness initials3_6
- Internal use only3_6
- Printed name of elector4_6
- Full residential address street numbernamecity4_6
- Postal code4_6
- Elector signature4_6
- Witness initials4_6
- Internal use only4_6
- Printed name of elector5_6
- Full residential address street numbernamecity5_6
- Postal code5_6
- Elector signature5_6
- Witness initials5_6
- Internal use only5_6
- Printed name of elector6_6
- Full residential address street numbernamecity6_6
- Postal code6_6
- Elector signature6_6
- Witness initials6_6
- Internal use only6_6
- Printed name of elector7_6
- Full residential address street numbernamecity7_6
- Postal code7_6
- Elector signature7_6
- Witness initials7_6
- Internal use only7_6
- Printed name of elector8_6
- Full residential address street numbernamecity8_6
- Postal code8_6
- Elector signature8_6
- Witness initials8_6
- Internal use only8_6
- Printed name of elector9_6
- Full residential address street numbernamecity9_6
- Postal code9_6
- Elector signature9_6
- Witness initials9_6
- Internal use only9_6
- Printed name of elector10_6
- Full residential address street numbernamecity10_6
- Postal code10_6
- Elector signature10_6
- Witness initials10_6
- Internal use only10_6
- Printed name of elector1_7
- Full residential address street numbernamecity1_7
- Postal code1_7
- Elector signature1_7
- Witness initials1_7
- Internal use only1_7
- Printed name of elector2_7
- Full residential address street numbernamecity2_7
- Postal code2_7
- Elector signature2_7
- Witness initials2_7
- Internal use only2_7
- Printed name of elector3_7
- Full residential address street numbernamecity3_7
- Postal code3_7
- Elector signature3_7
- Witness initials3_7
- Internal use only3_7
- Printed name of elector4_7
- Full residential address street numbernamecity4_7
- Postal code4_7
- Elector signature4_7
- Witness initials4_7
- Internal use only4_7
- Printed name of elector5_7
- Full residential address street numbernamecity5_7
- Postal code5_7
- Elector signature5_7
- Witness initials5_7
- Internal use only5_7
- Printed name of elector6_7
- Full residential address street numbernamecity6_7
- Postal code6_7
- Elector signature6_7
- Witness initials6_7
- Internal use only6_7
- Printed name of elector7_7
- Full residential address street numbernamecity7_7
- Postal code7_7
- Elector signature7_7
- Witness initials7_7
- Internal use only7_7
- Printed name of elector8_7
- Full residential address street numbernamecity8_7
- Postal code8_7
- Elector signature8_7
- Witness initials8_7
- Internal use only8_7
- Printed name of elector9_7
- Full residential address street numbernamecity9_7
- Postal code9_7
- Elector signature9_7
- Witness initials9_7
- Internal use only9_7
- Printed name of elector10_7
- Full residential address street numbernamecity10_7
- Postal code10_7
- Elector signature10_7
- Witness initials10_7
- Internal use only10_7
- Printed name of elector1_8
- Full residential address street numbernamecity1_8
- Postal code1_8
- Elector signature1_8
- Witness initials1_8
- Internal use only1_8
- Printed name of elector2_8
- Full residential address street numbernamecity2_8
- Postal code2_8
- Elector signature2_8
- Witness initials2_8
- Internal use only2_8
- Printed name of elector3_8
- Full residential address street numbernamecity3_8
- Postal code3_8
- Elector signature3_8
- Witness initials3_8
- Internal use only3_8
- Printed name of elector4_8
- Full residential address street numbernamecity4_8
- Postal code4_8
- Elector signature4_8
- Witness initials4_8
- Internal use only4_8
- Printed name of elector5_8
- Full residential address street numbernamecity5_8
- Postal code5_8
- Elector signature5_8
- Witness initials5_8
- Internal use only5_8
- Printed name of elector6_8
- Full residential address street numbernamecity6_8
- Postal code6_8
- Elector signature6_8
- Witness initials6_8
- Internal use only6_8
- Printed name of elector7_8
- Full residential address street numbernamecity7_8
- Postal code7_8
- Elector signature7_8
- Witness initials7_8
- Internal use only7_8
- Printed name of elector8_8
- Full residential address street numbernamecity8_8
- Postal code8_8
- Elector signature8_8
- Witness initials8_8
- Internal use only8_8
- Printed name of elector9_8
- Full residential address street numbernamecity9_8
- Postal code9_8
- Elector signature9_8
- Witness initials9_8
- Internal use only9_8
- Printed name of elector10_8
- Full residential address street numbernamecity10_8
- Postal code10_8
- Elector signature10_8
- Witness initials10_8
- Internal use only10_8
- Printed name of elector1_9
- Full residential address street numbernamecity1_9
- Postal code1_9
- Elector signature1_9
- Witness initials1_9
- Internal use only1_9
- Printed name of elector2_9
- Full residential address street numbernamecity2_9
- Postal code2_9
- Elector signature2_9
- Witness initials2_9
- Internal use only2_9
- Printed name of elector3_9
- Full residential address street numbernamecity3_9
- Postal code3_9
- Elector signature3_9
- Witness initials3_9
- Internal use only3_9
- Printed name of elector4_9
- Full residential address street numbernamecity4_9
- Postal code4_9
- Elector signature4_9
- Witness initials4_9
- Internal use only4_9
- Printed name of elector5_9
- Full residential address street numbernamecity5_9
- Postal code5_9
- Elector signature5_9
- Witness initials5_9
- Internal use only5_9
- Printed name of elector6_9
- Full residential address street numbernamecity6_9
- Postal code6_9
- Elector signature6_9
- Witness initials6_9
- Internal use only6_9
- Printed name of elector7_9
- Full residential address street numbernamecity7_9
- Postal code7_9
- Elector signature7_9
- Witness initials7_9
- Internal use only7_9
- Printed name of elector8_9
- Full residential address street numbernamecity8_9
- Postal code8_9
- Elector signature8_9
- Witness initials8_9
- Internal use only8_9
- Printed name of elector9_9
- Full residential address street numbernamecity9_9
- Postal code9_9
- Elector signature9_9
- Witness initials9_9
- Internal use only9_9
- Printed name of elector10_9
- Full residential address street numbernamecity10_9
- Postal code10_9
- Elector signature10_9
- Witness initials10_9
- Internal use only10_9
- Printed name of elector1_10
- Full residential address street numbernamecity1_10
- Postal code1_10
- Elector signature1_10
- Witness initials1_10
- Internal use only1_10
- Printed name of elector2_10
- Full residential address street numbernamecity2_10
- Postal code2_10
- Elector signature2_10
- Witness initials2_10
- Internal use only2_10
- Printed name of elector3_10
- Full residential address street numbernamecity3_10
- Postal code3_10
- Elector signature3_10
- Witness initials3_10
- Internal use only3_10
- Printed name of elector4_10
- Full residential address street numbernamecity4_10
- Postal code4_10
- Elector signature4_10
- Witness initials4_10
- Internal use only4_10
- Printed name of elector5_10
- Full residential address street numbernamecity5_10
- Postal code5_10
- Elector signature5_10
- Witness initials5_10
- Internal use only5_10
- Printed name of elector6_10
- Full residential address street numbernamecity6_10
- Postal code6_10
- Elector signature6_10
- Witness initials6_10
- Internal use only6_10
- Printed name of elector7_10
- Full residential address street numbernamecity7_10
- Postal code7_10
- Elector signature7_10
- Witness initials7_10
- Internal use only7_10
- Printed name of elector8_10
- Full residential address street numbernamecity8_10
- Postal code8_10
- Elector signature8_10
- Witness initials8_10
- Internal use only8_10
- Printed name of elector9_10
- Full residential address street numbernamecity9_10
- Postal code9_10
- Elector signature9_10
- Witness initials9_10
- Internal use only9_10
- Printed name of elector10_10
- Full residential address street numbernamecity10_10
- Postal code10_10
- Elector signature10_10
- Witness initials10_10
- Internal use only10_10
- Printed name of elector1_11
- Full residential address street numbernamecity1_11
- Postal code1_11
- Elector signature1_11
- Witness initials1_11
- Internal use only1_11
- Printed name of elector2_11
- Full residential address street numbernamecity2_11
- Postal code2_11
- Elector signature2_11
- Witness initials2_11
- Internal use only2_11
- Printed name of elector3_11
- Full residential address street numbernamecity3_11
- Postal code3_11
- Elector signature3_11
- Witness initials3_11
- Internal use only3_11
- Printed name of elector4_11
- Full residential address street numbernamecity4_11
- Postal code4_11
- Elector signature4_11
- Witness initials4_11
- Internal use only4_11
- Printed name of elector5_11
- Full residential address street numbernamecity5_11
- Postal code5_11
- Elector signature5_11
- Witness initials5_11
- Internal use only5_11
- Printed name of elector6_11
- Full residential address street numbernamecity6_11
- Postal code6_11
- Elector signature6_11
- Witness initials6_11
- Internal use only6_11
- Printed name of elector7_11
- Full residential address street numbernamecity7_11
- Postal code7_11
- Elector signature7_11
- Witness initials7_11
- Internal use only7_11
- Printed name of elector8_11
- Full residential address street numbernamecity8_11
- Postal code8_11
- Elector signature8_11
- Witness initials8_11
- Internal use only8_11
- Printed name of elector9_11
- Full residential address street numbernamecity9_11
- Postal code9_11
- Elector signature9_11
- Witness initials9_11
- Internal use only9_11
- Printed name of elector10_11
- Full residential address street numbernamecity10_11
- Postal code10_11
- Elector signature10_11
- Witness initials10_11
- Internal use only10_11
- Printed name of elector1_12
- Full residential address street numbernamecity1_12
- Postal code1_12
- Elector signature1_12
- Witness initials1_12
- Internal use only1_12
- Printed name of elector2_12
- Full residential address street numbernamecity2_12
- Postal code2_12
- Elector signature2_12
- Witness initials2_12
- Internal use only2_12
- Printed name of elector3_12
- Full residential address street numbernamecity3_12
- Postal code3_12
- Elector signature3_12
- Witness initials3_12
- Internal use only3_12
- Printed name of elector4_12
- Full residential address street numbernamecity4_12
- Postal code4_12
- Elector signature4_12
- Witness initials4_12
- Internal use only4_12
- Printed name of elector5_12
- Full residential address street numbernamecity5_12
- Postal code5_12
- Elector signature5_12
- Witness initials5_12
- Internal use only5_12
- Printed name of elector6_12
- Full residential address street numbernamecity6_12
- Postal code6_12
- Elector signature6_12
- Witness initials6_12
- Internal use only6_12
- Printed name of elector7_12
- Full residential address street numbernamecity7_12
- Postal code7_12
- Elector signature7_12
- Witness initials7_12
- Internal use only7_12
- Printed name of elector8_12
- Full residential address street numbernamecity8_12
- Postal code8_12
- Elector signature8_12
- Witness initials8_12
- Internal use only8_12
- Printed name of elector9_12
- Full residential address street numbernamecity9_12
- Postal code9_12
- Elector signature9_12
- Witness initials9_12
- Internal use only9_12
- Printed name of elector10_12
- Full residential address street numbernamecity10_12
- Postal code10_12
- Elector signature10_12
- Witness initials10_12
- Internal use only10_12
- Printed name of elector1_13
- Full residential address street numbernamecity1_13
- Postal code1_13
- Elector signature1_13
- Witness initials1_13
- Internal use only1_13
- Printed name of elector2_13
- Full residential address street numbernamecity2_13
- Postal code2_13
- Elector signature2_13
- Witness initials2_13
- Internal use only2_13
- Printed name of elector3_13
- Full residential address street numbernamecity3_13
- Postal code3_13
- Elector signature3_13
- Witness initials3_13
- Internal use only3_13
- Printed name of elector4_13
- Full residential address street numbernamecity4_13
- Postal code4_13
- Elector signature4_13
- Witness initials4_13
- Internal use only4_13
- Printed name of elector5_13
- Full residential address street numbernamecity5_13
- Postal code5_13
- Elector signature5_13
- Witness initials5_13
- Internal use only5_13
- Printed name of elector6_13
- Full residential address street numbernamecity6_13
- Postal code6_13
- Elector signature6_13
- Witness initials6_13
- Internal use only6_13
- Printed name of elector7_13
- Full residential address street numbernamecity7_13
- Postal code7_13
- Elector signature7_13
- Witness initials7_13
- Internal use only7_13
- Printed name of elector8_13
- Full residential address street numbernamecity8_13
- Postal code8_13
- Elector signature8_13
- Witness initials8_13
- Internal use only8_13
- Printed name of elector9_13
- Full residential address street numbernamecity9_13
- Postal code9_13
- Elector signature9_13
- Witness initials9_13
- Internal use only9_13
- Printed name of elector10_13
- Full residential address street numbernamecity10_13
- Postal code10_13
- Elector signature10_13
- Witness initials10_13
- Internal use only10_13
- Printed name of elector1_14
- Full residential address street numbernamecity1_14
- Postal code1_14
- Elector signature1_14
- Witness initials1_14
- Internal use only1_14
- Printed name of elector2_14
- Full residential address street numbernamecity2_14
- Postal code2_14
- Elector signature2_14
- Witness initials2_14
- Internal use only2_14
- Printed name of elector3_14
- Full residential address street numbernamecity3_14
- Postal code3_14
- Elector signature3_14
- Witness initials3_14
- Internal use only3_14
- Printed name of elector4_14
- Full residential address street numbernamecity4_14
- Postal code4_14
- Elector signature4_14
- Witness initials4_14
- Internal use only4_14
- Printed name of elector5_14
- Full residential address street numbernamecity5_14
- Postal code5_14
- Elector signature5_14
- Witness initials5_14
- Internal use only5_14
- Printed name of elector6_14
- Full residential address street numbernamecity6_14
- Postal code6_14
- Elector signature6_14
- Witness initials6_14
- Internal use only6_14
- Printed name of elector7_14
- Full residential address street numbernamecity7_14
- Postal code7_14
- Elector signature7_14
- Witness initials7_14
- Internal use only7_14
- Printed name of elector8_14
- Full residential address street numbernamecity8_14
- Postal code8_14
- Elector signature8_14
- Witness initials8_14
- Internal use only8_14
- Printed name of elector9_14
- Full residential address street numbernamecity9_14
- Postal code9_14
- Elector signature9_14
- Witness initials9_14
- Internal use only9_14
- Printed name of elector10_14
- Full residential address street numbernamecity10_14
- Postal code10_14
- Elector signature10_14
- Witness initials10_14
- Internal use only10_14
- Printed name of elector1_15
- Full residential address street numbernamecity1_15
- Postal code1_15
- Elector signature1_15
- Witness initials1_15
- Internal use only1_15
- Printed name of elector2_15
- Full residential address street numbernamecity2_15
- Postal code2_15
- Elector signature2_15
- Witness initials2_15
- Internal use only2_15
- Printed name of elector3_15
- Full residential address street numbernamecity3_15
- Postal code3_15
- Elector signature3_15
- Witness initials3_15
- Internal use only3_15
- Printed name of elector4_15
- Full residential address street numbernamecity4_15
- Postal code4_15
- Elector signature4_15
- Witness initials4_15
- Internal use only4_15
- Printed name of elector5_15
- Full residential address street numbernamecity5_15
- Postal code5_15
- Elector signature5_15
- Witness initials5_15
- Internal use only5_15
- Printed name of elector6_15
- Full residential address street numbernamecity6_15
- Postal code6_15
- Elector signature6_15
- Witness initials6_15
- Internal use only6_15
- Printed name of elector7_15
- Full residential address street numbernamecity7_15
- Postal code7_15
- Elector signature7_15
- Witness initials7_15
- Internal use only7_15
- Printed name of elector8_15
- Full residential address street numbernamecity8_15
- Postal code8_15
- Elector signature8_15
- Witness initials8_15
- Internal use only8_15
- Printed name of elector9_15
- Full residential address street numbernamecity9_15
- Postal code9_15
- Elector signature9_15
- Witness initials9_15
- Internal use only9_15
- Printed name of elector10_15
- Full residential address street numbernamecity10_15
- Postal code10_15
- Elector signature10_15
- Witness initials10_15
- Internal use only10_15
- Printed name of elector1_16
- Full residential address street numbernamecity1_16
- Postal code1_16
- Elector signature1_16
- Witness initials1_16
- Internal use only1_16
- Printed name of elector2_16
- Full residential address street numbernamecity2_16
- Postal code2_16
- Elector signature2_16
- Witness initials2_16
- Internal use only2_16
- Printed name of elector3_16
- Full residential address street numbernamecity3_16
- Postal code3_16
- Elector signature3_16
- Witness initials3_16
- Internal use only3_16
- Printed name of elector4_16
- Full residential address street numbernamecity4_16
- Postal code4_16
- Elector signature4_16
- Witness initials4_16
- Internal use only4_16
- Printed name of elector5_16
- Full residential address street numbernamecity5_16
- Postal code5_16
- Elector signature5_16
- Witness initials5_16
- Internal use only5_16
- Printed name of elector6_16
- Full residential address street numbernamecity6_16
- Postal code6_16
- Elector signature6_16
- Witness initials6_16
- Internal use only6_16
- Printed name of elector7_16
- Full residential address street numbernamecity7_16
- Postal code7_16
- Elector signature7_16
- Witness initials7_16
- Internal use only7_16
- Printed name of elector8_16
- Full residential address street numbernamecity8_16
- Postal code8_16
- Elector signature8_16
- Witness initials8_16
- Internal use only8_16
- Printed name of elector9_16
- Full residential address street numbernamecity9_16
- Postal code9_16
- Elector signature9_16
- Witness initials9_16
- Internal use only9_16
- Printed name of elector10_16
- Full residential address street numbernamecity10_16
- Postal code10_16
- Elector signature10_16
- Witness initials10_16
- Internal use only10_16
- Have you completed the Nomination Paper EC 20010 Off
- Do you have authorized proof of identify Off
- Are you endorsed by a political party Off
- Have you made a nomination appointment Off
- Last name - Candidate Name
- First name - Candidate Name
- Name of electoral district- Candidate Information
- First name - Candidate Information
- Last name - Candidate Information
- Ballot Name Off
- Ballot First name(s)
- Ballot Last name(s)
- Gender -Candidate information
- Date of birth (YYY-MM-DD) - Gender -Candidate information
- language of correspondence - Candidate information Off
- Email -Contact information
- Primary phone number - Contact information
- Ext - Primary phone number
- Alternate phone number - Contact information
- Ext - Alternate phone number
- Fax number- Alternate phone number
- Unit -Residential address
- Street -Residential address
- Street name -Residential address
- City -Residential address
- ProvinceTerritory -Residential address
- Postal code - -Residential address
- Mailing address - same as residential address Off
- Occupation- Candidate occupation
- Sharing of information with the Conflict of Interest and Ethics Commissioner and the House of Commons including the Library of Parliament Off
- where applicable if the returning officer is unable to verify that I have been endorsed by the political party identified in section A of this Nomination Paper I wish to Off
- Date of Signature (YYYY-MM-DD) - Candidate signature
- Date of Signature (YYYY-MM-DD) -Signature of person receiving the solemn declaration
- Campaign delegate information
- First name - Campaign delegate information
- Last name - Campaign delegate information
- Language of correspondence - Campaign delegate information Off
- Email - Contact information -Campaign Delegate
- Primary phone number - Contact information -Campaign Delegate
- Primary phone number EXT - Contact information -Campaign Delegate
- Alternate phone number - Contact information -Campaign Delegate
- Alternate phone number EXT - Contact information -Campaign Delegate
- Fax nmuber- Contact information -Campaign Delegate
- Street - Residential address -Campaign delegate
- Street name - Residential address -Campaign delegate
- City - Residential address -Campaign delegate
- ProvinceTerritory - Residential address -Campaign delegate
- Postal Code - Residential address -Campaign delegate
- Campaign delegate - Mailing address ndash Same as residential address Off
- Unit - Residential address -Campaign delegate
- Date (YYYY-MM-DD) - Candidate authorization Signature
- Date (YYYY-MM-DD) - Candidate campaign Signature
- First name - Official agent information
- Last name - Official agent information
- Language of correspondence - Official agent information Off
- Email - Official agent information
- Primary phone number - Official agent information
- Primary phone number EXT - Official agent information
- Alternate phone number EXT - Official agent information
- Alternate phone number - Official agent information
- Fax number - Official agent information
- Unit -Residential address - Official Agent
- Street name -Residential address - Official Agent
- City -Residential address - Official Agent
- Street -Residential address - Official Agent
- ProvinceTerritory -Residential address - Official Agent
- Postal code-Residential address - Official Agent
- Mailing address ndash Same as residential address- Official Agent Off
- Date (YYYY-MM-DD) - Official agent signature
- First name - Auditor information
- Last name - Auditor information
- Language of correspondence - Auditor information Off
- Email - Auditor information
- Primary phone number - Auditor information
- Primary phone number EXT- Auditor information
- Alternate phone number - Auditor information
- Alternate phone number EXT- Auditor information
- Fax number - Auditor information
- Name of firm- Auditor organizational information
- Occupation of auditor - Auditor organizational information
- Professional designation - Auditor organizational information Off
- Designation registration number
- Make cheque payable to
- Unit - Address (where cheque is sent)
- Street - Address (where cheque is sent)
- Street name - Address (where cheque is sent)
- City - Address (where cheque is sent)
- ProvinceTerritory - Address (where cheque is sent)
- Postal code - Address (where cheque is sent)
- Date (YYY-MM-DD) - Auditor signature
- Unit - Campaign office address (optional)
- Street - Campaign office address (optional)
- Street name - Campaign office address (optional)
- City - Campaign office address (optional)
- ProvinceTerritory- Campaign office address (optional)
- Postal code - Campaign office address (optional)
- Name of witness
- Full address of witness
- Name of candidate
- Electoral district
- Year
- Name of candidate2
- Electoral district2
- Year2
- Name of witness2
- Full address of witness2
- Name of candidate3
- Electoral district3
- Year3
- Full address of witness3
- Name of witness3
- Name of candidate 4
- Electoral district4
- Year4
- Full address of witness 4
- Name of witness 4
- Name of candidate5
- Electoral district5
- Year5
- Full address of witness5
- Name of witness5
- Name of candidate6
- Electoral district6
- Year6
- Name of witness6
- Full address of witness6
- Name of candidate7
- Electoral district7
- Year7
- Full address of witness7
- Name of witness7
- Name of candidate8
- Electoral district8
- Year8
- Full address of witness8
- Name of witness8
- Name of candidate9
- Electoral district9
- Year9
- Full address of witness 9
- Name of witness 9
- Name of candidate10
- Electoral district10
- Year10
- Full address of witness10
- Name of witness10
- Name of candidate11
- Electoral district11
- Year11
- Full address of witness11
- Name of witness11
- Name of candidate12
- Electoral district12
- Year12
- Full address of witness12
- Name of witness12
- Name of candidate13
- Electoral district13
- Year13
- Full address of witness13
- Name of witness13
- Name of candidate14
- Electoral district14
- Year14
- Name of witness14
- Full address of witness14
- Name of candidate1
- Electoral district1
- Year1
- Name of witness1
- Full address of witness1
- Name of candidate15
- Electoral district15
- Year15
- Name of witness15
- Full address of witness15
- unit -Mailing address
- Street -Mailing address
- Street name -Mailing address
- City -Mailing address
- ProvinceTerritory -Mailing address
- Postal code -Mailing address
- Unit - Mailing address -Campaign delegate
- Street - Mailing address -Campaign delegate
- Street name - Mailing address -Campaign delegate
- City - Mailing address -Campaign delegate
- ProvinceTerritory- Mailing address -Campaign delegate
- Postal code- Mailing address -Campaign delegate
- Unit -Mailing address - Official Agent
- Street -Mailing address - Official Agent
- Street name -Mailing address - Official Agent
- city -Mailing address - Official Agent
- ProvinceTerritory-Mailing address - Official Agent
- Postal code-Mailing address - Official Agent
8BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
16
9BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
17
10BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
18
11BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
19
12BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
20
13BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
21
14BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
22
15BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
23
16BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
24
17BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
25
18BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
26
19BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
27
20BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
28
21BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
29
22BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
30
EC 20010 (022019)
SECTION G ndash 23B Are You Ready to Submit Your Nomination
Have you completed the Nomination Paper (EC 20010)
bull Are all mandatory fields in sections AndashE complete
bull Have you collected the required number of signatures from qualified electors in section F
o For most electoral districts 100 electors must consent to your candidacy
o For electoral districts identified in Schedule 3 only 50 electors are required
o To ensure a smooth nomination process Elections Canada recommends collecting signatures from at least 150 electors
Do you have authorized proof of identify
bull For a list of authorized identification visit the Elections Canada website
bull If a campaign delegate is submitting on your behalf they must bring a copy of your identification documents signed by you
bull If you want an alternative name to appear on the ballot additional documentation is required visit electionsca for details
Are you endorsed by a political party
bull Make sure your party has submitted the required documentation to Elections Canada attesting your designated political affiliation
Have you made a nomination appointment
bull To facilitate the nomination process make an appointment with the returning officer to finalize the filing of the complete nomination package
bull The nomination period closes 21 days before election day at 200 pm local time
31
- Nomination Paperof a Candidate at a Federal General Election or By-election
- Table of Contents
- General Information
- SECTION A ndash Candidate Information (Mandatory)
- SECTION B ndash Campaign Delegate (Optional)
- SECTION C ndash Official Agent (Mandatory)
- SECTION D ndash Auditor (Optional)
- SECTION E ndash Campaign Office (Optional)
- SECTION F ndash Electors Consenting to Candidacy (Mandatory)
-
- Name of electoral district
- Political affiliation
- Telephone number to be posted on electionsca
- Website to be posted on electionsca including prefix http https
- Printed name of elector1
- Full residential address street numbernamecity1
- Postal code1
- Elector signature1
- Witness initials1
- Internal use only1
- Printed name of elector2
- Full residential address street numbernamecity2
- Postal code2
- Elector signature2
- Witness initials2
- Internal use only2
- Printed name of elector3
- Full residential address street numbernamecity3
- Postal code3
- Elector signature3
- Witness initials3
- Internal use only3
- Printed name of elector4
- Full residential address street numbernamecity4
- Postal code4
- Elector signature4
- Witness initials4
- Internal use only4
- Printed name of elector5
- Full residential address street numbernamecity5
- Postal code5
- Elector signature5
- Witness initials5
- Internal use only5
- Printed name of elector6
- Full residential address street numbernamecity6
- Postal code6
- Elector signature6
- Witness initials6
- Internal use only6
- Printed name of elector7
- Full residential address street numbernamecity7
- Postal code7
- Elector signature7
- Witness initials7
- Internal use only7
- Printed name of elector8
- Full residential address street numbernamecity8
- Postal code8
- Elector signature8
- Witness initials8
- Internal use only8
- Printed name of elector9
- Full residential address street numbernamecity9
- Postal code9
- Elector signature9
- Witness initials9
- Internal use only9
- Printed name of elector10
- Full residential address street numbernamecity10
- Postal code10
- Elector signature10
- Witness initials10
- Internal use only10
- Printed name of elector1_2
- Full residential address street numbernamecity1_2
- Postal code1_2
- Elector signature1_2
- Witness initials1_2
- Internal use only1_2
- Printed name of elector2_2
- Full residential address street numbernamecity2_2
- Postal code2_2
- Elector signature2_2
- Witness initials2_2
- Internal use only2_2
- Printed name of elector3_2
- Full residential address street numbernamecity3_2
- Postal code3_2
- Elector signature3_2
- Witness initials3_2
- Internal use only3_2
- Printed name of elector4_2
- Full residential address street numbernamecity4_2
- Postal code4_2
- Elector signature4_2
- Witness initials4_2
- Internal use only4_2
- Printed name of elector5_2
- Full residential address street numbernamecity5_2
- Postal code5_2
- Elector signature5_2
- Witness initials5_2
- Internal use only5_2
- Printed name of elector6_2
- Full residential address street numbernamecity6_2
- Postal code6_2
- Elector signature6_2
- Witness initials6_2
- Internal use only6_2
- Printed name of elector7_2
- Full residential address street numbernamecity7_2
- Postal code7_2
- Elector signature7_2
- Witness initials7_2
- Internal use only7_2
- Printed name of elector8_2
- Full residential address street numbernamecity8_2
- Postal code8_2
- Elector signature8_2
- Witness initials8_2
- Internal use only8_2
- Printed name of elector9_2
- Full residential address street numbernamecity9_2
- Postal code9_2
- Elector signature9_2
- Witness initials9_2
- Internal use only9_2
- Printed name of elector10_2
- Full residential address street numbernamecity10_2
- Postal code10_2
- Elector signature10_2
- Witness initials10_2
- Internal use only10_2
- Printed name of elector1_3
- Full residential address street numbernamecity1_3
- Postal code1_3
- Elector signature1_3
- Witness initials1_3
- Internal use only1_3
- Printed name of elector2_3
- Full residential address street numbernamecity2_3
- Postal code2_3
- Elector signature2_3
- Witness initials2_3
- Internal use only2_3
- Printed name of elector3_3
- Full residential address street numbernamecity3_3
- Postal code3_3
- Elector signature3_3
- Witness initials3_3
- Internal use only3_3
- Printed name of elector4_3
- Full residential address street numbernamecity4_3
- Postal code4_3
- Elector signature4_3
- Witness initials4_3
- Internal use only4_3
- Printed name of elector5_3
- Full residential address street numbernamecity5_3
- Postal code5_3
- Elector signature5_3
- Witness initials5_3
- Internal use only5_3
- Printed name of elector6_3
- Full residential address street numbernamecity6_3
- Postal code6_3
- Elector signature6_3
- Witness initials6_3
- Internal use only6_3
- Printed name of elector7_3
- Full residential address street numbernamecity7_3
- Postal code7_3
- Elector signature7_3
- Witness initials7_3
- Internal use only7_3
- Printed name of elector8_3
- Full residential address street numbernamecity8_3
- Postal code8_3
- Elector signature8_3
- Witness initials8_3
- Internal use only8_3
- Printed name of elector9_3
- Full residential address street numbernamecity9_3
- Postal code9_3
- Elector signature9_3
- Witness initials9_3
- Internal use only9_3
- Printed name of elector10_3
- Full residential address street numbernamecity10_3
- Postal code10_3
- Elector signature10_3
- Witness initials10_3
- Internal use only10_3
- Printed name of elector1_4
- Full residential address street numbernamecity1_4
- Postal code1_4
- Elector signature1_4
- Witness initials1_4
- Internal use only1_4
- Printed name of elector2_4
- Full residential address street numbernamecity2_4
- Postal code2_4
- Elector signature2_4
- Witness initials2_4
- Internal use only2_4
- Printed name of elector3_4
- Full residential address street numbernamecity3_4
- Postal code3_4
- Elector signature3_4
- Witness initials3_4
- Internal use only3_4
- Printed name of elector4_4
- Full residential address street numbernamecity4_4
- Postal code4_4
- Elector signature4_4
- Witness initials4_4
- Internal use only4_4
- Printed name of elector5_4
- Full residential address street numbernamecity5_4
- Postal code5_4
- Elector signature5_4
- Witness initials5_4
- Internal use only5_4
- Printed name of elector6_4
- Full residential address street numbernamecity6_4
- Postal code6_4
- Elector signature6_4
- Witness initials6_4
- Internal use only6_4
- Printed name of elector7_4
- Full residential address street numbernamecity7_4
- Postal code7_4
- Elector signature7_4
- Witness initials7_4
- Internal use only7_4
- Printed name of elector8_4
- Full residential address street numbernamecity8_4
- Postal code8_4
- Elector signature8_4
- Witness initials8_4
- Internal use only8_4
- Printed name of elector9_4
- Full residential address street numbernamecity9_4
- Postal code9_4
- Elector signature9_4
- Witness initials9_4
- Internal use only9_4
- Printed name of elector10_4
- Full residential address street numbernamecity10_4
- Postal code10_4
- Elector signature10_4
- Witness initials10_4
- Internal use only10_4
- Printed name of elector1_5
- Full residential address street numbernamecity1_5
- Postal code1_5
- Elector signature1_5
- Witness initials1_5
- Internal use only1_5
- Printed name of elector2_5
- Full residential address street numbernamecity2_5
- Postal code2_5
- Elector signature2_5
- Witness initials2_5
- Internal use only2_5
- Printed name of elector3_5
- Full residential address street numbernamecity3_5
- Postal code3_5
- Elector signature3_5
- Witness initials3_5
- Internal use only3_5
- Printed name of elector4_5
- Full residential address street numbernamecity4_5
- Postal code4_5
- Elector signature4_5
- Witness initials4_5
- Internal use only4_5
- Printed name of elector5_5
- Full residential address street numbernamecity5_5
- Postal code5_5
- Elector signature5_5
- Witness initials5_5
- Internal use only5_5
- Printed name of elector6_5
- Full residential address street numbernamecity6_5
- Postal code6_5
- Elector signature6_5
- Witness initials6_5
- Internal use only6_5
- Printed name of elector7_5
- Full residential address street numbernamecity7_5
- Postal code7_5
- Elector signature7_5
- Witness initials7_5
- Internal use only7_5
- Printed name of elector8_5
- Full residential address street numbernamecity8_5
- Postal code8_5
- Elector signature8_5
- Witness initials8_5
- Internal use only8_5
- Printed name of elector9_5
- Full residential address street numbernamecity9_5
- Postal code9_5
- Elector signature9_5
- Witness initials9_5
- Internal use only9_5
- Printed name of elector10_5
- Full residential address street numbernamecity10_5
- Postal code10_5
- Elector signature10_5
- Witness initials10_5
- Internal use only10_5
- Printed name of elector1_6
- Full residential address street numbernamecity1_6
- Postal code1_6
- Elector signature1_6
- Witness initials1_6
- Internal use only1_6
- Printed name of elector2_6
- Full residential address street numbernamecity2_6
- Postal code2_6
- Elector signature2_6
- Witness initials2_6
- Internal use only2_6
- Printed name of elector3_6
- Full residential address street numbernamecity3_6
- Postal code3_6
- Elector signature3_6
- Witness initials3_6
- Internal use only3_6
- Printed name of elector4_6
- Full residential address street numbernamecity4_6
- Postal code4_6
- Elector signature4_6
- Witness initials4_6
- Internal use only4_6
- Printed name of elector5_6
- Full residential address street numbernamecity5_6
- Postal code5_6
- Elector signature5_6
- Witness initials5_6
- Internal use only5_6
- Printed name of elector6_6
- Full residential address street numbernamecity6_6
- Postal code6_6
- Elector signature6_6
- Witness initials6_6
- Internal use only6_6
- Printed name of elector7_6
- Full residential address street numbernamecity7_6
- Postal code7_6
- Elector signature7_6
- Witness initials7_6
- Internal use only7_6
- Printed name of elector8_6
- Full residential address street numbernamecity8_6
- Postal code8_6
- Elector signature8_6
- Witness initials8_6
- Internal use only8_6
- Printed name of elector9_6
- Full residential address street numbernamecity9_6
- Postal code9_6
- Elector signature9_6
- Witness initials9_6
- Internal use only9_6
- Printed name of elector10_6
- Full residential address street numbernamecity10_6
- Postal code10_6
- Elector signature10_6
- Witness initials10_6
- Internal use only10_6
- Printed name of elector1_7
- Full residential address street numbernamecity1_7
- Postal code1_7
- Elector signature1_7
- Witness initials1_7
- Internal use only1_7
- Printed name of elector2_7
- Full residential address street numbernamecity2_7
- Postal code2_7
- Elector signature2_7
- Witness initials2_7
- Internal use only2_7
- Printed name of elector3_7
- Full residential address street numbernamecity3_7
- Postal code3_7
- Elector signature3_7
- Witness initials3_7
- Internal use only3_7
- Printed name of elector4_7
- Full residential address street numbernamecity4_7
- Postal code4_7
- Elector signature4_7
- Witness initials4_7
- Internal use only4_7
- Printed name of elector5_7
- Full residential address street numbernamecity5_7
- Postal code5_7
- Elector signature5_7
- Witness initials5_7
- Internal use only5_7
- Printed name of elector6_7
- Full residential address street numbernamecity6_7
- Postal code6_7
- Elector signature6_7
- Witness initials6_7
- Internal use only6_7
- Printed name of elector7_7
- Full residential address street numbernamecity7_7
- Postal code7_7
- Elector signature7_7
- Witness initials7_7
- Internal use only7_7
- Printed name of elector8_7
- Full residential address street numbernamecity8_7
- Postal code8_7
- Elector signature8_7
- Witness initials8_7
- Internal use only8_7
- Printed name of elector9_7
- Full residential address street numbernamecity9_7
- Postal code9_7
- Elector signature9_7
- Witness initials9_7
- Internal use only9_7
- Printed name of elector10_7
- Full residential address street numbernamecity10_7
- Postal code10_7
- Elector signature10_7
- Witness initials10_7
- Internal use only10_7
- Printed name of elector1_8
- Full residential address street numbernamecity1_8
- Postal code1_8
- Elector signature1_8
- Witness initials1_8
- Internal use only1_8
- Printed name of elector2_8
- Full residential address street numbernamecity2_8
- Postal code2_8
- Elector signature2_8
- Witness initials2_8
- Internal use only2_8
- Printed name of elector3_8
- Full residential address street numbernamecity3_8
- Postal code3_8
- Elector signature3_8
- Witness initials3_8
- Internal use only3_8
- Printed name of elector4_8
- Full residential address street numbernamecity4_8
- Postal code4_8
- Elector signature4_8
- Witness initials4_8
- Internal use only4_8
- Printed name of elector5_8
- Full residential address street numbernamecity5_8
- Postal code5_8
- Elector signature5_8
- Witness initials5_8
- Internal use only5_8
- Printed name of elector6_8
- Full residential address street numbernamecity6_8
- Postal code6_8
- Elector signature6_8
- Witness initials6_8
- Internal use only6_8
- Printed name of elector7_8
- Full residential address street numbernamecity7_8
- Postal code7_8
- Elector signature7_8
- Witness initials7_8
- Internal use only7_8
- Printed name of elector8_8
- Full residential address street numbernamecity8_8
- Postal code8_8
- Elector signature8_8
- Witness initials8_8
- Internal use only8_8
- Printed name of elector9_8
- Full residential address street numbernamecity9_8
- Postal code9_8
- Elector signature9_8
- Witness initials9_8
- Internal use only9_8
- Printed name of elector10_8
- Full residential address street numbernamecity10_8
- Postal code10_8
- Elector signature10_8
- Witness initials10_8
- Internal use only10_8
- Printed name of elector1_9
- Full residential address street numbernamecity1_9
- Postal code1_9
- Elector signature1_9
- Witness initials1_9
- Internal use only1_9
- Printed name of elector2_9
- Full residential address street numbernamecity2_9
- Postal code2_9
- Elector signature2_9
- Witness initials2_9
- Internal use only2_9
- Printed name of elector3_9
- Full residential address street numbernamecity3_9
- Postal code3_9
- Elector signature3_9
- Witness initials3_9
- Internal use only3_9
- Printed name of elector4_9
- Full residential address street numbernamecity4_9
- Postal code4_9
- Elector signature4_9
- Witness initials4_9
- Internal use only4_9
- Printed name of elector5_9
- Full residential address street numbernamecity5_9
- Postal code5_9
- Elector signature5_9
- Witness initials5_9
- Internal use only5_9
- Printed name of elector6_9
- Full residential address street numbernamecity6_9
- Postal code6_9
- Elector signature6_9
- Witness initials6_9
- Internal use only6_9
- Printed name of elector7_9
- Full residential address street numbernamecity7_9
- Postal code7_9
- Elector signature7_9
- Witness initials7_9
- Internal use only7_9
- Printed name of elector8_9
- Full residential address street numbernamecity8_9
- Postal code8_9
- Elector signature8_9
- Witness initials8_9
- Internal use only8_9
- Printed name of elector9_9
- Full residential address street numbernamecity9_9
- Postal code9_9
- Elector signature9_9
- Witness initials9_9
- Internal use only9_9
- Printed name of elector10_9
- Full residential address street numbernamecity10_9
- Postal code10_9
- Elector signature10_9
- Witness initials10_9
- Internal use only10_9
- Printed name of elector1_10
- Full residential address street numbernamecity1_10
- Postal code1_10
- Elector signature1_10
- Witness initials1_10
- Internal use only1_10
- Printed name of elector2_10
- Full residential address street numbernamecity2_10
- Postal code2_10
- Elector signature2_10
- Witness initials2_10
- Internal use only2_10
- Printed name of elector3_10
- Full residential address street numbernamecity3_10
- Postal code3_10
- Elector signature3_10
- Witness initials3_10
- Internal use only3_10
- Printed name of elector4_10
- Full residential address street numbernamecity4_10
- Postal code4_10
- Elector signature4_10
- Witness initials4_10
- Internal use only4_10
- Printed name of elector5_10
- Full residential address street numbernamecity5_10
- Postal code5_10
- Elector signature5_10
- Witness initials5_10
- Internal use only5_10
- Printed name of elector6_10
- Full residential address street numbernamecity6_10
- Postal code6_10
- Elector signature6_10
- Witness initials6_10
- Internal use only6_10
- Printed name of elector7_10
- Full residential address street numbernamecity7_10
- Postal code7_10
- Elector signature7_10
- Witness initials7_10
- Internal use only7_10
- Printed name of elector8_10
- Full residential address street numbernamecity8_10
- Postal code8_10
- Elector signature8_10
- Witness initials8_10
- Internal use only8_10
- Printed name of elector9_10
- Full residential address street numbernamecity9_10
- Postal code9_10
- Elector signature9_10
- Witness initials9_10
- Internal use only9_10
- Printed name of elector10_10
- Full residential address street numbernamecity10_10
- Postal code10_10
- Elector signature10_10
- Witness initials10_10
- Internal use only10_10
- Printed name of elector1_11
- Full residential address street numbernamecity1_11
- Postal code1_11
- Elector signature1_11
- Witness initials1_11
- Internal use only1_11
- Printed name of elector2_11
- Full residential address street numbernamecity2_11
- Postal code2_11
- Elector signature2_11
- Witness initials2_11
- Internal use only2_11
- Printed name of elector3_11
- Full residential address street numbernamecity3_11
- Postal code3_11
- Elector signature3_11
- Witness initials3_11
- Internal use only3_11
- Printed name of elector4_11
- Full residential address street numbernamecity4_11
- Postal code4_11
- Elector signature4_11
- Witness initials4_11
- Internal use only4_11
- Printed name of elector5_11
- Full residential address street numbernamecity5_11
- Postal code5_11
- Elector signature5_11
- Witness initials5_11
- Internal use only5_11
- Printed name of elector6_11
- Full residential address street numbernamecity6_11
- Postal code6_11
- Elector signature6_11
- Witness initials6_11
- Internal use only6_11
- Printed name of elector7_11
- Full residential address street numbernamecity7_11
- Postal code7_11
- Elector signature7_11
- Witness initials7_11
- Internal use only7_11
- Printed name of elector8_11
- Full residential address street numbernamecity8_11
- Postal code8_11
- Elector signature8_11
- Witness initials8_11
- Internal use only8_11
- Printed name of elector9_11
- Full residential address street numbernamecity9_11
- Postal code9_11
- Elector signature9_11
- Witness initials9_11
- Internal use only9_11
- Printed name of elector10_11
- Full residential address street numbernamecity10_11
- Postal code10_11
- Elector signature10_11
- Witness initials10_11
- Internal use only10_11
- Printed name of elector1_12
- Full residential address street numbernamecity1_12
- Postal code1_12
- Elector signature1_12
- Witness initials1_12
- Internal use only1_12
- Printed name of elector2_12
- Full residential address street numbernamecity2_12
- Postal code2_12
- Elector signature2_12
- Witness initials2_12
- Internal use only2_12
- Printed name of elector3_12
- Full residential address street numbernamecity3_12
- Postal code3_12
- Elector signature3_12
- Witness initials3_12
- Internal use only3_12
- Printed name of elector4_12
- Full residential address street numbernamecity4_12
- Postal code4_12
- Elector signature4_12
- Witness initials4_12
- Internal use only4_12
- Printed name of elector5_12
- Full residential address street numbernamecity5_12
- Postal code5_12
- Elector signature5_12
- Witness initials5_12
- Internal use only5_12
- Printed name of elector6_12
- Full residential address street numbernamecity6_12
- Postal code6_12
- Elector signature6_12
- Witness initials6_12
- Internal use only6_12
- Printed name of elector7_12
- Full residential address street numbernamecity7_12
- Postal code7_12
- Elector signature7_12
- Witness initials7_12
- Internal use only7_12
- Printed name of elector8_12
- Full residential address street numbernamecity8_12
- Postal code8_12
- Elector signature8_12
- Witness initials8_12
- Internal use only8_12
- Printed name of elector9_12
- Full residential address street numbernamecity9_12
- Postal code9_12
- Elector signature9_12
- Witness initials9_12
- Internal use only9_12
- Printed name of elector10_12
- Full residential address street numbernamecity10_12
- Postal code10_12
- Elector signature10_12
- Witness initials10_12
- Internal use only10_12
- Printed name of elector1_13
- Full residential address street numbernamecity1_13
- Postal code1_13
- Elector signature1_13
- Witness initials1_13
- Internal use only1_13
- Printed name of elector2_13
- Full residential address street numbernamecity2_13
- Postal code2_13
- Elector signature2_13
- Witness initials2_13
- Internal use only2_13
- Printed name of elector3_13
- Full residential address street numbernamecity3_13
- Postal code3_13
- Elector signature3_13
- Witness initials3_13
- Internal use only3_13
- Printed name of elector4_13
- Full residential address street numbernamecity4_13
- Postal code4_13
- Elector signature4_13
- Witness initials4_13
- Internal use only4_13
- Printed name of elector5_13
- Full residential address street numbernamecity5_13
- Postal code5_13
- Elector signature5_13
- Witness initials5_13
- Internal use only5_13
- Printed name of elector6_13
- Full residential address street numbernamecity6_13
- Postal code6_13
- Elector signature6_13
- Witness initials6_13
- Internal use only6_13
- Printed name of elector7_13
- Full residential address street numbernamecity7_13
- Postal code7_13
- Elector signature7_13
- Witness initials7_13
- Internal use only7_13
- Printed name of elector8_13
- Full residential address street numbernamecity8_13
- Postal code8_13
- Elector signature8_13
- Witness initials8_13
- Internal use only8_13
- Printed name of elector9_13
- Full residential address street numbernamecity9_13
- Postal code9_13
- Elector signature9_13
- Witness initials9_13
- Internal use only9_13
- Printed name of elector10_13
- Full residential address street numbernamecity10_13
- Postal code10_13
- Elector signature10_13
- Witness initials10_13
- Internal use only10_13
- Printed name of elector1_14
- Full residential address street numbernamecity1_14
- Postal code1_14
- Elector signature1_14
- Witness initials1_14
- Internal use only1_14
- Printed name of elector2_14
- Full residential address street numbernamecity2_14
- Postal code2_14
- Elector signature2_14
- Witness initials2_14
- Internal use only2_14
- Printed name of elector3_14
- Full residential address street numbernamecity3_14
- Postal code3_14
- Elector signature3_14
- Witness initials3_14
- Internal use only3_14
- Printed name of elector4_14
- Full residential address street numbernamecity4_14
- Postal code4_14
- Elector signature4_14
- Witness initials4_14
- Internal use only4_14
- Printed name of elector5_14
- Full residential address street numbernamecity5_14
- Postal code5_14
- Elector signature5_14
- Witness initials5_14
- Internal use only5_14
- Printed name of elector6_14
- Full residential address street numbernamecity6_14
- Postal code6_14
- Elector signature6_14
- Witness initials6_14
- Internal use only6_14
- Printed name of elector7_14
- Full residential address street numbernamecity7_14
- Postal code7_14
- Elector signature7_14
- Witness initials7_14
- Internal use only7_14
- Printed name of elector8_14
- Full residential address street numbernamecity8_14
- Postal code8_14
- Elector signature8_14
- Witness initials8_14
- Internal use only8_14
- Printed name of elector9_14
- Full residential address street numbernamecity9_14
- Postal code9_14
- Elector signature9_14
- Witness initials9_14
- Internal use only9_14
- Printed name of elector10_14
- Full residential address street numbernamecity10_14
- Postal code10_14
- Elector signature10_14
- Witness initials10_14
- Internal use only10_14
- Printed name of elector1_15
- Full residential address street numbernamecity1_15
- Postal code1_15
- Elector signature1_15
- Witness initials1_15
- Internal use only1_15
- Printed name of elector2_15
- Full residential address street numbernamecity2_15
- Postal code2_15
- Elector signature2_15
- Witness initials2_15
- Internal use only2_15
- Printed name of elector3_15
- Full residential address street numbernamecity3_15
- Postal code3_15
- Elector signature3_15
- Witness initials3_15
- Internal use only3_15
- Printed name of elector4_15
- Full residential address street numbernamecity4_15
- Postal code4_15
- Elector signature4_15
- Witness initials4_15
- Internal use only4_15
- Printed name of elector5_15
- Full residential address street numbernamecity5_15
- Postal code5_15
- Elector signature5_15
- Witness initials5_15
- Internal use only5_15
- Printed name of elector6_15
- Full residential address street numbernamecity6_15
- Postal code6_15
- Elector signature6_15
- Witness initials6_15
- Internal use only6_15
- Printed name of elector7_15
- Full residential address street numbernamecity7_15
- Postal code7_15
- Elector signature7_15
- Witness initials7_15
- Internal use only7_15
- Printed name of elector8_15
- Full residential address street numbernamecity8_15
- Postal code8_15
- Elector signature8_15
- Witness initials8_15
- Internal use only8_15
- Printed name of elector9_15
- Full residential address street numbernamecity9_15
- Postal code9_15
- Elector signature9_15
- Witness initials9_15
- Internal use only9_15
- Printed name of elector10_15
- Full residential address street numbernamecity10_15
- Postal code10_15
- Elector signature10_15
- Witness initials10_15
- Internal use only10_15
- Printed name of elector1_16
- Full residential address street numbernamecity1_16
- Postal code1_16
- Elector signature1_16
- Witness initials1_16
- Internal use only1_16
- Printed name of elector2_16
- Full residential address street numbernamecity2_16
- Postal code2_16
- Elector signature2_16
- Witness initials2_16
- Internal use only2_16
- Printed name of elector3_16
- Full residential address street numbernamecity3_16
- Postal code3_16
- Elector signature3_16
- Witness initials3_16
- Internal use only3_16
- Printed name of elector4_16
- Full residential address street numbernamecity4_16
- Postal code4_16
- Elector signature4_16
- Witness initials4_16
- Internal use only4_16
- Printed name of elector5_16
- Full residential address street numbernamecity5_16
- Postal code5_16
- Elector signature5_16
- Witness initials5_16
- Internal use only5_16
- Printed name of elector6_16
- Full residential address street numbernamecity6_16
- Postal code6_16
- Elector signature6_16
- Witness initials6_16
- Internal use only6_16
- Printed name of elector7_16
- Full residential address street numbernamecity7_16
- Postal code7_16
- Elector signature7_16
- Witness initials7_16
- Internal use only7_16
- Printed name of elector8_16
- Full residential address street numbernamecity8_16
- Postal code8_16
- Elector signature8_16
- Witness initials8_16
- Internal use only8_16
- Printed name of elector9_16
- Full residential address street numbernamecity9_16
- Postal code9_16
- Elector signature9_16
- Witness initials9_16
- Internal use only9_16
- Printed name of elector10_16
- Full residential address street numbernamecity10_16
- Postal code10_16
- Elector signature10_16
- Witness initials10_16
- Internal use only10_16
- Have you completed the Nomination Paper EC 20010 Off
- Do you have authorized proof of identify Off
- Are you endorsed by a political party Off
- Have you made a nomination appointment Off
- Last name - Candidate Name
- First name - Candidate Name
- Name of electoral district- Candidate Information
- First name - Candidate Information
- Last name - Candidate Information
- Ballot Name Off
- Ballot First name(s)
- Ballot Last name(s)
- Gender -Candidate information
- Date of birth (YYY-MM-DD) - Gender -Candidate information
- language of correspondence - Candidate information Off
- Email -Contact information
- Primary phone number - Contact information
- Ext - Primary phone number
- Alternate phone number - Contact information
- Ext - Alternate phone number
- Fax number- Alternate phone number
- Unit -Residential address
- Street -Residential address
- Street name -Residential address
- City -Residential address
- ProvinceTerritory -Residential address
- Postal code - -Residential address
- Mailing address - same as residential address Off
- Occupation- Candidate occupation
- Sharing of information with the Conflict of Interest and Ethics Commissioner and the House of Commons including the Library of Parliament Off
- where applicable if the returning officer is unable to verify that I have been endorsed by the political party identified in section A of this Nomination Paper I wish to Off
- Date of Signature (YYYY-MM-DD) - Candidate signature
- Date of Signature (YYYY-MM-DD) -Signature of person receiving the solemn declaration
- Campaign delegate information
- First name - Campaign delegate information
- Last name - Campaign delegate information
- Language of correspondence - Campaign delegate information Off
- Email - Contact information -Campaign Delegate
- Primary phone number - Contact information -Campaign Delegate
- Primary phone number EXT - Contact information -Campaign Delegate
- Alternate phone number - Contact information -Campaign Delegate
- Alternate phone number EXT - Contact information -Campaign Delegate
- Fax nmuber- Contact information -Campaign Delegate
- Street - Residential address -Campaign delegate
- Street name - Residential address -Campaign delegate
- City - Residential address -Campaign delegate
- ProvinceTerritory - Residential address -Campaign delegate
- Postal Code - Residential address -Campaign delegate
- Campaign delegate - Mailing address ndash Same as residential address Off
- Unit - Residential address -Campaign delegate
- Date (YYYY-MM-DD) - Candidate authorization Signature
- Date (YYYY-MM-DD) - Candidate campaign Signature
- First name - Official agent information
- Last name - Official agent information
- Language of correspondence - Official agent information Off
- Email - Official agent information
- Primary phone number - Official agent information
- Primary phone number EXT - Official agent information
- Alternate phone number EXT - Official agent information
- Alternate phone number - Official agent information
- Fax number - Official agent information
- Unit -Residential address - Official Agent
- Street name -Residential address - Official Agent
- City -Residential address - Official Agent
- Street -Residential address - Official Agent
- ProvinceTerritory -Residential address - Official Agent
- Postal code-Residential address - Official Agent
- Mailing address ndash Same as residential address- Official Agent Off
- Date (YYYY-MM-DD) - Official agent signature
- First name - Auditor information
- Last name - Auditor information
- Language of correspondence - Auditor information Off
- Email - Auditor information
- Primary phone number - Auditor information
- Primary phone number EXT- Auditor information
- Alternate phone number - Auditor information
- Alternate phone number EXT- Auditor information
- Fax number - Auditor information
- Name of firm- Auditor organizational information
- Occupation of auditor - Auditor organizational information
- Professional designation - Auditor organizational information Off
- Designation registration number
- Make cheque payable to
- Unit - Address (where cheque is sent)
- Street - Address (where cheque is sent)
- Street name - Address (where cheque is sent)
- City - Address (where cheque is sent)
- ProvinceTerritory - Address (where cheque is sent)
- Postal code - Address (where cheque is sent)
- Date (YYY-MM-DD) - Auditor signature
- Unit - Campaign office address (optional)
- Street - Campaign office address (optional)
- Street name - Campaign office address (optional)
- City - Campaign office address (optional)
- ProvinceTerritory- Campaign office address (optional)
- Postal code - Campaign office address (optional)
- Name of witness
- Full address of witness
- Name of candidate
- Electoral district
- Year
- Name of candidate2
- Electoral district2
- Year2
- Name of witness2
- Full address of witness2
- Name of candidate3
- Electoral district3
- Year3
- Full address of witness3
- Name of witness3
- Name of candidate 4
- Electoral district4
- Year4
- Full address of witness 4
- Name of witness 4
- Name of candidate5
- Electoral district5
- Year5
- Full address of witness5
- Name of witness5
- Name of candidate6
- Electoral district6
- Year6
- Name of witness6
- Full address of witness6
- Name of candidate7
- Electoral district7
- Year7
- Full address of witness7
- Name of witness7
- Name of candidate8
- Electoral district8
- Year8
- Full address of witness8
- Name of witness8
- Name of candidate9
- Electoral district9
- Year9
- Full address of witness 9
- Name of witness 9
- Name of candidate10
- Electoral district10
- Year10
- Full address of witness10
- Name of witness10
- Name of candidate11
- Electoral district11
- Year11
- Full address of witness11
- Name of witness11
- Name of candidate12
- Electoral district12
- Year12
- Full address of witness12
- Name of witness12
- Name of candidate13
- Electoral district13
- Year13
- Full address of witness13
- Name of witness13
- Name of candidate14
- Electoral district14
- Year14
- Name of witness14
- Full address of witness14
- Name of candidate1
- Electoral district1
- Year1
- Name of witness1
- Full address of witness1
- Name of candidate15
- Electoral district15
- Year15
- Name of witness15
- Full address of witness15
- unit -Mailing address
- Street -Mailing address
- Street name -Mailing address
- City -Mailing address
- ProvinceTerritory -Mailing address
- Postal code -Mailing address
- Unit - Mailing address -Campaign delegate
- Street - Mailing address -Campaign delegate
- Street name - Mailing address -Campaign delegate
- City - Mailing address -Campaign delegate
- ProvinceTerritory- Mailing address -Campaign delegate
- Postal code- Mailing address -Campaign delegate
- Unit -Mailing address - Official Agent
- Street -Mailing address - Official Agent
- Street name -Mailing address - Official Agent
- city -Mailing address - Official Agent
- ProvinceTerritory-Mailing address - Official Agent
- Postal code-Mailing address - Official Agent
9BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
17
10BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
18
11BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
19
12BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
20
13BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
21
14BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
22
15BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
23
16BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
24
17BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
25
18BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
26
19BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
27
20BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
28
21BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
29
22BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
30
EC 20010 (022019)
SECTION G ndash 23B Are You Ready to Submit Your Nomination
Have you completed the Nomination Paper (EC 20010)
bull Are all mandatory fields in sections AndashE complete
bull Have you collected the required number of signatures from qualified electors in section F
o For most electoral districts 100 electors must consent to your candidacy
o For electoral districts identified in Schedule 3 only 50 electors are required
o To ensure a smooth nomination process Elections Canada recommends collecting signatures from at least 150 electors
Do you have authorized proof of identify
bull For a list of authorized identification visit the Elections Canada website
bull If a campaign delegate is submitting on your behalf they must bring a copy of your identification documents signed by you
bull If you want an alternative name to appear on the ballot additional documentation is required visit electionsca for details
Are you endorsed by a political party
bull Make sure your party has submitted the required documentation to Elections Canada attesting your designated political affiliation
Have you made a nomination appointment
bull To facilitate the nomination process make an appointment with the returning officer to finalize the filing of the complete nomination package
bull The nomination period closes 21 days before election day at 200 pm local time
31
- Nomination Paperof a Candidate at a Federal General Election or By-election
- Table of Contents
- General Information
- SECTION A ndash Candidate Information (Mandatory)
- SECTION B ndash Campaign Delegate (Optional)
- SECTION C ndash Official Agent (Mandatory)
- SECTION D ndash Auditor (Optional)
- SECTION E ndash Campaign Office (Optional)
- SECTION F ndash Electors Consenting to Candidacy (Mandatory)
-
- Name of electoral district
- Political affiliation
- Telephone number to be posted on electionsca
- Website to be posted on electionsca including prefix http https
- Printed name of elector1
- Full residential address street numbernamecity1
- Postal code1
- Elector signature1
- Witness initials1
- Internal use only1
- Printed name of elector2
- Full residential address street numbernamecity2
- Postal code2
- Elector signature2
- Witness initials2
- Internal use only2
- Printed name of elector3
- Full residential address street numbernamecity3
- Postal code3
- Elector signature3
- Witness initials3
- Internal use only3
- Printed name of elector4
- Full residential address street numbernamecity4
- Postal code4
- Elector signature4
- Witness initials4
- Internal use only4
- Printed name of elector5
- Full residential address street numbernamecity5
- Postal code5
- Elector signature5
- Witness initials5
- Internal use only5
- Printed name of elector6
- Full residential address street numbernamecity6
- Postal code6
- Elector signature6
- Witness initials6
- Internal use only6
- Printed name of elector7
- Full residential address street numbernamecity7
- Postal code7
- Elector signature7
- Witness initials7
- Internal use only7
- Printed name of elector8
- Full residential address street numbernamecity8
- Postal code8
- Elector signature8
- Witness initials8
- Internal use only8
- Printed name of elector9
- Full residential address street numbernamecity9
- Postal code9
- Elector signature9
- Witness initials9
- Internal use only9
- Printed name of elector10
- Full residential address street numbernamecity10
- Postal code10
- Elector signature10
- Witness initials10
- Internal use only10
- Printed name of elector1_2
- Full residential address street numbernamecity1_2
- Postal code1_2
- Elector signature1_2
- Witness initials1_2
- Internal use only1_2
- Printed name of elector2_2
- Full residential address street numbernamecity2_2
- Postal code2_2
- Elector signature2_2
- Witness initials2_2
- Internal use only2_2
- Printed name of elector3_2
- Full residential address street numbernamecity3_2
- Postal code3_2
- Elector signature3_2
- Witness initials3_2
- Internal use only3_2
- Printed name of elector4_2
- Full residential address street numbernamecity4_2
- Postal code4_2
- Elector signature4_2
- Witness initials4_2
- Internal use only4_2
- Printed name of elector5_2
- Full residential address street numbernamecity5_2
- Postal code5_2
- Elector signature5_2
- Witness initials5_2
- Internal use only5_2
- Printed name of elector6_2
- Full residential address street numbernamecity6_2
- Postal code6_2
- Elector signature6_2
- Witness initials6_2
- Internal use only6_2
- Printed name of elector7_2
- Full residential address street numbernamecity7_2
- Postal code7_2
- Elector signature7_2
- Witness initials7_2
- Internal use only7_2
- Printed name of elector8_2
- Full residential address street numbernamecity8_2
- Postal code8_2
- Elector signature8_2
- Witness initials8_2
- Internal use only8_2
- Printed name of elector9_2
- Full residential address street numbernamecity9_2
- Postal code9_2
- Elector signature9_2
- Witness initials9_2
- Internal use only9_2
- Printed name of elector10_2
- Full residential address street numbernamecity10_2
- Postal code10_2
- Elector signature10_2
- Witness initials10_2
- Internal use only10_2
- Printed name of elector1_3
- Full residential address street numbernamecity1_3
- Postal code1_3
- Elector signature1_3
- Witness initials1_3
- Internal use only1_3
- Printed name of elector2_3
- Full residential address street numbernamecity2_3
- Postal code2_3
- Elector signature2_3
- Witness initials2_3
- Internal use only2_3
- Printed name of elector3_3
- Full residential address street numbernamecity3_3
- Postal code3_3
- Elector signature3_3
- Witness initials3_3
- Internal use only3_3
- Printed name of elector4_3
- Full residential address street numbernamecity4_3
- Postal code4_3
- Elector signature4_3
- Witness initials4_3
- Internal use only4_3
- Printed name of elector5_3
- Full residential address street numbernamecity5_3
- Postal code5_3
- Elector signature5_3
- Witness initials5_3
- Internal use only5_3
- Printed name of elector6_3
- Full residential address street numbernamecity6_3
- Postal code6_3
- Elector signature6_3
- Witness initials6_3
- Internal use only6_3
- Printed name of elector7_3
- Full residential address street numbernamecity7_3
- Postal code7_3
- Elector signature7_3
- Witness initials7_3
- Internal use only7_3
- Printed name of elector8_3
- Full residential address street numbernamecity8_3
- Postal code8_3
- Elector signature8_3
- Witness initials8_3
- Internal use only8_3
- Printed name of elector9_3
- Full residential address street numbernamecity9_3
- Postal code9_3
- Elector signature9_3
- Witness initials9_3
- Internal use only9_3
- Printed name of elector10_3
- Full residential address street numbernamecity10_3
- Postal code10_3
- Elector signature10_3
- Witness initials10_3
- Internal use only10_3
- Printed name of elector1_4
- Full residential address street numbernamecity1_4
- Postal code1_4
- Elector signature1_4
- Witness initials1_4
- Internal use only1_4
- Printed name of elector2_4
- Full residential address street numbernamecity2_4
- Postal code2_4
- Elector signature2_4
- Witness initials2_4
- Internal use only2_4
- Printed name of elector3_4
- Full residential address street numbernamecity3_4
- Postal code3_4
- Elector signature3_4
- Witness initials3_4
- Internal use only3_4
- Printed name of elector4_4
- Full residential address street numbernamecity4_4
- Postal code4_4
- Elector signature4_4
- Witness initials4_4
- Internal use only4_4
- Printed name of elector5_4
- Full residential address street numbernamecity5_4
- Postal code5_4
- Elector signature5_4
- Witness initials5_4
- Internal use only5_4
- Printed name of elector6_4
- Full residential address street numbernamecity6_4
- Postal code6_4
- Elector signature6_4
- Witness initials6_4
- Internal use only6_4
- Printed name of elector7_4
- Full residential address street numbernamecity7_4
- Postal code7_4
- Elector signature7_4
- Witness initials7_4
- Internal use only7_4
- Printed name of elector8_4
- Full residential address street numbernamecity8_4
- Postal code8_4
- Elector signature8_4
- Witness initials8_4
- Internal use only8_4
- Printed name of elector9_4
- Full residential address street numbernamecity9_4
- Postal code9_4
- Elector signature9_4
- Witness initials9_4
- Internal use only9_4
- Printed name of elector10_4
- Full residential address street numbernamecity10_4
- Postal code10_4
- Elector signature10_4
- Witness initials10_4
- Internal use only10_4
- Printed name of elector1_5
- Full residential address street numbernamecity1_5
- Postal code1_5
- Elector signature1_5
- Witness initials1_5
- Internal use only1_5
- Printed name of elector2_5
- Full residential address street numbernamecity2_5
- Postal code2_5
- Elector signature2_5
- Witness initials2_5
- Internal use only2_5
- Printed name of elector3_5
- Full residential address street numbernamecity3_5
- Postal code3_5
- Elector signature3_5
- Witness initials3_5
- Internal use only3_5
- Printed name of elector4_5
- Full residential address street numbernamecity4_5
- Postal code4_5
- Elector signature4_5
- Witness initials4_5
- Internal use only4_5
- Printed name of elector5_5
- Full residential address street numbernamecity5_5
- Postal code5_5
- Elector signature5_5
- Witness initials5_5
- Internal use only5_5
- Printed name of elector6_5
- Full residential address street numbernamecity6_5
- Postal code6_5
- Elector signature6_5
- Witness initials6_5
- Internal use only6_5
- Printed name of elector7_5
- Full residential address street numbernamecity7_5
- Postal code7_5
- Elector signature7_5
- Witness initials7_5
- Internal use only7_5
- Printed name of elector8_5
- Full residential address street numbernamecity8_5
- Postal code8_5
- Elector signature8_5
- Witness initials8_5
- Internal use only8_5
- Printed name of elector9_5
- Full residential address street numbernamecity9_5
- Postal code9_5
- Elector signature9_5
- Witness initials9_5
- Internal use only9_5
- Printed name of elector10_5
- Full residential address street numbernamecity10_5
- Postal code10_5
- Elector signature10_5
- Witness initials10_5
- Internal use only10_5
- Printed name of elector1_6
- Full residential address street numbernamecity1_6
- Postal code1_6
- Elector signature1_6
- Witness initials1_6
- Internal use only1_6
- Printed name of elector2_6
- Full residential address street numbernamecity2_6
- Postal code2_6
- Elector signature2_6
- Witness initials2_6
- Internal use only2_6
- Printed name of elector3_6
- Full residential address street numbernamecity3_6
- Postal code3_6
- Elector signature3_6
- Witness initials3_6
- Internal use only3_6
- Printed name of elector4_6
- Full residential address street numbernamecity4_6
- Postal code4_6
- Elector signature4_6
- Witness initials4_6
- Internal use only4_6
- Printed name of elector5_6
- Full residential address street numbernamecity5_6
- Postal code5_6
- Elector signature5_6
- Witness initials5_6
- Internal use only5_6
- Printed name of elector6_6
- Full residential address street numbernamecity6_6
- Postal code6_6
- Elector signature6_6
- Witness initials6_6
- Internal use only6_6
- Printed name of elector7_6
- Full residential address street numbernamecity7_6
- Postal code7_6
- Elector signature7_6
- Witness initials7_6
- Internal use only7_6
- Printed name of elector8_6
- Full residential address street numbernamecity8_6
- Postal code8_6
- Elector signature8_6
- Witness initials8_6
- Internal use only8_6
- Printed name of elector9_6
- Full residential address street numbernamecity9_6
- Postal code9_6
- Elector signature9_6
- Witness initials9_6
- Internal use only9_6
- Printed name of elector10_6
- Full residential address street numbernamecity10_6
- Postal code10_6
- Elector signature10_6
- Witness initials10_6
- Internal use only10_6
- Printed name of elector1_7
- Full residential address street numbernamecity1_7
- Postal code1_7
- Elector signature1_7
- Witness initials1_7
- Internal use only1_7
- Printed name of elector2_7
- Full residential address street numbernamecity2_7
- Postal code2_7
- Elector signature2_7
- Witness initials2_7
- Internal use only2_7
- Printed name of elector3_7
- Full residential address street numbernamecity3_7
- Postal code3_7
- Elector signature3_7
- Witness initials3_7
- Internal use only3_7
- Printed name of elector4_7
- Full residential address street numbernamecity4_7
- Postal code4_7
- Elector signature4_7
- Witness initials4_7
- Internal use only4_7
- Printed name of elector5_7
- Full residential address street numbernamecity5_7
- Postal code5_7
- Elector signature5_7
- Witness initials5_7
- Internal use only5_7
- Printed name of elector6_7
- Full residential address street numbernamecity6_7
- Postal code6_7
- Elector signature6_7
- Witness initials6_7
- Internal use only6_7
- Printed name of elector7_7
- Full residential address street numbernamecity7_7
- Postal code7_7
- Elector signature7_7
- Witness initials7_7
- Internal use only7_7
- Printed name of elector8_7
- Full residential address street numbernamecity8_7
- Postal code8_7
- Elector signature8_7
- Witness initials8_7
- Internal use only8_7
- Printed name of elector9_7
- Full residential address street numbernamecity9_7
- Postal code9_7
- Elector signature9_7
- Witness initials9_7
- Internal use only9_7
- Printed name of elector10_7
- Full residential address street numbernamecity10_7
- Postal code10_7
- Elector signature10_7
- Witness initials10_7
- Internal use only10_7
- Printed name of elector1_8
- Full residential address street numbernamecity1_8
- Postal code1_8
- Elector signature1_8
- Witness initials1_8
- Internal use only1_8
- Printed name of elector2_8
- Full residential address street numbernamecity2_8
- Postal code2_8
- Elector signature2_8
- Witness initials2_8
- Internal use only2_8
- Printed name of elector3_8
- Full residential address street numbernamecity3_8
- Postal code3_8
- Elector signature3_8
- Witness initials3_8
- Internal use only3_8
- Printed name of elector4_8
- Full residential address street numbernamecity4_8
- Postal code4_8
- Elector signature4_8
- Witness initials4_8
- Internal use only4_8
- Printed name of elector5_8
- Full residential address street numbernamecity5_8
- Postal code5_8
- Elector signature5_8
- Witness initials5_8
- Internal use only5_8
- Printed name of elector6_8
- Full residential address street numbernamecity6_8
- Postal code6_8
- Elector signature6_8
- Witness initials6_8
- Internal use only6_8
- Printed name of elector7_8
- Full residential address street numbernamecity7_8
- Postal code7_8
- Elector signature7_8
- Witness initials7_8
- Internal use only7_8
- Printed name of elector8_8
- Full residential address street numbernamecity8_8
- Postal code8_8
- Elector signature8_8
- Witness initials8_8
- Internal use only8_8
- Printed name of elector9_8
- Full residential address street numbernamecity9_8
- Postal code9_8
- Elector signature9_8
- Witness initials9_8
- Internal use only9_8
- Printed name of elector10_8
- Full residential address street numbernamecity10_8
- Postal code10_8
- Elector signature10_8
- Witness initials10_8
- Internal use only10_8
- Printed name of elector1_9
- Full residential address street numbernamecity1_9
- Postal code1_9
- Elector signature1_9
- Witness initials1_9
- Internal use only1_9
- Printed name of elector2_9
- Full residential address street numbernamecity2_9
- Postal code2_9
- Elector signature2_9
- Witness initials2_9
- Internal use only2_9
- Printed name of elector3_9
- Full residential address street numbernamecity3_9
- Postal code3_9
- Elector signature3_9
- Witness initials3_9
- Internal use only3_9
- Printed name of elector4_9
- Full residential address street numbernamecity4_9
- Postal code4_9
- Elector signature4_9
- Witness initials4_9
- Internal use only4_9
- Printed name of elector5_9
- Full residential address street numbernamecity5_9
- Postal code5_9
- Elector signature5_9
- Witness initials5_9
- Internal use only5_9
- Printed name of elector6_9
- Full residential address street numbernamecity6_9
- Postal code6_9
- Elector signature6_9
- Witness initials6_9
- Internal use only6_9
- Printed name of elector7_9
- Full residential address street numbernamecity7_9
- Postal code7_9
- Elector signature7_9
- Witness initials7_9
- Internal use only7_9
- Printed name of elector8_9
- Full residential address street numbernamecity8_9
- Postal code8_9
- Elector signature8_9
- Witness initials8_9
- Internal use only8_9
- Printed name of elector9_9
- Full residential address street numbernamecity9_9
- Postal code9_9
- Elector signature9_9
- Witness initials9_9
- Internal use only9_9
- Printed name of elector10_9
- Full residential address street numbernamecity10_9
- Postal code10_9
- Elector signature10_9
- Witness initials10_9
- Internal use only10_9
- Printed name of elector1_10
- Full residential address street numbernamecity1_10
- Postal code1_10
- Elector signature1_10
- Witness initials1_10
- Internal use only1_10
- Printed name of elector2_10
- Full residential address street numbernamecity2_10
- Postal code2_10
- Elector signature2_10
- Witness initials2_10
- Internal use only2_10
- Printed name of elector3_10
- Full residential address street numbernamecity3_10
- Postal code3_10
- Elector signature3_10
- Witness initials3_10
- Internal use only3_10
- Printed name of elector4_10
- Full residential address street numbernamecity4_10
- Postal code4_10
- Elector signature4_10
- Witness initials4_10
- Internal use only4_10
- Printed name of elector5_10
- Full residential address street numbernamecity5_10
- Postal code5_10
- Elector signature5_10
- Witness initials5_10
- Internal use only5_10
- Printed name of elector6_10
- Full residential address street numbernamecity6_10
- Postal code6_10
- Elector signature6_10
- Witness initials6_10
- Internal use only6_10
- Printed name of elector7_10
- Full residential address street numbernamecity7_10
- Postal code7_10
- Elector signature7_10
- Witness initials7_10
- Internal use only7_10
- Printed name of elector8_10
- Full residential address street numbernamecity8_10
- Postal code8_10
- Elector signature8_10
- Witness initials8_10
- Internal use only8_10
- Printed name of elector9_10
- Full residential address street numbernamecity9_10
- Postal code9_10
- Elector signature9_10
- Witness initials9_10
- Internal use only9_10
- Printed name of elector10_10
- Full residential address street numbernamecity10_10
- Postal code10_10
- Elector signature10_10
- Witness initials10_10
- Internal use only10_10
- Printed name of elector1_11
- Full residential address street numbernamecity1_11
- Postal code1_11
- Elector signature1_11
- Witness initials1_11
- Internal use only1_11
- Printed name of elector2_11
- Full residential address street numbernamecity2_11
- Postal code2_11
- Elector signature2_11
- Witness initials2_11
- Internal use only2_11
- Printed name of elector3_11
- Full residential address street numbernamecity3_11
- Postal code3_11
- Elector signature3_11
- Witness initials3_11
- Internal use only3_11
- Printed name of elector4_11
- Full residential address street numbernamecity4_11
- Postal code4_11
- Elector signature4_11
- Witness initials4_11
- Internal use only4_11
- Printed name of elector5_11
- Full residential address street numbernamecity5_11
- Postal code5_11
- Elector signature5_11
- Witness initials5_11
- Internal use only5_11
- Printed name of elector6_11
- Full residential address street numbernamecity6_11
- Postal code6_11
- Elector signature6_11
- Witness initials6_11
- Internal use only6_11
- Printed name of elector7_11
- Full residential address street numbernamecity7_11
- Postal code7_11
- Elector signature7_11
- Witness initials7_11
- Internal use only7_11
- Printed name of elector8_11
- Full residential address street numbernamecity8_11
- Postal code8_11
- Elector signature8_11
- Witness initials8_11
- Internal use only8_11
- Printed name of elector9_11
- Full residential address street numbernamecity9_11
- Postal code9_11
- Elector signature9_11
- Witness initials9_11
- Internal use only9_11
- Printed name of elector10_11
- Full residential address street numbernamecity10_11
- Postal code10_11
- Elector signature10_11
- Witness initials10_11
- Internal use only10_11
- Printed name of elector1_12
- Full residential address street numbernamecity1_12
- Postal code1_12
- Elector signature1_12
- Witness initials1_12
- Internal use only1_12
- Printed name of elector2_12
- Full residential address street numbernamecity2_12
- Postal code2_12
- Elector signature2_12
- Witness initials2_12
- Internal use only2_12
- Printed name of elector3_12
- Full residential address street numbernamecity3_12
- Postal code3_12
- Elector signature3_12
- Witness initials3_12
- Internal use only3_12
- Printed name of elector4_12
- Full residential address street numbernamecity4_12
- Postal code4_12
- Elector signature4_12
- Witness initials4_12
- Internal use only4_12
- Printed name of elector5_12
- Full residential address street numbernamecity5_12
- Postal code5_12
- Elector signature5_12
- Witness initials5_12
- Internal use only5_12
- Printed name of elector6_12
- Full residential address street numbernamecity6_12
- Postal code6_12
- Elector signature6_12
- Witness initials6_12
- Internal use only6_12
- Printed name of elector7_12
- Full residential address street numbernamecity7_12
- Postal code7_12
- Elector signature7_12
- Witness initials7_12
- Internal use only7_12
- Printed name of elector8_12
- Full residential address street numbernamecity8_12
- Postal code8_12
- Elector signature8_12
- Witness initials8_12
- Internal use only8_12
- Printed name of elector9_12
- Full residential address street numbernamecity9_12
- Postal code9_12
- Elector signature9_12
- Witness initials9_12
- Internal use only9_12
- Printed name of elector10_12
- Full residential address street numbernamecity10_12
- Postal code10_12
- Elector signature10_12
- Witness initials10_12
- Internal use only10_12
- Printed name of elector1_13
- Full residential address street numbernamecity1_13
- Postal code1_13
- Elector signature1_13
- Witness initials1_13
- Internal use only1_13
- Printed name of elector2_13
- Full residential address street numbernamecity2_13
- Postal code2_13
- Elector signature2_13
- Witness initials2_13
- Internal use only2_13
- Printed name of elector3_13
- Full residential address street numbernamecity3_13
- Postal code3_13
- Elector signature3_13
- Witness initials3_13
- Internal use only3_13
- Printed name of elector4_13
- Full residential address street numbernamecity4_13
- Postal code4_13
- Elector signature4_13
- Witness initials4_13
- Internal use only4_13
- Printed name of elector5_13
- Full residential address street numbernamecity5_13
- Postal code5_13
- Elector signature5_13
- Witness initials5_13
- Internal use only5_13
- Printed name of elector6_13
- Full residential address street numbernamecity6_13
- Postal code6_13
- Elector signature6_13
- Witness initials6_13
- Internal use only6_13
- Printed name of elector7_13
- Full residential address street numbernamecity7_13
- Postal code7_13
- Elector signature7_13
- Witness initials7_13
- Internal use only7_13
- Printed name of elector8_13
- Full residential address street numbernamecity8_13
- Postal code8_13
- Elector signature8_13
- Witness initials8_13
- Internal use only8_13
- Printed name of elector9_13
- Full residential address street numbernamecity9_13
- Postal code9_13
- Elector signature9_13
- Witness initials9_13
- Internal use only9_13
- Printed name of elector10_13
- Full residential address street numbernamecity10_13
- Postal code10_13
- Elector signature10_13
- Witness initials10_13
- Internal use only10_13
- Printed name of elector1_14
- Full residential address street numbernamecity1_14
- Postal code1_14
- Elector signature1_14
- Witness initials1_14
- Internal use only1_14
- Printed name of elector2_14
- Full residential address street numbernamecity2_14
- Postal code2_14
- Elector signature2_14
- Witness initials2_14
- Internal use only2_14
- Printed name of elector3_14
- Full residential address street numbernamecity3_14
- Postal code3_14
- Elector signature3_14
- Witness initials3_14
- Internal use only3_14
- Printed name of elector4_14
- Full residential address street numbernamecity4_14
- Postal code4_14
- Elector signature4_14
- Witness initials4_14
- Internal use only4_14
- Printed name of elector5_14
- Full residential address street numbernamecity5_14
- Postal code5_14
- Elector signature5_14
- Witness initials5_14
- Internal use only5_14
- Printed name of elector6_14
- Full residential address street numbernamecity6_14
- Postal code6_14
- Elector signature6_14
- Witness initials6_14
- Internal use only6_14
- Printed name of elector7_14
- Full residential address street numbernamecity7_14
- Postal code7_14
- Elector signature7_14
- Witness initials7_14
- Internal use only7_14
- Printed name of elector8_14
- Full residential address street numbernamecity8_14
- Postal code8_14
- Elector signature8_14
- Witness initials8_14
- Internal use only8_14
- Printed name of elector9_14
- Full residential address street numbernamecity9_14
- Postal code9_14
- Elector signature9_14
- Witness initials9_14
- Internal use only9_14
- Printed name of elector10_14
- Full residential address street numbernamecity10_14
- Postal code10_14
- Elector signature10_14
- Witness initials10_14
- Internal use only10_14
- Printed name of elector1_15
- Full residential address street numbernamecity1_15
- Postal code1_15
- Elector signature1_15
- Witness initials1_15
- Internal use only1_15
- Printed name of elector2_15
- Full residential address street numbernamecity2_15
- Postal code2_15
- Elector signature2_15
- Witness initials2_15
- Internal use only2_15
- Printed name of elector3_15
- Full residential address street numbernamecity3_15
- Postal code3_15
- Elector signature3_15
- Witness initials3_15
- Internal use only3_15
- Printed name of elector4_15
- Full residential address street numbernamecity4_15
- Postal code4_15
- Elector signature4_15
- Witness initials4_15
- Internal use only4_15
- Printed name of elector5_15
- Full residential address street numbernamecity5_15
- Postal code5_15
- Elector signature5_15
- Witness initials5_15
- Internal use only5_15
- Printed name of elector6_15
- Full residential address street numbernamecity6_15
- Postal code6_15
- Elector signature6_15
- Witness initials6_15
- Internal use only6_15
- Printed name of elector7_15
- Full residential address street numbernamecity7_15
- Postal code7_15
- Elector signature7_15
- Witness initials7_15
- Internal use only7_15
- Printed name of elector8_15
- Full residential address street numbernamecity8_15
- Postal code8_15
- Elector signature8_15
- Witness initials8_15
- Internal use only8_15
- Printed name of elector9_15
- Full residential address street numbernamecity9_15
- Postal code9_15
- Elector signature9_15
- Witness initials9_15
- Internal use only9_15
- Printed name of elector10_15
- Full residential address street numbernamecity10_15
- Postal code10_15
- Elector signature10_15
- Witness initials10_15
- Internal use only10_15
- Printed name of elector1_16
- Full residential address street numbernamecity1_16
- Postal code1_16
- Elector signature1_16
- Witness initials1_16
- Internal use only1_16
- Printed name of elector2_16
- Full residential address street numbernamecity2_16
- Postal code2_16
- Elector signature2_16
- Witness initials2_16
- Internal use only2_16
- Printed name of elector3_16
- Full residential address street numbernamecity3_16
- Postal code3_16
- Elector signature3_16
- Witness initials3_16
- Internal use only3_16
- Printed name of elector4_16
- Full residential address street numbernamecity4_16
- Postal code4_16
- Elector signature4_16
- Witness initials4_16
- Internal use only4_16
- Printed name of elector5_16
- Full residential address street numbernamecity5_16
- Postal code5_16
- Elector signature5_16
- Witness initials5_16
- Internal use only5_16
- Printed name of elector6_16
- Full residential address street numbernamecity6_16
- Postal code6_16
- Elector signature6_16
- Witness initials6_16
- Internal use only6_16
- Printed name of elector7_16
- Full residential address street numbernamecity7_16
- Postal code7_16
- Elector signature7_16
- Witness initials7_16
- Internal use only7_16
- Printed name of elector8_16
- Full residential address street numbernamecity8_16
- Postal code8_16
- Elector signature8_16
- Witness initials8_16
- Internal use only8_16
- Printed name of elector9_16
- Full residential address street numbernamecity9_16
- Postal code9_16
- Elector signature9_16
- Witness initials9_16
- Internal use only9_16
- Printed name of elector10_16
- Full residential address street numbernamecity10_16
- Postal code10_16
- Elector signature10_16
- Witness initials10_16
- Internal use only10_16
- Have you completed the Nomination Paper EC 20010 Off
- Do you have authorized proof of identify Off
- Are you endorsed by a political party Off
- Have you made a nomination appointment Off
- Last name - Candidate Name
- First name - Candidate Name
- Name of electoral district- Candidate Information
- First name - Candidate Information
- Last name - Candidate Information
- Ballot Name Off
- Ballot First name(s)
- Ballot Last name(s)
- Gender -Candidate information
- Date of birth (YYY-MM-DD) - Gender -Candidate information
- language of correspondence - Candidate information Off
- Email -Contact information
- Primary phone number - Contact information
- Ext - Primary phone number
- Alternate phone number - Contact information
- Ext - Alternate phone number
- Fax number- Alternate phone number
- Unit -Residential address
- Street -Residential address
- Street name -Residential address
- City -Residential address
- ProvinceTerritory -Residential address
- Postal code - -Residential address
- Mailing address - same as residential address Off
- Occupation- Candidate occupation
- Sharing of information with the Conflict of Interest and Ethics Commissioner and the House of Commons including the Library of Parliament Off
- where applicable if the returning officer is unable to verify that I have been endorsed by the political party identified in section A of this Nomination Paper I wish to Off
- Date of Signature (YYYY-MM-DD) - Candidate signature
- Date of Signature (YYYY-MM-DD) -Signature of person receiving the solemn declaration
- Campaign delegate information
- First name - Campaign delegate information
- Last name - Campaign delegate information
- Language of correspondence - Campaign delegate information Off
- Email - Contact information -Campaign Delegate
- Primary phone number - Contact information -Campaign Delegate
- Primary phone number EXT - Contact information -Campaign Delegate
- Alternate phone number - Contact information -Campaign Delegate
- Alternate phone number EXT - Contact information -Campaign Delegate
- Fax nmuber- Contact information -Campaign Delegate
- Street - Residential address -Campaign delegate
- Street name - Residential address -Campaign delegate
- City - Residential address -Campaign delegate
- ProvinceTerritory - Residential address -Campaign delegate
- Postal Code - Residential address -Campaign delegate
- Campaign delegate - Mailing address ndash Same as residential address Off
- Unit - Residential address -Campaign delegate
- Date (YYYY-MM-DD) - Candidate authorization Signature
- Date (YYYY-MM-DD) - Candidate campaign Signature
- First name - Official agent information
- Last name - Official agent information
- Language of correspondence - Official agent information Off
- Email - Official agent information
- Primary phone number - Official agent information
- Primary phone number EXT - Official agent information
- Alternate phone number EXT - Official agent information
- Alternate phone number - Official agent information
- Fax number - Official agent information
- Unit -Residential address - Official Agent
- Street name -Residential address - Official Agent
- City -Residential address - Official Agent
- Street -Residential address - Official Agent
- ProvinceTerritory -Residential address - Official Agent
- Postal code-Residential address - Official Agent
- Mailing address ndash Same as residential address- Official Agent Off
- Date (YYYY-MM-DD) - Official agent signature
- First name - Auditor information
- Last name - Auditor information
- Language of correspondence - Auditor information Off
- Email - Auditor information
- Primary phone number - Auditor information
- Primary phone number EXT- Auditor information
- Alternate phone number - Auditor information
- Alternate phone number EXT- Auditor information
- Fax number - Auditor information
- Name of firm- Auditor organizational information
- Occupation of auditor - Auditor organizational information
- Professional designation - Auditor organizational information Off
- Designation registration number
- Make cheque payable to
- Unit - Address (where cheque is sent)
- Street - Address (where cheque is sent)
- Street name - Address (where cheque is sent)
- City - Address (where cheque is sent)
- ProvinceTerritory - Address (where cheque is sent)
- Postal code - Address (where cheque is sent)
- Date (YYY-MM-DD) - Auditor signature
- Unit - Campaign office address (optional)
- Street - Campaign office address (optional)
- Street name - Campaign office address (optional)
- City - Campaign office address (optional)
- ProvinceTerritory- Campaign office address (optional)
- Postal code - Campaign office address (optional)
- Name of witness
- Full address of witness
- Name of candidate
- Electoral district
- Year
- Name of candidate2
- Electoral district2
- Year2
- Name of witness2
- Full address of witness2
- Name of candidate3
- Electoral district3
- Year3
- Full address of witness3
- Name of witness3
- Name of candidate 4
- Electoral district4
- Year4
- Full address of witness 4
- Name of witness 4
- Name of candidate5
- Electoral district5
- Year5
- Full address of witness5
- Name of witness5
- Name of candidate6
- Electoral district6
- Year6
- Name of witness6
- Full address of witness6
- Name of candidate7
- Electoral district7
- Year7
- Full address of witness7
- Name of witness7
- Name of candidate8
- Electoral district8
- Year8
- Full address of witness8
- Name of witness8
- Name of candidate9
- Electoral district9
- Year9
- Full address of witness 9
- Name of witness 9
- Name of candidate10
- Electoral district10
- Year10
- Full address of witness10
- Name of witness10
- Name of candidate11
- Electoral district11
- Year11
- Full address of witness11
- Name of witness11
- Name of candidate12
- Electoral district12
- Year12
- Full address of witness12
- Name of witness12
- Name of candidate13
- Electoral district13
- Year13
- Full address of witness13
- Name of witness13
- Name of candidate14
- Electoral district14
- Year14
- Name of witness14
- Full address of witness14
- Name of candidate1
- Electoral district1
- Year1
- Name of witness1
- Full address of witness1
- Name of candidate15
- Electoral district15
- Year15
- Name of witness15
- Full address of witness15
- unit -Mailing address
- Street -Mailing address
- Street name -Mailing address
- City -Mailing address
- ProvinceTerritory -Mailing address
- Postal code -Mailing address
- Unit - Mailing address -Campaign delegate
- Street - Mailing address -Campaign delegate
- Street name - Mailing address -Campaign delegate
- City - Mailing address -Campaign delegate
- ProvinceTerritory- Mailing address -Campaign delegate
- Postal code- Mailing address -Campaign delegate
- Unit -Mailing address - Official Agent
- Street -Mailing address - Official Agent
- Street name -Mailing address - Official Agent
- city -Mailing address - Official Agent
- ProvinceTerritory-Mailing address - Official Agent
- Postal code-Mailing address - Official Agent
10BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
18
11BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
19
12BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
20
13BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
21
14BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
22
15BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
23
16BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
24
17BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
25
18BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
26
19BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
27
20BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
28
21BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
29
22BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
30
EC 20010 (022019)
SECTION G ndash 23B Are You Ready to Submit Your Nomination
Have you completed the Nomination Paper (EC 20010)
bull Are all mandatory fields in sections AndashE complete
bull Have you collected the required number of signatures from qualified electors in section F
o For most electoral districts 100 electors must consent to your candidacy
o For electoral districts identified in Schedule 3 only 50 electors are required
o To ensure a smooth nomination process Elections Canada recommends collecting signatures from at least 150 electors
Do you have authorized proof of identify
bull For a list of authorized identification visit the Elections Canada website
bull If a campaign delegate is submitting on your behalf they must bring a copy of your identification documents signed by you
bull If you want an alternative name to appear on the ballot additional documentation is required visit electionsca for details
Are you endorsed by a political party
bull Make sure your party has submitted the required documentation to Elections Canada attesting your designated political affiliation
Have you made a nomination appointment
bull To facilitate the nomination process make an appointment with the returning officer to finalize the filing of the complete nomination package
bull The nomination period closes 21 days before election day at 200 pm local time
31
- Nomination Paperof a Candidate at a Federal General Election or By-election
- Table of Contents
- General Information
- SECTION A ndash Candidate Information (Mandatory)
- SECTION B ndash Campaign Delegate (Optional)
- SECTION C ndash Official Agent (Mandatory)
- SECTION D ndash Auditor (Optional)
- SECTION E ndash Campaign Office (Optional)
- SECTION F ndash Electors Consenting to Candidacy (Mandatory)
-
- Name of electoral district
- Political affiliation
- Telephone number to be posted on electionsca
- Website to be posted on electionsca including prefix http https
- Printed name of elector1
- Full residential address street numbernamecity1
- Postal code1
- Elector signature1
- Witness initials1
- Internal use only1
- Printed name of elector2
- Full residential address street numbernamecity2
- Postal code2
- Elector signature2
- Witness initials2
- Internal use only2
- Printed name of elector3
- Full residential address street numbernamecity3
- Postal code3
- Elector signature3
- Witness initials3
- Internal use only3
- Printed name of elector4
- Full residential address street numbernamecity4
- Postal code4
- Elector signature4
- Witness initials4
- Internal use only4
- Printed name of elector5
- Full residential address street numbernamecity5
- Postal code5
- Elector signature5
- Witness initials5
- Internal use only5
- Printed name of elector6
- Full residential address street numbernamecity6
- Postal code6
- Elector signature6
- Witness initials6
- Internal use only6
- Printed name of elector7
- Full residential address street numbernamecity7
- Postal code7
- Elector signature7
- Witness initials7
- Internal use only7
- Printed name of elector8
- Full residential address street numbernamecity8
- Postal code8
- Elector signature8
- Witness initials8
- Internal use only8
- Printed name of elector9
- Full residential address street numbernamecity9
- Postal code9
- Elector signature9
- Witness initials9
- Internal use only9
- Printed name of elector10
- Full residential address street numbernamecity10
- Postal code10
- Elector signature10
- Witness initials10
- Internal use only10
- Printed name of elector1_2
- Full residential address street numbernamecity1_2
- Postal code1_2
- Elector signature1_2
- Witness initials1_2
- Internal use only1_2
- Printed name of elector2_2
- Full residential address street numbernamecity2_2
- Postal code2_2
- Elector signature2_2
- Witness initials2_2
- Internal use only2_2
- Printed name of elector3_2
- Full residential address street numbernamecity3_2
- Postal code3_2
- Elector signature3_2
- Witness initials3_2
- Internal use only3_2
- Printed name of elector4_2
- Full residential address street numbernamecity4_2
- Postal code4_2
- Elector signature4_2
- Witness initials4_2
- Internal use only4_2
- Printed name of elector5_2
- Full residential address street numbernamecity5_2
- Postal code5_2
- Elector signature5_2
- Witness initials5_2
- Internal use only5_2
- Printed name of elector6_2
- Full residential address street numbernamecity6_2
- Postal code6_2
- Elector signature6_2
- Witness initials6_2
- Internal use only6_2
- Printed name of elector7_2
- Full residential address street numbernamecity7_2
- Postal code7_2
- Elector signature7_2
- Witness initials7_2
- Internal use only7_2
- Printed name of elector8_2
- Full residential address street numbernamecity8_2
- Postal code8_2
- Elector signature8_2
- Witness initials8_2
- Internal use only8_2
- Printed name of elector9_2
- Full residential address street numbernamecity9_2
- Postal code9_2
- Elector signature9_2
- Witness initials9_2
- Internal use only9_2
- Printed name of elector10_2
- Full residential address street numbernamecity10_2
- Postal code10_2
- Elector signature10_2
- Witness initials10_2
- Internal use only10_2
- Printed name of elector1_3
- Full residential address street numbernamecity1_3
- Postal code1_3
- Elector signature1_3
- Witness initials1_3
- Internal use only1_3
- Printed name of elector2_3
- Full residential address street numbernamecity2_3
- Postal code2_3
- Elector signature2_3
- Witness initials2_3
- Internal use only2_3
- Printed name of elector3_3
- Full residential address street numbernamecity3_3
- Postal code3_3
- Elector signature3_3
- Witness initials3_3
- Internal use only3_3
- Printed name of elector4_3
- Full residential address street numbernamecity4_3
- Postal code4_3
- Elector signature4_3
- Witness initials4_3
- Internal use only4_3
- Printed name of elector5_3
- Full residential address street numbernamecity5_3
- Postal code5_3
- Elector signature5_3
- Witness initials5_3
- Internal use only5_3
- Printed name of elector6_3
- Full residential address street numbernamecity6_3
- Postal code6_3
- Elector signature6_3
- Witness initials6_3
- Internal use only6_3
- Printed name of elector7_3
- Full residential address street numbernamecity7_3
- Postal code7_3
- Elector signature7_3
- Witness initials7_3
- Internal use only7_3
- Printed name of elector8_3
- Full residential address street numbernamecity8_3
- Postal code8_3
- Elector signature8_3
- Witness initials8_3
- Internal use only8_3
- Printed name of elector9_3
- Full residential address street numbernamecity9_3
- Postal code9_3
- Elector signature9_3
- Witness initials9_3
- Internal use only9_3
- Printed name of elector10_3
- Full residential address street numbernamecity10_3
- Postal code10_3
- Elector signature10_3
- Witness initials10_3
- Internal use only10_3
- Printed name of elector1_4
- Full residential address street numbernamecity1_4
- Postal code1_4
- Elector signature1_4
- Witness initials1_4
- Internal use only1_4
- Printed name of elector2_4
- Full residential address street numbernamecity2_4
- Postal code2_4
- Elector signature2_4
- Witness initials2_4
- Internal use only2_4
- Printed name of elector3_4
- Full residential address street numbernamecity3_4
- Postal code3_4
- Elector signature3_4
- Witness initials3_4
- Internal use only3_4
- Printed name of elector4_4
- Full residential address street numbernamecity4_4
- Postal code4_4
- Elector signature4_4
- Witness initials4_4
- Internal use only4_4
- Printed name of elector5_4
- Full residential address street numbernamecity5_4
- Postal code5_4
- Elector signature5_4
- Witness initials5_4
- Internal use only5_4
- Printed name of elector6_4
- Full residential address street numbernamecity6_4
- Postal code6_4
- Elector signature6_4
- Witness initials6_4
- Internal use only6_4
- Printed name of elector7_4
- Full residential address street numbernamecity7_4
- Postal code7_4
- Elector signature7_4
- Witness initials7_4
- Internal use only7_4
- Printed name of elector8_4
- Full residential address street numbernamecity8_4
- Postal code8_4
- Elector signature8_4
- Witness initials8_4
- Internal use only8_4
- Printed name of elector9_4
- Full residential address street numbernamecity9_4
- Postal code9_4
- Elector signature9_4
- Witness initials9_4
- Internal use only9_4
- Printed name of elector10_4
- Full residential address street numbernamecity10_4
- Postal code10_4
- Elector signature10_4
- Witness initials10_4
- Internal use only10_4
- Printed name of elector1_5
- Full residential address street numbernamecity1_5
- Postal code1_5
- Elector signature1_5
- Witness initials1_5
- Internal use only1_5
- Printed name of elector2_5
- Full residential address street numbernamecity2_5
- Postal code2_5
- Elector signature2_5
- Witness initials2_5
- Internal use only2_5
- Printed name of elector3_5
- Full residential address street numbernamecity3_5
- Postal code3_5
- Elector signature3_5
- Witness initials3_5
- Internal use only3_5
- Printed name of elector4_5
- Full residential address street numbernamecity4_5
- Postal code4_5
- Elector signature4_5
- Witness initials4_5
- Internal use only4_5
- Printed name of elector5_5
- Full residential address street numbernamecity5_5
- Postal code5_5
- Elector signature5_5
- Witness initials5_5
- Internal use only5_5
- Printed name of elector6_5
- Full residential address street numbernamecity6_5
- Postal code6_5
- Elector signature6_5
- Witness initials6_5
- Internal use only6_5
- Printed name of elector7_5
- Full residential address street numbernamecity7_5
- Postal code7_5
- Elector signature7_5
- Witness initials7_5
- Internal use only7_5
- Printed name of elector8_5
- Full residential address street numbernamecity8_5
- Postal code8_5
- Elector signature8_5
- Witness initials8_5
- Internal use only8_5
- Printed name of elector9_5
- Full residential address street numbernamecity9_5
- Postal code9_5
- Elector signature9_5
- Witness initials9_5
- Internal use only9_5
- Printed name of elector10_5
- Full residential address street numbernamecity10_5
- Postal code10_5
- Elector signature10_5
- Witness initials10_5
- Internal use only10_5
- Printed name of elector1_6
- Full residential address street numbernamecity1_6
- Postal code1_6
- Elector signature1_6
- Witness initials1_6
- Internal use only1_6
- Printed name of elector2_6
- Full residential address street numbernamecity2_6
- Postal code2_6
- Elector signature2_6
- Witness initials2_6
- Internal use only2_6
- Printed name of elector3_6
- Full residential address street numbernamecity3_6
- Postal code3_6
- Elector signature3_6
- Witness initials3_6
- Internal use only3_6
- Printed name of elector4_6
- Full residential address street numbernamecity4_6
- Postal code4_6
- Elector signature4_6
- Witness initials4_6
- Internal use only4_6
- Printed name of elector5_6
- Full residential address street numbernamecity5_6
- Postal code5_6
- Elector signature5_6
- Witness initials5_6
- Internal use only5_6
- Printed name of elector6_6
- Full residential address street numbernamecity6_6
- Postal code6_6
- Elector signature6_6
- Witness initials6_6
- Internal use only6_6
- Printed name of elector7_6
- Full residential address street numbernamecity7_6
- Postal code7_6
- Elector signature7_6
- Witness initials7_6
- Internal use only7_6
- Printed name of elector8_6
- Full residential address street numbernamecity8_6
- Postal code8_6
- Elector signature8_6
- Witness initials8_6
- Internal use only8_6
- Printed name of elector9_6
- Full residential address street numbernamecity9_6
- Postal code9_6
- Elector signature9_6
- Witness initials9_6
- Internal use only9_6
- Printed name of elector10_6
- Full residential address street numbernamecity10_6
- Postal code10_6
- Elector signature10_6
- Witness initials10_6
- Internal use only10_6
- Printed name of elector1_7
- Full residential address street numbernamecity1_7
- Postal code1_7
- Elector signature1_7
- Witness initials1_7
- Internal use only1_7
- Printed name of elector2_7
- Full residential address street numbernamecity2_7
- Postal code2_7
- Elector signature2_7
- Witness initials2_7
- Internal use only2_7
- Printed name of elector3_7
- Full residential address street numbernamecity3_7
- Postal code3_7
- Elector signature3_7
- Witness initials3_7
- Internal use only3_7
- Printed name of elector4_7
- Full residential address street numbernamecity4_7
- Postal code4_7
- Elector signature4_7
- Witness initials4_7
- Internal use only4_7
- Printed name of elector5_7
- Full residential address street numbernamecity5_7
- Postal code5_7
- Elector signature5_7
- Witness initials5_7
- Internal use only5_7
- Printed name of elector6_7
- Full residential address street numbernamecity6_7
- Postal code6_7
- Elector signature6_7
- Witness initials6_7
- Internal use only6_7
- Printed name of elector7_7
- Full residential address street numbernamecity7_7
- Postal code7_7
- Elector signature7_7
- Witness initials7_7
- Internal use only7_7
- Printed name of elector8_7
- Full residential address street numbernamecity8_7
- Postal code8_7
- Elector signature8_7
- Witness initials8_7
- Internal use only8_7
- Printed name of elector9_7
- Full residential address street numbernamecity9_7
- Postal code9_7
- Elector signature9_7
- Witness initials9_7
- Internal use only9_7
- Printed name of elector10_7
- Full residential address street numbernamecity10_7
- Postal code10_7
- Elector signature10_7
- Witness initials10_7
- Internal use only10_7
- Printed name of elector1_8
- Full residential address street numbernamecity1_8
- Postal code1_8
- Elector signature1_8
- Witness initials1_8
- Internal use only1_8
- Printed name of elector2_8
- Full residential address street numbernamecity2_8
- Postal code2_8
- Elector signature2_8
- Witness initials2_8
- Internal use only2_8
- Printed name of elector3_8
- Full residential address street numbernamecity3_8
- Postal code3_8
- Elector signature3_8
- Witness initials3_8
- Internal use only3_8
- Printed name of elector4_8
- Full residential address street numbernamecity4_8
- Postal code4_8
- Elector signature4_8
- Witness initials4_8
- Internal use only4_8
- Printed name of elector5_8
- Full residential address street numbernamecity5_8
- Postal code5_8
- Elector signature5_8
- Witness initials5_8
- Internal use only5_8
- Printed name of elector6_8
- Full residential address street numbernamecity6_8
- Postal code6_8
- Elector signature6_8
- Witness initials6_8
- Internal use only6_8
- Printed name of elector7_8
- Full residential address street numbernamecity7_8
- Postal code7_8
- Elector signature7_8
- Witness initials7_8
- Internal use only7_8
- Printed name of elector8_8
- Full residential address street numbernamecity8_8
- Postal code8_8
- Elector signature8_8
- Witness initials8_8
- Internal use only8_8
- Printed name of elector9_8
- Full residential address street numbernamecity9_8
- Postal code9_8
- Elector signature9_8
- Witness initials9_8
- Internal use only9_8
- Printed name of elector10_8
- Full residential address street numbernamecity10_8
- Postal code10_8
- Elector signature10_8
- Witness initials10_8
- Internal use only10_8
- Printed name of elector1_9
- Full residential address street numbernamecity1_9
- Postal code1_9
- Elector signature1_9
- Witness initials1_9
- Internal use only1_9
- Printed name of elector2_9
- Full residential address street numbernamecity2_9
- Postal code2_9
- Elector signature2_9
- Witness initials2_9
- Internal use only2_9
- Printed name of elector3_9
- Full residential address street numbernamecity3_9
- Postal code3_9
- Elector signature3_9
- Witness initials3_9
- Internal use only3_9
- Printed name of elector4_9
- Full residential address street numbernamecity4_9
- Postal code4_9
- Elector signature4_9
- Witness initials4_9
- Internal use only4_9
- Printed name of elector5_9
- Full residential address street numbernamecity5_9
- Postal code5_9
- Elector signature5_9
- Witness initials5_9
- Internal use only5_9
- Printed name of elector6_9
- Full residential address street numbernamecity6_9
- Postal code6_9
- Elector signature6_9
- Witness initials6_9
- Internal use only6_9
- Printed name of elector7_9
- Full residential address street numbernamecity7_9
- Postal code7_9
- Elector signature7_9
- Witness initials7_9
- Internal use only7_9
- Printed name of elector8_9
- Full residential address street numbernamecity8_9
- Postal code8_9
- Elector signature8_9
- Witness initials8_9
- Internal use only8_9
- Printed name of elector9_9
- Full residential address street numbernamecity9_9
- Postal code9_9
- Elector signature9_9
- Witness initials9_9
- Internal use only9_9
- Printed name of elector10_9
- Full residential address street numbernamecity10_9
- Postal code10_9
- Elector signature10_9
- Witness initials10_9
- Internal use only10_9
- Printed name of elector1_10
- Full residential address street numbernamecity1_10
- Postal code1_10
- Elector signature1_10
- Witness initials1_10
- Internal use only1_10
- Printed name of elector2_10
- Full residential address street numbernamecity2_10
- Postal code2_10
- Elector signature2_10
- Witness initials2_10
- Internal use only2_10
- Printed name of elector3_10
- Full residential address street numbernamecity3_10
- Postal code3_10
- Elector signature3_10
- Witness initials3_10
- Internal use only3_10
- Printed name of elector4_10
- Full residential address street numbernamecity4_10
- Postal code4_10
- Elector signature4_10
- Witness initials4_10
- Internal use only4_10
- Printed name of elector5_10
- Full residential address street numbernamecity5_10
- Postal code5_10
- Elector signature5_10
- Witness initials5_10
- Internal use only5_10
- Printed name of elector6_10
- Full residential address street numbernamecity6_10
- Postal code6_10
- Elector signature6_10
- Witness initials6_10
- Internal use only6_10
- Printed name of elector7_10
- Full residential address street numbernamecity7_10
- Postal code7_10
- Elector signature7_10
- Witness initials7_10
- Internal use only7_10
- Printed name of elector8_10
- Full residential address street numbernamecity8_10
- Postal code8_10
- Elector signature8_10
- Witness initials8_10
- Internal use only8_10
- Printed name of elector9_10
- Full residential address street numbernamecity9_10
- Postal code9_10
- Elector signature9_10
- Witness initials9_10
- Internal use only9_10
- Printed name of elector10_10
- Full residential address street numbernamecity10_10
- Postal code10_10
- Elector signature10_10
- Witness initials10_10
- Internal use only10_10
- Printed name of elector1_11
- Full residential address street numbernamecity1_11
- Postal code1_11
- Elector signature1_11
- Witness initials1_11
- Internal use only1_11
- Printed name of elector2_11
- Full residential address street numbernamecity2_11
- Postal code2_11
- Elector signature2_11
- Witness initials2_11
- Internal use only2_11
- Printed name of elector3_11
- Full residential address street numbernamecity3_11
- Postal code3_11
- Elector signature3_11
- Witness initials3_11
- Internal use only3_11
- Printed name of elector4_11
- Full residential address street numbernamecity4_11
- Postal code4_11
- Elector signature4_11
- Witness initials4_11
- Internal use only4_11
- Printed name of elector5_11
- Full residential address street numbernamecity5_11
- Postal code5_11
- Elector signature5_11
- Witness initials5_11
- Internal use only5_11
- Printed name of elector6_11
- Full residential address street numbernamecity6_11
- Postal code6_11
- Elector signature6_11
- Witness initials6_11
- Internal use only6_11
- Printed name of elector7_11
- Full residential address street numbernamecity7_11
- Postal code7_11
- Elector signature7_11
- Witness initials7_11
- Internal use only7_11
- Printed name of elector8_11
- Full residential address street numbernamecity8_11
- Postal code8_11
- Elector signature8_11
- Witness initials8_11
- Internal use only8_11
- Printed name of elector9_11
- Full residential address street numbernamecity9_11
- Postal code9_11
- Elector signature9_11
- Witness initials9_11
- Internal use only9_11
- Printed name of elector10_11
- Full residential address street numbernamecity10_11
- Postal code10_11
- Elector signature10_11
- Witness initials10_11
- Internal use only10_11
- Printed name of elector1_12
- Full residential address street numbernamecity1_12
- Postal code1_12
- Elector signature1_12
- Witness initials1_12
- Internal use only1_12
- Printed name of elector2_12
- Full residential address street numbernamecity2_12
- Postal code2_12
- Elector signature2_12
- Witness initials2_12
- Internal use only2_12
- Printed name of elector3_12
- Full residential address street numbernamecity3_12
- Postal code3_12
- Elector signature3_12
- Witness initials3_12
- Internal use only3_12
- Printed name of elector4_12
- Full residential address street numbernamecity4_12
- Postal code4_12
- Elector signature4_12
- Witness initials4_12
- Internal use only4_12
- Printed name of elector5_12
- Full residential address street numbernamecity5_12
- Postal code5_12
- Elector signature5_12
- Witness initials5_12
- Internal use only5_12
- Printed name of elector6_12
- Full residential address street numbernamecity6_12
- Postal code6_12
- Elector signature6_12
- Witness initials6_12
- Internal use only6_12
- Printed name of elector7_12
- Full residential address street numbernamecity7_12
- Postal code7_12
- Elector signature7_12
- Witness initials7_12
- Internal use only7_12
- Printed name of elector8_12
- Full residential address street numbernamecity8_12
- Postal code8_12
- Elector signature8_12
- Witness initials8_12
- Internal use only8_12
- Printed name of elector9_12
- Full residential address street numbernamecity9_12
- Postal code9_12
- Elector signature9_12
- Witness initials9_12
- Internal use only9_12
- Printed name of elector10_12
- Full residential address street numbernamecity10_12
- Postal code10_12
- Elector signature10_12
- Witness initials10_12
- Internal use only10_12
- Printed name of elector1_13
- Full residential address street numbernamecity1_13
- Postal code1_13
- Elector signature1_13
- Witness initials1_13
- Internal use only1_13
- Printed name of elector2_13
- Full residential address street numbernamecity2_13
- Postal code2_13
- Elector signature2_13
- Witness initials2_13
- Internal use only2_13
- Printed name of elector3_13
- Full residential address street numbernamecity3_13
- Postal code3_13
- Elector signature3_13
- Witness initials3_13
- Internal use only3_13
- Printed name of elector4_13
- Full residential address street numbernamecity4_13
- Postal code4_13
- Elector signature4_13
- Witness initials4_13
- Internal use only4_13
- Printed name of elector5_13
- Full residential address street numbernamecity5_13
- Postal code5_13
- Elector signature5_13
- Witness initials5_13
- Internal use only5_13
- Printed name of elector6_13
- Full residential address street numbernamecity6_13
- Postal code6_13
- Elector signature6_13
- Witness initials6_13
- Internal use only6_13
- Printed name of elector7_13
- Full residential address street numbernamecity7_13
- Postal code7_13
- Elector signature7_13
- Witness initials7_13
- Internal use only7_13
- Printed name of elector8_13
- Full residential address street numbernamecity8_13
- Postal code8_13
- Elector signature8_13
- Witness initials8_13
- Internal use only8_13
- Printed name of elector9_13
- Full residential address street numbernamecity9_13
- Postal code9_13
- Elector signature9_13
- Witness initials9_13
- Internal use only9_13
- Printed name of elector10_13
- Full residential address street numbernamecity10_13
- Postal code10_13
- Elector signature10_13
- Witness initials10_13
- Internal use only10_13
- Printed name of elector1_14
- Full residential address street numbernamecity1_14
- Postal code1_14
- Elector signature1_14
- Witness initials1_14
- Internal use only1_14
- Printed name of elector2_14
- Full residential address street numbernamecity2_14
- Postal code2_14
- Elector signature2_14
- Witness initials2_14
- Internal use only2_14
- Printed name of elector3_14
- Full residential address street numbernamecity3_14
- Postal code3_14
- Elector signature3_14
- Witness initials3_14
- Internal use only3_14
- Printed name of elector4_14
- Full residential address street numbernamecity4_14
- Postal code4_14
- Elector signature4_14
- Witness initials4_14
- Internal use only4_14
- Printed name of elector5_14
- Full residential address street numbernamecity5_14
- Postal code5_14
- Elector signature5_14
- Witness initials5_14
- Internal use only5_14
- Printed name of elector6_14
- Full residential address street numbernamecity6_14
- Postal code6_14
- Elector signature6_14
- Witness initials6_14
- Internal use only6_14
- Printed name of elector7_14
- Full residential address street numbernamecity7_14
- Postal code7_14
- Elector signature7_14
- Witness initials7_14
- Internal use only7_14
- Printed name of elector8_14
- Full residential address street numbernamecity8_14
- Postal code8_14
- Elector signature8_14
- Witness initials8_14
- Internal use only8_14
- Printed name of elector9_14
- Full residential address street numbernamecity9_14
- Postal code9_14
- Elector signature9_14
- Witness initials9_14
- Internal use only9_14
- Printed name of elector10_14
- Full residential address street numbernamecity10_14
- Postal code10_14
- Elector signature10_14
- Witness initials10_14
- Internal use only10_14
- Printed name of elector1_15
- Full residential address street numbernamecity1_15
- Postal code1_15
- Elector signature1_15
- Witness initials1_15
- Internal use only1_15
- Printed name of elector2_15
- Full residential address street numbernamecity2_15
- Postal code2_15
- Elector signature2_15
- Witness initials2_15
- Internal use only2_15
- Printed name of elector3_15
- Full residential address street numbernamecity3_15
- Postal code3_15
- Elector signature3_15
- Witness initials3_15
- Internal use only3_15
- Printed name of elector4_15
- Full residential address street numbernamecity4_15
- Postal code4_15
- Elector signature4_15
- Witness initials4_15
- Internal use only4_15
- Printed name of elector5_15
- Full residential address street numbernamecity5_15
- Postal code5_15
- Elector signature5_15
- Witness initials5_15
- Internal use only5_15
- Printed name of elector6_15
- Full residential address street numbernamecity6_15
- Postal code6_15
- Elector signature6_15
- Witness initials6_15
- Internal use only6_15
- Printed name of elector7_15
- Full residential address street numbernamecity7_15
- Postal code7_15
- Elector signature7_15
- Witness initials7_15
- Internal use only7_15
- Printed name of elector8_15
- Full residential address street numbernamecity8_15
- Postal code8_15
- Elector signature8_15
- Witness initials8_15
- Internal use only8_15
- Printed name of elector9_15
- Full residential address street numbernamecity9_15
- Postal code9_15
- Elector signature9_15
- Witness initials9_15
- Internal use only9_15
- Printed name of elector10_15
- Full residential address street numbernamecity10_15
- Postal code10_15
- Elector signature10_15
- Witness initials10_15
- Internal use only10_15
- Printed name of elector1_16
- Full residential address street numbernamecity1_16
- Postal code1_16
- Elector signature1_16
- Witness initials1_16
- Internal use only1_16
- Printed name of elector2_16
- Full residential address street numbernamecity2_16
- Postal code2_16
- Elector signature2_16
- Witness initials2_16
- Internal use only2_16
- Printed name of elector3_16
- Full residential address street numbernamecity3_16
- Postal code3_16
- Elector signature3_16
- Witness initials3_16
- Internal use only3_16
- Printed name of elector4_16
- Full residential address street numbernamecity4_16
- Postal code4_16
- Elector signature4_16
- Witness initials4_16
- Internal use only4_16
- Printed name of elector5_16
- Full residential address street numbernamecity5_16
- Postal code5_16
- Elector signature5_16
- Witness initials5_16
- Internal use only5_16
- Printed name of elector6_16
- Full residential address street numbernamecity6_16
- Postal code6_16
- Elector signature6_16
- Witness initials6_16
- Internal use only6_16
- Printed name of elector7_16
- Full residential address street numbernamecity7_16
- Postal code7_16
- Elector signature7_16
- Witness initials7_16
- Internal use only7_16
- Printed name of elector8_16
- Full residential address street numbernamecity8_16
- Postal code8_16
- Elector signature8_16
- Witness initials8_16
- Internal use only8_16
- Printed name of elector9_16
- Full residential address street numbernamecity9_16
- Postal code9_16
- Elector signature9_16
- Witness initials9_16
- Internal use only9_16
- Printed name of elector10_16
- Full residential address street numbernamecity10_16
- Postal code10_16
- Elector signature10_16
- Witness initials10_16
- Internal use only10_16
- Have you completed the Nomination Paper EC 20010 Off
- Do you have authorized proof of identify Off
- Are you endorsed by a political party Off
- Have you made a nomination appointment Off
- Last name - Candidate Name
- First name - Candidate Name
- Name of electoral district- Candidate Information
- First name - Candidate Information
- Last name - Candidate Information
- Ballot Name Off
- Ballot First name(s)
- Ballot Last name(s)
- Gender -Candidate information
- Date of birth (YYY-MM-DD) - Gender -Candidate information
- language of correspondence - Candidate information Off
- Email -Contact information
- Primary phone number - Contact information
- Ext - Primary phone number
- Alternate phone number - Contact information
- Ext - Alternate phone number
- Fax number- Alternate phone number
- Unit -Residential address
- Street -Residential address
- Street name -Residential address
- City -Residential address
- ProvinceTerritory -Residential address
- Postal code - -Residential address
- Mailing address - same as residential address Off
- Occupation- Candidate occupation
- Sharing of information with the Conflict of Interest and Ethics Commissioner and the House of Commons including the Library of Parliament Off
- where applicable if the returning officer is unable to verify that I have been endorsed by the political party identified in section A of this Nomination Paper I wish to Off
- Date of Signature (YYYY-MM-DD) - Candidate signature
- Date of Signature (YYYY-MM-DD) -Signature of person receiving the solemn declaration
- Campaign delegate information
- First name - Campaign delegate information
- Last name - Campaign delegate information
- Language of correspondence - Campaign delegate information Off
- Email - Contact information -Campaign Delegate
- Primary phone number - Contact information -Campaign Delegate
- Primary phone number EXT - Contact information -Campaign Delegate
- Alternate phone number - Contact information -Campaign Delegate
- Alternate phone number EXT - Contact information -Campaign Delegate
- Fax nmuber- Contact information -Campaign Delegate
- Street - Residential address -Campaign delegate
- Street name - Residential address -Campaign delegate
- City - Residential address -Campaign delegate
- ProvinceTerritory - Residential address -Campaign delegate
- Postal Code - Residential address -Campaign delegate
- Campaign delegate - Mailing address ndash Same as residential address Off
- Unit - Residential address -Campaign delegate
- Date (YYYY-MM-DD) - Candidate authorization Signature
- Date (YYYY-MM-DD) - Candidate campaign Signature
- First name - Official agent information
- Last name - Official agent information
- Language of correspondence - Official agent information Off
- Email - Official agent information
- Primary phone number - Official agent information
- Primary phone number EXT - Official agent information
- Alternate phone number EXT - Official agent information
- Alternate phone number - Official agent information
- Fax number - Official agent information
- Unit -Residential address - Official Agent
- Street name -Residential address - Official Agent
- City -Residential address - Official Agent
- Street -Residential address - Official Agent
- ProvinceTerritory -Residential address - Official Agent
- Postal code-Residential address - Official Agent
- Mailing address ndash Same as residential address- Official Agent Off
- Date (YYYY-MM-DD) - Official agent signature
- First name - Auditor information
- Last name - Auditor information
- Language of correspondence - Auditor information Off
- Email - Auditor information
- Primary phone number - Auditor information
- Primary phone number EXT- Auditor information
- Alternate phone number - Auditor information
- Alternate phone number EXT- Auditor information
- Fax number - Auditor information
- Name of firm- Auditor organizational information
- Occupation of auditor - Auditor organizational information
- Professional designation - Auditor organizational information Off
- Designation registration number
- Make cheque payable to
- Unit - Address (where cheque is sent)
- Street - Address (where cheque is sent)
- Street name - Address (where cheque is sent)
- City - Address (where cheque is sent)
- ProvinceTerritory - Address (where cheque is sent)
- Postal code - Address (where cheque is sent)
- Date (YYY-MM-DD) - Auditor signature
- Unit - Campaign office address (optional)
- Street - Campaign office address (optional)
- Street name - Campaign office address (optional)
- City - Campaign office address (optional)
- ProvinceTerritory- Campaign office address (optional)
- Postal code - Campaign office address (optional)
- Name of witness
- Full address of witness
- Name of candidate
- Electoral district
- Year
- Name of candidate2
- Electoral district2
- Year2
- Name of witness2
- Full address of witness2
- Name of candidate3
- Electoral district3
- Year3
- Full address of witness3
- Name of witness3
- Name of candidate 4
- Electoral district4
- Year4
- Full address of witness 4
- Name of witness 4
- Name of candidate5
- Electoral district5
- Year5
- Full address of witness5
- Name of witness5
- Name of candidate6
- Electoral district6
- Year6
- Name of witness6
- Full address of witness6
- Name of candidate7
- Electoral district7
- Year7
- Full address of witness7
- Name of witness7
- Name of candidate8
- Electoral district8
- Year8
- Full address of witness8
- Name of witness8
- Name of candidate9
- Electoral district9
- Year9
- Full address of witness 9
- Name of witness 9
- Name of candidate10
- Electoral district10
- Year10
- Full address of witness10
- Name of witness10
- Name of candidate11
- Electoral district11
- Year11
- Full address of witness11
- Name of witness11
- Name of candidate12
- Electoral district12
- Year12
- Full address of witness12
- Name of witness12
- Name of candidate13
- Electoral district13
- Year13
- Full address of witness13
- Name of witness13
- Name of candidate14
- Electoral district14
- Year14
- Name of witness14
- Full address of witness14
- Name of candidate1
- Electoral district1
- Year1
- Name of witness1
- Full address of witness1
- Name of candidate15
- Electoral district15
- Year15
- Name of witness15
- Full address of witness15
- unit -Mailing address
- Street -Mailing address
- Street name -Mailing address
- City -Mailing address
- ProvinceTerritory -Mailing address
- Postal code -Mailing address
- Unit - Mailing address -Campaign delegate
- Street - Mailing address -Campaign delegate
- Street name - Mailing address -Campaign delegate
- City - Mailing address -Campaign delegate
- ProvinceTerritory- Mailing address -Campaign delegate
- Postal code- Mailing address -Campaign delegate
- Unit -Mailing address - Official Agent
- Street -Mailing address - Official Agent
- Street name -Mailing address - Official Agent
- city -Mailing address - Official Agent
- ProvinceTerritory-Mailing address - Official Agent
- Postal code-Mailing address - Official Agent
11BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
19
12BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
20
13BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
21
14BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
22
15BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
23
16BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
24
17BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
25
18BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
26
19BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
27
20BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
28
21BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
29
22BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
30
EC 20010 (022019)
SECTION G ndash 23B Are You Ready to Submit Your Nomination
Have you completed the Nomination Paper (EC 20010)
bull Are all mandatory fields in sections AndashE complete
bull Have you collected the required number of signatures from qualified electors in section F
o For most electoral districts 100 electors must consent to your candidacy
o For electoral districts identified in Schedule 3 only 50 electors are required
o To ensure a smooth nomination process Elections Canada recommends collecting signatures from at least 150 electors
Do you have authorized proof of identify
bull For a list of authorized identification visit the Elections Canada website
bull If a campaign delegate is submitting on your behalf they must bring a copy of your identification documents signed by you
bull If you want an alternative name to appear on the ballot additional documentation is required visit electionsca for details
Are you endorsed by a political party
bull Make sure your party has submitted the required documentation to Elections Canada attesting your designated political affiliation
Have you made a nomination appointment
bull To facilitate the nomination process make an appointment with the returning officer to finalize the filing of the complete nomination package
bull The nomination period closes 21 days before election day at 200 pm local time
31
- Nomination Paperof a Candidate at a Federal General Election or By-election
- Table of Contents
- General Information
- SECTION A ndash Candidate Information (Mandatory)
- SECTION B ndash Campaign Delegate (Optional)
- SECTION C ndash Official Agent (Mandatory)
- SECTION D ndash Auditor (Optional)
- SECTION E ndash Campaign Office (Optional)
- SECTION F ndash Electors Consenting to Candidacy (Mandatory)
-
- Name of electoral district
- Political affiliation
- Telephone number to be posted on electionsca
- Website to be posted on electionsca including prefix http https
- Printed name of elector1
- Full residential address street numbernamecity1
- Postal code1
- Elector signature1
- Witness initials1
- Internal use only1
- Printed name of elector2
- Full residential address street numbernamecity2
- Postal code2
- Elector signature2
- Witness initials2
- Internal use only2
- Printed name of elector3
- Full residential address street numbernamecity3
- Postal code3
- Elector signature3
- Witness initials3
- Internal use only3
- Printed name of elector4
- Full residential address street numbernamecity4
- Postal code4
- Elector signature4
- Witness initials4
- Internal use only4
- Printed name of elector5
- Full residential address street numbernamecity5
- Postal code5
- Elector signature5
- Witness initials5
- Internal use only5
- Printed name of elector6
- Full residential address street numbernamecity6
- Postal code6
- Elector signature6
- Witness initials6
- Internal use only6
- Printed name of elector7
- Full residential address street numbernamecity7
- Postal code7
- Elector signature7
- Witness initials7
- Internal use only7
- Printed name of elector8
- Full residential address street numbernamecity8
- Postal code8
- Elector signature8
- Witness initials8
- Internal use only8
- Printed name of elector9
- Full residential address street numbernamecity9
- Postal code9
- Elector signature9
- Witness initials9
- Internal use only9
- Printed name of elector10
- Full residential address street numbernamecity10
- Postal code10
- Elector signature10
- Witness initials10
- Internal use only10
- Printed name of elector1_2
- Full residential address street numbernamecity1_2
- Postal code1_2
- Elector signature1_2
- Witness initials1_2
- Internal use only1_2
- Printed name of elector2_2
- Full residential address street numbernamecity2_2
- Postal code2_2
- Elector signature2_2
- Witness initials2_2
- Internal use only2_2
- Printed name of elector3_2
- Full residential address street numbernamecity3_2
- Postal code3_2
- Elector signature3_2
- Witness initials3_2
- Internal use only3_2
- Printed name of elector4_2
- Full residential address street numbernamecity4_2
- Postal code4_2
- Elector signature4_2
- Witness initials4_2
- Internal use only4_2
- Printed name of elector5_2
- Full residential address street numbernamecity5_2
- Postal code5_2
- Elector signature5_2
- Witness initials5_2
- Internal use only5_2
- Printed name of elector6_2
- Full residential address street numbernamecity6_2
- Postal code6_2
- Elector signature6_2
- Witness initials6_2
- Internal use only6_2
- Printed name of elector7_2
- Full residential address street numbernamecity7_2
- Postal code7_2
- Elector signature7_2
- Witness initials7_2
- Internal use only7_2
- Printed name of elector8_2
- Full residential address street numbernamecity8_2
- Postal code8_2
- Elector signature8_2
- Witness initials8_2
- Internal use only8_2
- Printed name of elector9_2
- Full residential address street numbernamecity9_2
- Postal code9_2
- Elector signature9_2
- Witness initials9_2
- Internal use only9_2
- Printed name of elector10_2
- Full residential address street numbernamecity10_2
- Postal code10_2
- Elector signature10_2
- Witness initials10_2
- Internal use only10_2
- Printed name of elector1_3
- Full residential address street numbernamecity1_3
- Postal code1_3
- Elector signature1_3
- Witness initials1_3
- Internal use only1_3
- Printed name of elector2_3
- Full residential address street numbernamecity2_3
- Postal code2_3
- Elector signature2_3
- Witness initials2_3
- Internal use only2_3
- Printed name of elector3_3
- Full residential address street numbernamecity3_3
- Postal code3_3
- Elector signature3_3
- Witness initials3_3
- Internal use only3_3
- Printed name of elector4_3
- Full residential address street numbernamecity4_3
- Postal code4_3
- Elector signature4_3
- Witness initials4_3
- Internal use only4_3
- Printed name of elector5_3
- Full residential address street numbernamecity5_3
- Postal code5_3
- Elector signature5_3
- Witness initials5_3
- Internal use only5_3
- Printed name of elector6_3
- Full residential address street numbernamecity6_3
- Postal code6_3
- Elector signature6_3
- Witness initials6_3
- Internal use only6_3
- Printed name of elector7_3
- Full residential address street numbernamecity7_3
- Postal code7_3
- Elector signature7_3
- Witness initials7_3
- Internal use only7_3
- Printed name of elector8_3
- Full residential address street numbernamecity8_3
- Postal code8_3
- Elector signature8_3
- Witness initials8_3
- Internal use only8_3
- Printed name of elector9_3
- Full residential address street numbernamecity9_3
- Postal code9_3
- Elector signature9_3
- Witness initials9_3
- Internal use only9_3
- Printed name of elector10_3
- Full residential address street numbernamecity10_3
- Postal code10_3
- Elector signature10_3
- Witness initials10_3
- Internal use only10_3
- Printed name of elector1_4
- Full residential address street numbernamecity1_4
- Postal code1_4
- Elector signature1_4
- Witness initials1_4
- Internal use only1_4
- Printed name of elector2_4
- Full residential address street numbernamecity2_4
- Postal code2_4
- Elector signature2_4
- Witness initials2_4
- Internal use only2_4
- Printed name of elector3_4
- Full residential address street numbernamecity3_4
- Postal code3_4
- Elector signature3_4
- Witness initials3_4
- Internal use only3_4
- Printed name of elector4_4
- Full residential address street numbernamecity4_4
- Postal code4_4
- Elector signature4_4
- Witness initials4_4
- Internal use only4_4
- Printed name of elector5_4
- Full residential address street numbernamecity5_4
- Postal code5_4
- Elector signature5_4
- Witness initials5_4
- Internal use only5_4
- Printed name of elector6_4
- Full residential address street numbernamecity6_4
- Postal code6_4
- Elector signature6_4
- Witness initials6_4
- Internal use only6_4
- Printed name of elector7_4
- Full residential address street numbernamecity7_4
- Postal code7_4
- Elector signature7_4
- Witness initials7_4
- Internal use only7_4
- Printed name of elector8_4
- Full residential address street numbernamecity8_4
- Postal code8_4
- Elector signature8_4
- Witness initials8_4
- Internal use only8_4
- Printed name of elector9_4
- Full residential address street numbernamecity9_4
- Postal code9_4
- Elector signature9_4
- Witness initials9_4
- Internal use only9_4
- Printed name of elector10_4
- Full residential address street numbernamecity10_4
- Postal code10_4
- Elector signature10_4
- Witness initials10_4
- Internal use only10_4
- Printed name of elector1_5
- Full residential address street numbernamecity1_5
- Postal code1_5
- Elector signature1_5
- Witness initials1_5
- Internal use only1_5
- Printed name of elector2_5
- Full residential address street numbernamecity2_5
- Postal code2_5
- Elector signature2_5
- Witness initials2_5
- Internal use only2_5
- Printed name of elector3_5
- Full residential address street numbernamecity3_5
- Postal code3_5
- Elector signature3_5
- Witness initials3_5
- Internal use only3_5
- Printed name of elector4_5
- Full residential address street numbernamecity4_5
- Postal code4_5
- Elector signature4_5
- Witness initials4_5
- Internal use only4_5
- Printed name of elector5_5
- Full residential address street numbernamecity5_5
- Postal code5_5
- Elector signature5_5
- Witness initials5_5
- Internal use only5_5
- Printed name of elector6_5
- Full residential address street numbernamecity6_5
- Postal code6_5
- Elector signature6_5
- Witness initials6_5
- Internal use only6_5
- Printed name of elector7_5
- Full residential address street numbernamecity7_5
- Postal code7_5
- Elector signature7_5
- Witness initials7_5
- Internal use only7_5
- Printed name of elector8_5
- Full residential address street numbernamecity8_5
- Postal code8_5
- Elector signature8_5
- Witness initials8_5
- Internal use only8_5
- Printed name of elector9_5
- Full residential address street numbernamecity9_5
- Postal code9_5
- Elector signature9_5
- Witness initials9_5
- Internal use only9_5
- Printed name of elector10_5
- Full residential address street numbernamecity10_5
- Postal code10_5
- Elector signature10_5
- Witness initials10_5
- Internal use only10_5
- Printed name of elector1_6
- Full residential address street numbernamecity1_6
- Postal code1_6
- Elector signature1_6
- Witness initials1_6
- Internal use only1_6
- Printed name of elector2_6
- Full residential address street numbernamecity2_6
- Postal code2_6
- Elector signature2_6
- Witness initials2_6
- Internal use only2_6
- Printed name of elector3_6
- Full residential address street numbernamecity3_6
- Postal code3_6
- Elector signature3_6
- Witness initials3_6
- Internal use only3_6
- Printed name of elector4_6
- Full residential address street numbernamecity4_6
- Postal code4_6
- Elector signature4_6
- Witness initials4_6
- Internal use only4_6
- Printed name of elector5_6
- Full residential address street numbernamecity5_6
- Postal code5_6
- Elector signature5_6
- Witness initials5_6
- Internal use only5_6
- Printed name of elector6_6
- Full residential address street numbernamecity6_6
- Postal code6_6
- Elector signature6_6
- Witness initials6_6
- Internal use only6_6
- Printed name of elector7_6
- Full residential address street numbernamecity7_6
- Postal code7_6
- Elector signature7_6
- Witness initials7_6
- Internal use only7_6
- Printed name of elector8_6
- Full residential address street numbernamecity8_6
- Postal code8_6
- Elector signature8_6
- Witness initials8_6
- Internal use only8_6
- Printed name of elector9_6
- Full residential address street numbernamecity9_6
- Postal code9_6
- Elector signature9_6
- Witness initials9_6
- Internal use only9_6
- Printed name of elector10_6
- Full residential address street numbernamecity10_6
- Postal code10_6
- Elector signature10_6
- Witness initials10_6
- Internal use only10_6
- Printed name of elector1_7
- Full residential address street numbernamecity1_7
- Postal code1_7
- Elector signature1_7
- Witness initials1_7
- Internal use only1_7
- Printed name of elector2_7
- Full residential address street numbernamecity2_7
- Postal code2_7
- Elector signature2_7
- Witness initials2_7
- Internal use only2_7
- Printed name of elector3_7
- Full residential address street numbernamecity3_7
- Postal code3_7
- Elector signature3_7
- Witness initials3_7
- Internal use only3_7
- Printed name of elector4_7
- Full residential address street numbernamecity4_7
- Postal code4_7
- Elector signature4_7
- Witness initials4_7
- Internal use only4_7
- Printed name of elector5_7
- Full residential address street numbernamecity5_7
- Postal code5_7
- Elector signature5_7
- Witness initials5_7
- Internal use only5_7
- Printed name of elector6_7
- Full residential address street numbernamecity6_7
- Postal code6_7
- Elector signature6_7
- Witness initials6_7
- Internal use only6_7
- Printed name of elector7_7
- Full residential address street numbernamecity7_7
- Postal code7_7
- Elector signature7_7
- Witness initials7_7
- Internal use only7_7
- Printed name of elector8_7
- Full residential address street numbernamecity8_7
- Postal code8_7
- Elector signature8_7
- Witness initials8_7
- Internal use only8_7
- Printed name of elector9_7
- Full residential address street numbernamecity9_7
- Postal code9_7
- Elector signature9_7
- Witness initials9_7
- Internal use only9_7
- Printed name of elector10_7
- Full residential address street numbernamecity10_7
- Postal code10_7
- Elector signature10_7
- Witness initials10_7
- Internal use only10_7
- Printed name of elector1_8
- Full residential address street numbernamecity1_8
- Postal code1_8
- Elector signature1_8
- Witness initials1_8
- Internal use only1_8
- Printed name of elector2_8
- Full residential address street numbernamecity2_8
- Postal code2_8
- Elector signature2_8
- Witness initials2_8
- Internal use only2_8
- Printed name of elector3_8
- Full residential address street numbernamecity3_8
- Postal code3_8
- Elector signature3_8
- Witness initials3_8
- Internal use only3_8
- Printed name of elector4_8
- Full residential address street numbernamecity4_8
- Postal code4_8
- Elector signature4_8
- Witness initials4_8
- Internal use only4_8
- Printed name of elector5_8
- Full residential address street numbernamecity5_8
- Postal code5_8
- Elector signature5_8
- Witness initials5_8
- Internal use only5_8
- Printed name of elector6_8
- Full residential address street numbernamecity6_8
- Postal code6_8
- Elector signature6_8
- Witness initials6_8
- Internal use only6_8
- Printed name of elector7_8
- Full residential address street numbernamecity7_8
- Postal code7_8
- Elector signature7_8
- Witness initials7_8
- Internal use only7_8
- Printed name of elector8_8
- Full residential address street numbernamecity8_8
- Postal code8_8
- Elector signature8_8
- Witness initials8_8
- Internal use only8_8
- Printed name of elector9_8
- Full residential address street numbernamecity9_8
- Postal code9_8
- Elector signature9_8
- Witness initials9_8
- Internal use only9_8
- Printed name of elector10_8
- Full residential address street numbernamecity10_8
- Postal code10_8
- Elector signature10_8
- Witness initials10_8
- Internal use only10_8
- Printed name of elector1_9
- Full residential address street numbernamecity1_9
- Postal code1_9
- Elector signature1_9
- Witness initials1_9
- Internal use only1_9
- Printed name of elector2_9
- Full residential address street numbernamecity2_9
- Postal code2_9
- Elector signature2_9
- Witness initials2_9
- Internal use only2_9
- Printed name of elector3_9
- Full residential address street numbernamecity3_9
- Postal code3_9
- Elector signature3_9
- Witness initials3_9
- Internal use only3_9
- Printed name of elector4_9
- Full residential address street numbernamecity4_9
- Postal code4_9
- Elector signature4_9
- Witness initials4_9
- Internal use only4_9
- Printed name of elector5_9
- Full residential address street numbernamecity5_9
- Postal code5_9
- Elector signature5_9
- Witness initials5_9
- Internal use only5_9
- Printed name of elector6_9
- Full residential address street numbernamecity6_9
- Postal code6_9
- Elector signature6_9
- Witness initials6_9
- Internal use only6_9
- Printed name of elector7_9
- Full residential address street numbernamecity7_9
- Postal code7_9
- Elector signature7_9
- Witness initials7_9
- Internal use only7_9
- Printed name of elector8_9
- Full residential address street numbernamecity8_9
- Postal code8_9
- Elector signature8_9
- Witness initials8_9
- Internal use only8_9
- Printed name of elector9_9
- Full residential address street numbernamecity9_9
- Postal code9_9
- Elector signature9_9
- Witness initials9_9
- Internal use only9_9
- Printed name of elector10_9
- Full residential address street numbernamecity10_9
- Postal code10_9
- Elector signature10_9
- Witness initials10_9
- Internal use only10_9
- Printed name of elector1_10
- Full residential address street numbernamecity1_10
- Postal code1_10
- Elector signature1_10
- Witness initials1_10
- Internal use only1_10
- Printed name of elector2_10
- Full residential address street numbernamecity2_10
- Postal code2_10
- Elector signature2_10
- Witness initials2_10
- Internal use only2_10
- Printed name of elector3_10
- Full residential address street numbernamecity3_10
- Postal code3_10
- Elector signature3_10
- Witness initials3_10
- Internal use only3_10
- Printed name of elector4_10
- Full residential address street numbernamecity4_10
- Postal code4_10
- Elector signature4_10
- Witness initials4_10
- Internal use only4_10
- Printed name of elector5_10
- Full residential address street numbernamecity5_10
- Postal code5_10
- Elector signature5_10
- Witness initials5_10
- Internal use only5_10
- Printed name of elector6_10
- Full residential address street numbernamecity6_10
- Postal code6_10
- Elector signature6_10
- Witness initials6_10
- Internal use only6_10
- Printed name of elector7_10
- Full residential address street numbernamecity7_10
- Postal code7_10
- Elector signature7_10
- Witness initials7_10
- Internal use only7_10
- Printed name of elector8_10
- Full residential address street numbernamecity8_10
- Postal code8_10
- Elector signature8_10
- Witness initials8_10
- Internal use only8_10
- Printed name of elector9_10
- Full residential address street numbernamecity9_10
- Postal code9_10
- Elector signature9_10
- Witness initials9_10
- Internal use only9_10
- Printed name of elector10_10
- Full residential address street numbernamecity10_10
- Postal code10_10
- Elector signature10_10
- Witness initials10_10
- Internal use only10_10
- Printed name of elector1_11
- Full residential address street numbernamecity1_11
- Postal code1_11
- Elector signature1_11
- Witness initials1_11
- Internal use only1_11
- Printed name of elector2_11
- Full residential address street numbernamecity2_11
- Postal code2_11
- Elector signature2_11
- Witness initials2_11
- Internal use only2_11
- Printed name of elector3_11
- Full residential address street numbernamecity3_11
- Postal code3_11
- Elector signature3_11
- Witness initials3_11
- Internal use only3_11
- Printed name of elector4_11
- Full residential address street numbernamecity4_11
- Postal code4_11
- Elector signature4_11
- Witness initials4_11
- Internal use only4_11
- Printed name of elector5_11
- Full residential address street numbernamecity5_11
- Postal code5_11
- Elector signature5_11
- Witness initials5_11
- Internal use only5_11
- Printed name of elector6_11
- Full residential address street numbernamecity6_11
- Postal code6_11
- Elector signature6_11
- Witness initials6_11
- Internal use only6_11
- Printed name of elector7_11
- Full residential address street numbernamecity7_11
- Postal code7_11
- Elector signature7_11
- Witness initials7_11
- Internal use only7_11
- Printed name of elector8_11
- Full residential address street numbernamecity8_11
- Postal code8_11
- Elector signature8_11
- Witness initials8_11
- Internal use only8_11
- Printed name of elector9_11
- Full residential address street numbernamecity9_11
- Postal code9_11
- Elector signature9_11
- Witness initials9_11
- Internal use only9_11
- Printed name of elector10_11
- Full residential address street numbernamecity10_11
- Postal code10_11
- Elector signature10_11
- Witness initials10_11
- Internal use only10_11
- Printed name of elector1_12
- Full residential address street numbernamecity1_12
- Postal code1_12
- Elector signature1_12
- Witness initials1_12
- Internal use only1_12
- Printed name of elector2_12
- Full residential address street numbernamecity2_12
- Postal code2_12
- Elector signature2_12
- Witness initials2_12
- Internal use only2_12
- Printed name of elector3_12
- Full residential address street numbernamecity3_12
- Postal code3_12
- Elector signature3_12
- Witness initials3_12
- Internal use only3_12
- Printed name of elector4_12
- Full residential address street numbernamecity4_12
- Postal code4_12
- Elector signature4_12
- Witness initials4_12
- Internal use only4_12
- Printed name of elector5_12
- Full residential address street numbernamecity5_12
- Postal code5_12
- Elector signature5_12
- Witness initials5_12
- Internal use only5_12
- Printed name of elector6_12
- Full residential address street numbernamecity6_12
- Postal code6_12
- Elector signature6_12
- Witness initials6_12
- Internal use only6_12
- Printed name of elector7_12
- Full residential address street numbernamecity7_12
- Postal code7_12
- Elector signature7_12
- Witness initials7_12
- Internal use only7_12
- Printed name of elector8_12
- Full residential address street numbernamecity8_12
- Postal code8_12
- Elector signature8_12
- Witness initials8_12
- Internal use only8_12
- Printed name of elector9_12
- Full residential address street numbernamecity9_12
- Postal code9_12
- Elector signature9_12
- Witness initials9_12
- Internal use only9_12
- Printed name of elector10_12
- Full residential address street numbernamecity10_12
- Postal code10_12
- Elector signature10_12
- Witness initials10_12
- Internal use only10_12
- Printed name of elector1_13
- Full residential address street numbernamecity1_13
- Postal code1_13
- Elector signature1_13
- Witness initials1_13
- Internal use only1_13
- Printed name of elector2_13
- Full residential address street numbernamecity2_13
- Postal code2_13
- Elector signature2_13
- Witness initials2_13
- Internal use only2_13
- Printed name of elector3_13
- Full residential address street numbernamecity3_13
- Postal code3_13
- Elector signature3_13
- Witness initials3_13
- Internal use only3_13
- Printed name of elector4_13
- Full residential address street numbernamecity4_13
- Postal code4_13
- Elector signature4_13
- Witness initials4_13
- Internal use only4_13
- Printed name of elector5_13
- Full residential address street numbernamecity5_13
- Postal code5_13
- Elector signature5_13
- Witness initials5_13
- Internal use only5_13
- Printed name of elector6_13
- Full residential address street numbernamecity6_13
- Postal code6_13
- Elector signature6_13
- Witness initials6_13
- Internal use only6_13
- Printed name of elector7_13
- Full residential address street numbernamecity7_13
- Postal code7_13
- Elector signature7_13
- Witness initials7_13
- Internal use only7_13
- Printed name of elector8_13
- Full residential address street numbernamecity8_13
- Postal code8_13
- Elector signature8_13
- Witness initials8_13
- Internal use only8_13
- Printed name of elector9_13
- Full residential address street numbernamecity9_13
- Postal code9_13
- Elector signature9_13
- Witness initials9_13
- Internal use only9_13
- Printed name of elector10_13
- Full residential address street numbernamecity10_13
- Postal code10_13
- Elector signature10_13
- Witness initials10_13
- Internal use only10_13
- Printed name of elector1_14
- Full residential address street numbernamecity1_14
- Postal code1_14
- Elector signature1_14
- Witness initials1_14
- Internal use only1_14
- Printed name of elector2_14
- Full residential address street numbernamecity2_14
- Postal code2_14
- Elector signature2_14
- Witness initials2_14
- Internal use only2_14
- Printed name of elector3_14
- Full residential address street numbernamecity3_14
- Postal code3_14
- Elector signature3_14
- Witness initials3_14
- Internal use only3_14
- Printed name of elector4_14
- Full residential address street numbernamecity4_14
- Postal code4_14
- Elector signature4_14
- Witness initials4_14
- Internal use only4_14
- Printed name of elector5_14
- Full residential address street numbernamecity5_14
- Postal code5_14
- Elector signature5_14
- Witness initials5_14
- Internal use only5_14
- Printed name of elector6_14
- Full residential address street numbernamecity6_14
- Postal code6_14
- Elector signature6_14
- Witness initials6_14
- Internal use only6_14
- Printed name of elector7_14
- Full residential address street numbernamecity7_14
- Postal code7_14
- Elector signature7_14
- Witness initials7_14
- Internal use only7_14
- Printed name of elector8_14
- Full residential address street numbernamecity8_14
- Postal code8_14
- Elector signature8_14
- Witness initials8_14
- Internal use only8_14
- Printed name of elector9_14
- Full residential address street numbernamecity9_14
- Postal code9_14
- Elector signature9_14
- Witness initials9_14
- Internal use only9_14
- Printed name of elector10_14
- Full residential address street numbernamecity10_14
- Postal code10_14
- Elector signature10_14
- Witness initials10_14
- Internal use only10_14
- Printed name of elector1_15
- Full residential address street numbernamecity1_15
- Postal code1_15
- Elector signature1_15
- Witness initials1_15
- Internal use only1_15
- Printed name of elector2_15
- Full residential address street numbernamecity2_15
- Postal code2_15
- Elector signature2_15
- Witness initials2_15
- Internal use only2_15
- Printed name of elector3_15
- Full residential address street numbernamecity3_15
- Postal code3_15
- Elector signature3_15
- Witness initials3_15
- Internal use only3_15
- Printed name of elector4_15
- Full residential address street numbernamecity4_15
- Postal code4_15
- Elector signature4_15
- Witness initials4_15
- Internal use only4_15
- Printed name of elector5_15
- Full residential address street numbernamecity5_15
- Postal code5_15
- Elector signature5_15
- Witness initials5_15
- Internal use only5_15
- Printed name of elector6_15
- Full residential address street numbernamecity6_15
- Postal code6_15
- Elector signature6_15
- Witness initials6_15
- Internal use only6_15
- Printed name of elector7_15
- Full residential address street numbernamecity7_15
- Postal code7_15
- Elector signature7_15
- Witness initials7_15
- Internal use only7_15
- Printed name of elector8_15
- Full residential address street numbernamecity8_15
- Postal code8_15
- Elector signature8_15
- Witness initials8_15
- Internal use only8_15
- Printed name of elector9_15
- Full residential address street numbernamecity9_15
- Postal code9_15
- Elector signature9_15
- Witness initials9_15
- Internal use only9_15
- Printed name of elector10_15
- Full residential address street numbernamecity10_15
- Postal code10_15
- Elector signature10_15
- Witness initials10_15
- Internal use only10_15
- Printed name of elector1_16
- Full residential address street numbernamecity1_16
- Postal code1_16
- Elector signature1_16
- Witness initials1_16
- Internal use only1_16
- Printed name of elector2_16
- Full residential address street numbernamecity2_16
- Postal code2_16
- Elector signature2_16
- Witness initials2_16
- Internal use only2_16
- Printed name of elector3_16
- Full residential address street numbernamecity3_16
- Postal code3_16
- Elector signature3_16
- Witness initials3_16
- Internal use only3_16
- Printed name of elector4_16
- Full residential address street numbernamecity4_16
- Postal code4_16
- Elector signature4_16
- Witness initials4_16
- Internal use only4_16
- Printed name of elector5_16
- Full residential address street numbernamecity5_16
- Postal code5_16
- Elector signature5_16
- Witness initials5_16
- Internal use only5_16
- Printed name of elector6_16
- Full residential address street numbernamecity6_16
- Postal code6_16
- Elector signature6_16
- Witness initials6_16
- Internal use only6_16
- Printed name of elector7_16
- Full residential address street numbernamecity7_16
- Postal code7_16
- Elector signature7_16
- Witness initials7_16
- Internal use only7_16
- Printed name of elector8_16
- Full residential address street numbernamecity8_16
- Postal code8_16
- Elector signature8_16
- Witness initials8_16
- Internal use only8_16
- Printed name of elector9_16
- Full residential address street numbernamecity9_16
- Postal code9_16
- Elector signature9_16
- Witness initials9_16
- Internal use only9_16
- Printed name of elector10_16
- Full residential address street numbernamecity10_16
- Postal code10_16
- Elector signature10_16
- Witness initials10_16
- Internal use only10_16
- Have you completed the Nomination Paper EC 20010 Off
- Do you have authorized proof of identify Off
- Are you endorsed by a political party Off
- Have you made a nomination appointment Off
- Last name - Candidate Name
- First name - Candidate Name
- Name of electoral district- Candidate Information
- First name - Candidate Information
- Last name - Candidate Information
- Ballot Name Off
- Ballot First name(s)
- Ballot Last name(s)
- Gender -Candidate information
- Date of birth (YYY-MM-DD) - Gender -Candidate information
- language of correspondence - Candidate information Off
- Email -Contact information
- Primary phone number - Contact information
- Ext - Primary phone number
- Alternate phone number - Contact information
- Ext - Alternate phone number
- Fax number- Alternate phone number
- Unit -Residential address
- Street -Residential address
- Street name -Residential address
- City -Residential address
- ProvinceTerritory -Residential address
- Postal code - -Residential address
- Mailing address - same as residential address Off
- Occupation- Candidate occupation
- Sharing of information with the Conflict of Interest and Ethics Commissioner and the House of Commons including the Library of Parliament Off
- where applicable if the returning officer is unable to verify that I have been endorsed by the political party identified in section A of this Nomination Paper I wish to Off
- Date of Signature (YYYY-MM-DD) - Candidate signature
- Date of Signature (YYYY-MM-DD) -Signature of person receiving the solemn declaration
- Campaign delegate information
- First name - Campaign delegate information
- Last name - Campaign delegate information
- Language of correspondence - Campaign delegate information Off
- Email - Contact information -Campaign Delegate
- Primary phone number - Contact information -Campaign Delegate
- Primary phone number EXT - Contact information -Campaign Delegate
- Alternate phone number - Contact information -Campaign Delegate
- Alternate phone number EXT - Contact information -Campaign Delegate
- Fax nmuber- Contact information -Campaign Delegate
- Street - Residential address -Campaign delegate
- Street name - Residential address -Campaign delegate
- City - Residential address -Campaign delegate
- ProvinceTerritory - Residential address -Campaign delegate
- Postal Code - Residential address -Campaign delegate
- Campaign delegate - Mailing address ndash Same as residential address Off
- Unit - Residential address -Campaign delegate
- Date (YYYY-MM-DD) - Candidate authorization Signature
- Date (YYYY-MM-DD) - Candidate campaign Signature
- First name - Official agent information
- Last name - Official agent information
- Language of correspondence - Official agent information Off
- Email - Official agent information
- Primary phone number - Official agent information
- Primary phone number EXT - Official agent information
- Alternate phone number EXT - Official agent information
- Alternate phone number - Official agent information
- Fax number - Official agent information
- Unit -Residential address - Official Agent
- Street name -Residential address - Official Agent
- City -Residential address - Official Agent
- Street -Residential address - Official Agent
- ProvinceTerritory -Residential address - Official Agent
- Postal code-Residential address - Official Agent
- Mailing address ndash Same as residential address- Official Agent Off
- Date (YYYY-MM-DD) - Official agent signature
- First name - Auditor information
- Last name - Auditor information
- Language of correspondence - Auditor information Off
- Email - Auditor information
- Primary phone number - Auditor information
- Primary phone number EXT- Auditor information
- Alternate phone number - Auditor information
- Alternate phone number EXT- Auditor information
- Fax number - Auditor information
- Name of firm- Auditor organizational information
- Occupation of auditor - Auditor organizational information
- Professional designation - Auditor organizational information Off
- Designation registration number
- Make cheque payable to
- Unit - Address (where cheque is sent)
- Street - Address (where cheque is sent)
- Street name - Address (where cheque is sent)
- City - Address (where cheque is sent)
- ProvinceTerritory - Address (where cheque is sent)
- Postal code - Address (where cheque is sent)
- Date (YYY-MM-DD) - Auditor signature
- Unit - Campaign office address (optional)
- Street - Campaign office address (optional)
- Street name - Campaign office address (optional)
- City - Campaign office address (optional)
- ProvinceTerritory- Campaign office address (optional)
- Postal code - Campaign office address (optional)
- Name of witness
- Full address of witness
- Name of candidate
- Electoral district
- Year
- Name of candidate2
- Electoral district2
- Year2
- Name of witness2
- Full address of witness2
- Name of candidate3
- Electoral district3
- Year3
- Full address of witness3
- Name of witness3
- Name of candidate 4
- Electoral district4
- Year4
- Full address of witness 4
- Name of witness 4
- Name of candidate5
- Electoral district5
- Year5
- Full address of witness5
- Name of witness5
- Name of candidate6
- Electoral district6
- Year6
- Name of witness6
- Full address of witness6
- Name of candidate7
- Electoral district7
- Year7
- Full address of witness7
- Name of witness7
- Name of candidate8
- Electoral district8
- Year8
- Full address of witness8
- Name of witness8
- Name of candidate9
- Electoral district9
- Year9
- Full address of witness 9
- Name of witness 9
- Name of candidate10
- Electoral district10
- Year10
- Full address of witness10
- Name of witness10
- Name of candidate11
- Electoral district11
- Year11
- Full address of witness11
- Name of witness11
- Name of candidate12
- Electoral district12
- Year12
- Full address of witness12
- Name of witness12
- Name of candidate13
- Electoral district13
- Year13
- Full address of witness13
- Name of witness13
- Name of candidate14
- Electoral district14
- Year14
- Name of witness14
- Full address of witness14
- Name of candidate1
- Electoral district1
- Year1
- Name of witness1
- Full address of witness1
- Name of candidate15
- Electoral district15
- Year15
- Name of witness15
- Full address of witness15
- unit -Mailing address
- Street -Mailing address
- Street name -Mailing address
- City -Mailing address
- ProvinceTerritory -Mailing address
- Postal code -Mailing address
- Unit - Mailing address -Campaign delegate
- Street - Mailing address -Campaign delegate
- Street name - Mailing address -Campaign delegate
- City - Mailing address -Campaign delegate
- ProvinceTerritory- Mailing address -Campaign delegate
- Postal code- Mailing address -Campaign delegate
- Unit -Mailing address - Official Agent
- Street -Mailing address - Official Agent
- Street name -Mailing address - Official Agent
- city -Mailing address - Official Agent
- ProvinceTerritory-Mailing address - Official Agent
- Postal code-Mailing address - Official Agent
12BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
20
13BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
21
14BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
22
15BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
23
16BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
24
17BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
25
18BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
26
19BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
27
20BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
28
21BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
29
22BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
30
EC 20010 (022019)
SECTION G ndash 23B Are You Ready to Submit Your Nomination
Have you completed the Nomination Paper (EC 20010)
bull Are all mandatory fields in sections AndashE complete
bull Have you collected the required number of signatures from qualified electors in section F
o For most electoral districts 100 electors must consent to your candidacy
o For electoral districts identified in Schedule 3 only 50 electors are required
o To ensure a smooth nomination process Elections Canada recommends collecting signatures from at least 150 electors
Do you have authorized proof of identify
bull For a list of authorized identification visit the Elections Canada website
bull If a campaign delegate is submitting on your behalf they must bring a copy of your identification documents signed by you
bull If you want an alternative name to appear on the ballot additional documentation is required visit electionsca for details
Are you endorsed by a political party
bull Make sure your party has submitted the required documentation to Elections Canada attesting your designated political affiliation
Have you made a nomination appointment
bull To facilitate the nomination process make an appointment with the returning officer to finalize the filing of the complete nomination package
bull The nomination period closes 21 days before election day at 200 pm local time
31
- Nomination Paperof a Candidate at a Federal General Election or By-election
- Table of Contents
- General Information
- SECTION A ndash Candidate Information (Mandatory)
- SECTION B ndash Campaign Delegate (Optional)
- SECTION C ndash Official Agent (Mandatory)
- SECTION D ndash Auditor (Optional)
- SECTION E ndash Campaign Office (Optional)
- SECTION F ndash Electors Consenting to Candidacy (Mandatory)
-
- Name of electoral district
- Political affiliation
- Telephone number to be posted on electionsca
- Website to be posted on electionsca including prefix http https
- Printed name of elector1
- Full residential address street numbernamecity1
- Postal code1
- Elector signature1
- Witness initials1
- Internal use only1
- Printed name of elector2
- Full residential address street numbernamecity2
- Postal code2
- Elector signature2
- Witness initials2
- Internal use only2
- Printed name of elector3
- Full residential address street numbernamecity3
- Postal code3
- Elector signature3
- Witness initials3
- Internal use only3
- Printed name of elector4
- Full residential address street numbernamecity4
- Postal code4
- Elector signature4
- Witness initials4
- Internal use only4
- Printed name of elector5
- Full residential address street numbernamecity5
- Postal code5
- Elector signature5
- Witness initials5
- Internal use only5
- Printed name of elector6
- Full residential address street numbernamecity6
- Postal code6
- Elector signature6
- Witness initials6
- Internal use only6
- Printed name of elector7
- Full residential address street numbernamecity7
- Postal code7
- Elector signature7
- Witness initials7
- Internal use only7
- Printed name of elector8
- Full residential address street numbernamecity8
- Postal code8
- Elector signature8
- Witness initials8
- Internal use only8
- Printed name of elector9
- Full residential address street numbernamecity9
- Postal code9
- Elector signature9
- Witness initials9
- Internal use only9
- Printed name of elector10
- Full residential address street numbernamecity10
- Postal code10
- Elector signature10
- Witness initials10
- Internal use only10
- Printed name of elector1_2
- Full residential address street numbernamecity1_2
- Postal code1_2
- Elector signature1_2
- Witness initials1_2
- Internal use only1_2
- Printed name of elector2_2
- Full residential address street numbernamecity2_2
- Postal code2_2
- Elector signature2_2
- Witness initials2_2
- Internal use only2_2
- Printed name of elector3_2
- Full residential address street numbernamecity3_2
- Postal code3_2
- Elector signature3_2
- Witness initials3_2
- Internal use only3_2
- Printed name of elector4_2
- Full residential address street numbernamecity4_2
- Postal code4_2
- Elector signature4_2
- Witness initials4_2
- Internal use only4_2
- Printed name of elector5_2
- Full residential address street numbernamecity5_2
- Postal code5_2
- Elector signature5_2
- Witness initials5_2
- Internal use only5_2
- Printed name of elector6_2
- Full residential address street numbernamecity6_2
- Postal code6_2
- Elector signature6_2
- Witness initials6_2
- Internal use only6_2
- Printed name of elector7_2
- Full residential address street numbernamecity7_2
- Postal code7_2
- Elector signature7_2
- Witness initials7_2
- Internal use only7_2
- Printed name of elector8_2
- Full residential address street numbernamecity8_2
- Postal code8_2
- Elector signature8_2
- Witness initials8_2
- Internal use only8_2
- Printed name of elector9_2
- Full residential address street numbernamecity9_2
- Postal code9_2
- Elector signature9_2
- Witness initials9_2
- Internal use only9_2
- Printed name of elector10_2
- Full residential address street numbernamecity10_2
- Postal code10_2
- Elector signature10_2
- Witness initials10_2
- Internal use only10_2
- Printed name of elector1_3
- Full residential address street numbernamecity1_3
- Postal code1_3
- Elector signature1_3
- Witness initials1_3
- Internal use only1_3
- Printed name of elector2_3
- Full residential address street numbernamecity2_3
- Postal code2_3
- Elector signature2_3
- Witness initials2_3
- Internal use only2_3
- Printed name of elector3_3
- Full residential address street numbernamecity3_3
- Postal code3_3
- Elector signature3_3
- Witness initials3_3
- Internal use only3_3
- Printed name of elector4_3
- Full residential address street numbernamecity4_3
- Postal code4_3
- Elector signature4_3
- Witness initials4_3
- Internal use only4_3
- Printed name of elector5_3
- Full residential address street numbernamecity5_3
- Postal code5_3
- Elector signature5_3
- Witness initials5_3
- Internal use only5_3
- Printed name of elector6_3
- Full residential address street numbernamecity6_3
- Postal code6_3
- Elector signature6_3
- Witness initials6_3
- Internal use only6_3
- Printed name of elector7_3
- Full residential address street numbernamecity7_3
- Postal code7_3
- Elector signature7_3
- Witness initials7_3
- Internal use only7_3
- Printed name of elector8_3
- Full residential address street numbernamecity8_3
- Postal code8_3
- Elector signature8_3
- Witness initials8_3
- Internal use only8_3
- Printed name of elector9_3
- Full residential address street numbernamecity9_3
- Postal code9_3
- Elector signature9_3
- Witness initials9_3
- Internal use only9_3
- Printed name of elector10_3
- Full residential address street numbernamecity10_3
- Postal code10_3
- Elector signature10_3
- Witness initials10_3
- Internal use only10_3
- Printed name of elector1_4
- Full residential address street numbernamecity1_4
- Postal code1_4
- Elector signature1_4
- Witness initials1_4
- Internal use only1_4
- Printed name of elector2_4
- Full residential address street numbernamecity2_4
- Postal code2_4
- Elector signature2_4
- Witness initials2_4
- Internal use only2_4
- Printed name of elector3_4
- Full residential address street numbernamecity3_4
- Postal code3_4
- Elector signature3_4
- Witness initials3_4
- Internal use only3_4
- Printed name of elector4_4
- Full residential address street numbernamecity4_4
- Postal code4_4
- Elector signature4_4
- Witness initials4_4
- Internal use only4_4
- Printed name of elector5_4
- Full residential address street numbernamecity5_4
- Postal code5_4
- Elector signature5_4
- Witness initials5_4
- Internal use only5_4
- Printed name of elector6_4
- Full residential address street numbernamecity6_4
- Postal code6_4
- Elector signature6_4
- Witness initials6_4
- Internal use only6_4
- Printed name of elector7_4
- Full residential address street numbernamecity7_4
- Postal code7_4
- Elector signature7_4
- Witness initials7_4
- Internal use only7_4
- Printed name of elector8_4
- Full residential address street numbernamecity8_4
- Postal code8_4
- Elector signature8_4
- Witness initials8_4
- Internal use only8_4
- Printed name of elector9_4
- Full residential address street numbernamecity9_4
- Postal code9_4
- Elector signature9_4
- Witness initials9_4
- Internal use only9_4
- Printed name of elector10_4
- Full residential address street numbernamecity10_4
- Postal code10_4
- Elector signature10_4
- Witness initials10_4
- Internal use only10_4
- Printed name of elector1_5
- Full residential address street numbernamecity1_5
- Postal code1_5
- Elector signature1_5
- Witness initials1_5
- Internal use only1_5
- Printed name of elector2_5
- Full residential address street numbernamecity2_5
- Postal code2_5
- Elector signature2_5
- Witness initials2_5
- Internal use only2_5
- Printed name of elector3_5
- Full residential address street numbernamecity3_5
- Postal code3_5
- Elector signature3_5
- Witness initials3_5
- Internal use only3_5
- Printed name of elector4_5
- Full residential address street numbernamecity4_5
- Postal code4_5
- Elector signature4_5
- Witness initials4_5
- Internal use only4_5
- Printed name of elector5_5
- Full residential address street numbernamecity5_5
- Postal code5_5
- Elector signature5_5
- Witness initials5_5
- Internal use only5_5
- Printed name of elector6_5
- Full residential address street numbernamecity6_5
- Postal code6_5
- Elector signature6_5
- Witness initials6_5
- Internal use only6_5
- Printed name of elector7_5
- Full residential address street numbernamecity7_5
- Postal code7_5
- Elector signature7_5
- Witness initials7_5
- Internal use only7_5
- Printed name of elector8_5
- Full residential address street numbernamecity8_5
- Postal code8_5
- Elector signature8_5
- Witness initials8_5
- Internal use only8_5
- Printed name of elector9_5
- Full residential address street numbernamecity9_5
- Postal code9_5
- Elector signature9_5
- Witness initials9_5
- Internal use only9_5
- Printed name of elector10_5
- Full residential address street numbernamecity10_5
- Postal code10_5
- Elector signature10_5
- Witness initials10_5
- Internal use only10_5
- Printed name of elector1_6
- Full residential address street numbernamecity1_6
- Postal code1_6
- Elector signature1_6
- Witness initials1_6
- Internal use only1_6
- Printed name of elector2_6
- Full residential address street numbernamecity2_6
- Postal code2_6
- Elector signature2_6
- Witness initials2_6
- Internal use only2_6
- Printed name of elector3_6
- Full residential address street numbernamecity3_6
- Postal code3_6
- Elector signature3_6
- Witness initials3_6
- Internal use only3_6
- Printed name of elector4_6
- Full residential address street numbernamecity4_6
- Postal code4_6
- Elector signature4_6
- Witness initials4_6
- Internal use only4_6
- Printed name of elector5_6
- Full residential address street numbernamecity5_6
- Postal code5_6
- Elector signature5_6
- Witness initials5_6
- Internal use only5_6
- Printed name of elector6_6
- Full residential address street numbernamecity6_6
- Postal code6_6
- Elector signature6_6
- Witness initials6_6
- Internal use only6_6
- Printed name of elector7_6
- Full residential address street numbernamecity7_6
- Postal code7_6
- Elector signature7_6
- Witness initials7_6
- Internal use only7_6
- Printed name of elector8_6
- Full residential address street numbernamecity8_6
- Postal code8_6
- Elector signature8_6
- Witness initials8_6
- Internal use only8_6
- Printed name of elector9_6
- Full residential address street numbernamecity9_6
- Postal code9_6
- Elector signature9_6
- Witness initials9_6
- Internal use only9_6
- Printed name of elector10_6
- Full residential address street numbernamecity10_6
- Postal code10_6
- Elector signature10_6
- Witness initials10_6
- Internal use only10_6
- Printed name of elector1_7
- Full residential address street numbernamecity1_7
- Postal code1_7
- Elector signature1_7
- Witness initials1_7
- Internal use only1_7
- Printed name of elector2_7
- Full residential address street numbernamecity2_7
- Postal code2_7
- Elector signature2_7
- Witness initials2_7
- Internal use only2_7
- Printed name of elector3_7
- Full residential address street numbernamecity3_7
- Postal code3_7
- Elector signature3_7
- Witness initials3_7
- Internal use only3_7
- Printed name of elector4_7
- Full residential address street numbernamecity4_7
- Postal code4_7
- Elector signature4_7
- Witness initials4_7
- Internal use only4_7
- Printed name of elector5_7
- Full residential address street numbernamecity5_7
- Postal code5_7
- Elector signature5_7
- Witness initials5_7
- Internal use only5_7
- Printed name of elector6_7
- Full residential address street numbernamecity6_7
- Postal code6_7
- Elector signature6_7
- Witness initials6_7
- Internal use only6_7
- Printed name of elector7_7
- Full residential address street numbernamecity7_7
- Postal code7_7
- Elector signature7_7
- Witness initials7_7
- Internal use only7_7
- Printed name of elector8_7
- Full residential address street numbernamecity8_7
- Postal code8_7
- Elector signature8_7
- Witness initials8_7
- Internal use only8_7
- Printed name of elector9_7
- Full residential address street numbernamecity9_7
- Postal code9_7
- Elector signature9_7
- Witness initials9_7
- Internal use only9_7
- Printed name of elector10_7
- Full residential address street numbernamecity10_7
- Postal code10_7
- Elector signature10_7
- Witness initials10_7
- Internal use only10_7
- Printed name of elector1_8
- Full residential address street numbernamecity1_8
- Postal code1_8
- Elector signature1_8
- Witness initials1_8
- Internal use only1_8
- Printed name of elector2_8
- Full residential address street numbernamecity2_8
- Postal code2_8
- Elector signature2_8
- Witness initials2_8
- Internal use only2_8
- Printed name of elector3_8
- Full residential address street numbernamecity3_8
- Postal code3_8
- Elector signature3_8
- Witness initials3_8
- Internal use only3_8
- Printed name of elector4_8
- Full residential address street numbernamecity4_8
- Postal code4_8
- Elector signature4_8
- Witness initials4_8
- Internal use only4_8
- Printed name of elector5_8
- Full residential address street numbernamecity5_8
- Postal code5_8
- Elector signature5_8
- Witness initials5_8
- Internal use only5_8
- Printed name of elector6_8
- Full residential address street numbernamecity6_8
- Postal code6_8
- Elector signature6_8
- Witness initials6_8
- Internal use only6_8
- Printed name of elector7_8
- Full residential address street numbernamecity7_8
- Postal code7_8
- Elector signature7_8
- Witness initials7_8
- Internal use only7_8
- Printed name of elector8_8
- Full residential address street numbernamecity8_8
- Postal code8_8
- Elector signature8_8
- Witness initials8_8
- Internal use only8_8
- Printed name of elector9_8
- Full residential address street numbernamecity9_8
- Postal code9_8
- Elector signature9_8
- Witness initials9_8
- Internal use only9_8
- Printed name of elector10_8
- Full residential address street numbernamecity10_8
- Postal code10_8
- Elector signature10_8
- Witness initials10_8
- Internal use only10_8
- Printed name of elector1_9
- Full residential address street numbernamecity1_9
- Postal code1_9
- Elector signature1_9
- Witness initials1_9
- Internal use only1_9
- Printed name of elector2_9
- Full residential address street numbernamecity2_9
- Postal code2_9
- Elector signature2_9
- Witness initials2_9
- Internal use only2_9
- Printed name of elector3_9
- Full residential address street numbernamecity3_9
- Postal code3_9
- Elector signature3_9
- Witness initials3_9
- Internal use only3_9
- Printed name of elector4_9
- Full residential address street numbernamecity4_9
- Postal code4_9
- Elector signature4_9
- Witness initials4_9
- Internal use only4_9
- Printed name of elector5_9
- Full residential address street numbernamecity5_9
- Postal code5_9
- Elector signature5_9
- Witness initials5_9
- Internal use only5_9
- Printed name of elector6_9
- Full residential address street numbernamecity6_9
- Postal code6_9
- Elector signature6_9
- Witness initials6_9
- Internal use only6_9
- Printed name of elector7_9
- Full residential address street numbernamecity7_9
- Postal code7_9
- Elector signature7_9
- Witness initials7_9
- Internal use only7_9
- Printed name of elector8_9
- Full residential address street numbernamecity8_9
- Postal code8_9
- Elector signature8_9
- Witness initials8_9
- Internal use only8_9
- Printed name of elector9_9
- Full residential address street numbernamecity9_9
- Postal code9_9
- Elector signature9_9
- Witness initials9_9
- Internal use only9_9
- Printed name of elector10_9
- Full residential address street numbernamecity10_9
- Postal code10_9
- Elector signature10_9
- Witness initials10_9
- Internal use only10_9
- Printed name of elector1_10
- Full residential address street numbernamecity1_10
- Postal code1_10
- Elector signature1_10
- Witness initials1_10
- Internal use only1_10
- Printed name of elector2_10
- Full residential address street numbernamecity2_10
- Postal code2_10
- Elector signature2_10
- Witness initials2_10
- Internal use only2_10
- Printed name of elector3_10
- Full residential address street numbernamecity3_10
- Postal code3_10
- Elector signature3_10
- Witness initials3_10
- Internal use only3_10
- Printed name of elector4_10
- Full residential address street numbernamecity4_10
- Postal code4_10
- Elector signature4_10
- Witness initials4_10
- Internal use only4_10
- Printed name of elector5_10
- Full residential address street numbernamecity5_10
- Postal code5_10
- Elector signature5_10
- Witness initials5_10
- Internal use only5_10
- Printed name of elector6_10
- Full residential address street numbernamecity6_10
- Postal code6_10
- Elector signature6_10
- Witness initials6_10
- Internal use only6_10
- Printed name of elector7_10
- Full residential address street numbernamecity7_10
- Postal code7_10
- Elector signature7_10
- Witness initials7_10
- Internal use only7_10
- Printed name of elector8_10
- Full residential address street numbernamecity8_10
- Postal code8_10
- Elector signature8_10
- Witness initials8_10
- Internal use only8_10
- Printed name of elector9_10
- Full residential address street numbernamecity9_10
- Postal code9_10
- Elector signature9_10
- Witness initials9_10
- Internal use only9_10
- Printed name of elector10_10
- Full residential address street numbernamecity10_10
- Postal code10_10
- Elector signature10_10
- Witness initials10_10
- Internal use only10_10
- Printed name of elector1_11
- Full residential address street numbernamecity1_11
- Postal code1_11
- Elector signature1_11
- Witness initials1_11
- Internal use only1_11
- Printed name of elector2_11
- Full residential address street numbernamecity2_11
- Postal code2_11
- Elector signature2_11
- Witness initials2_11
- Internal use only2_11
- Printed name of elector3_11
- Full residential address street numbernamecity3_11
- Postal code3_11
- Elector signature3_11
- Witness initials3_11
- Internal use only3_11
- Printed name of elector4_11
- Full residential address street numbernamecity4_11
- Postal code4_11
- Elector signature4_11
- Witness initials4_11
- Internal use only4_11
- Printed name of elector5_11
- Full residential address street numbernamecity5_11
- Postal code5_11
- Elector signature5_11
- Witness initials5_11
- Internal use only5_11
- Printed name of elector6_11
- Full residential address street numbernamecity6_11
- Postal code6_11
- Elector signature6_11
- Witness initials6_11
- Internal use only6_11
- Printed name of elector7_11
- Full residential address street numbernamecity7_11
- Postal code7_11
- Elector signature7_11
- Witness initials7_11
- Internal use only7_11
- Printed name of elector8_11
- Full residential address street numbernamecity8_11
- Postal code8_11
- Elector signature8_11
- Witness initials8_11
- Internal use only8_11
- Printed name of elector9_11
- Full residential address street numbernamecity9_11
- Postal code9_11
- Elector signature9_11
- Witness initials9_11
- Internal use only9_11
- Printed name of elector10_11
- Full residential address street numbernamecity10_11
- Postal code10_11
- Elector signature10_11
- Witness initials10_11
- Internal use only10_11
- Printed name of elector1_12
- Full residential address street numbernamecity1_12
- Postal code1_12
- Elector signature1_12
- Witness initials1_12
- Internal use only1_12
- Printed name of elector2_12
- Full residential address street numbernamecity2_12
- Postal code2_12
- Elector signature2_12
- Witness initials2_12
- Internal use only2_12
- Printed name of elector3_12
- Full residential address street numbernamecity3_12
- Postal code3_12
- Elector signature3_12
- Witness initials3_12
- Internal use only3_12
- Printed name of elector4_12
- Full residential address street numbernamecity4_12
- Postal code4_12
- Elector signature4_12
- Witness initials4_12
- Internal use only4_12
- Printed name of elector5_12
- Full residential address street numbernamecity5_12
- Postal code5_12
- Elector signature5_12
- Witness initials5_12
- Internal use only5_12
- Printed name of elector6_12
- Full residential address street numbernamecity6_12
- Postal code6_12
- Elector signature6_12
- Witness initials6_12
- Internal use only6_12
- Printed name of elector7_12
- Full residential address street numbernamecity7_12
- Postal code7_12
- Elector signature7_12
- Witness initials7_12
- Internal use only7_12
- Printed name of elector8_12
- Full residential address street numbernamecity8_12
- Postal code8_12
- Elector signature8_12
- Witness initials8_12
- Internal use only8_12
- Printed name of elector9_12
- Full residential address street numbernamecity9_12
- Postal code9_12
- Elector signature9_12
- Witness initials9_12
- Internal use only9_12
- Printed name of elector10_12
- Full residential address street numbernamecity10_12
- Postal code10_12
- Elector signature10_12
- Witness initials10_12
- Internal use only10_12
- Printed name of elector1_13
- Full residential address street numbernamecity1_13
- Postal code1_13
- Elector signature1_13
- Witness initials1_13
- Internal use only1_13
- Printed name of elector2_13
- Full residential address street numbernamecity2_13
- Postal code2_13
- Elector signature2_13
- Witness initials2_13
- Internal use only2_13
- Printed name of elector3_13
- Full residential address street numbernamecity3_13
- Postal code3_13
- Elector signature3_13
- Witness initials3_13
- Internal use only3_13
- Printed name of elector4_13
- Full residential address street numbernamecity4_13
- Postal code4_13
- Elector signature4_13
- Witness initials4_13
- Internal use only4_13
- Printed name of elector5_13
- Full residential address street numbernamecity5_13
- Postal code5_13
- Elector signature5_13
- Witness initials5_13
- Internal use only5_13
- Printed name of elector6_13
- Full residential address street numbernamecity6_13
- Postal code6_13
- Elector signature6_13
- Witness initials6_13
- Internal use only6_13
- Printed name of elector7_13
- Full residential address street numbernamecity7_13
- Postal code7_13
- Elector signature7_13
- Witness initials7_13
- Internal use only7_13
- Printed name of elector8_13
- Full residential address street numbernamecity8_13
- Postal code8_13
- Elector signature8_13
- Witness initials8_13
- Internal use only8_13
- Printed name of elector9_13
- Full residential address street numbernamecity9_13
- Postal code9_13
- Elector signature9_13
- Witness initials9_13
- Internal use only9_13
- Printed name of elector10_13
- Full residential address street numbernamecity10_13
- Postal code10_13
- Elector signature10_13
- Witness initials10_13
- Internal use only10_13
- Printed name of elector1_14
- Full residential address street numbernamecity1_14
- Postal code1_14
- Elector signature1_14
- Witness initials1_14
- Internal use only1_14
- Printed name of elector2_14
- Full residential address street numbernamecity2_14
- Postal code2_14
- Elector signature2_14
- Witness initials2_14
- Internal use only2_14
- Printed name of elector3_14
- Full residential address street numbernamecity3_14
- Postal code3_14
- Elector signature3_14
- Witness initials3_14
- Internal use only3_14
- Printed name of elector4_14
- Full residential address street numbernamecity4_14
- Postal code4_14
- Elector signature4_14
- Witness initials4_14
- Internal use only4_14
- Printed name of elector5_14
- Full residential address street numbernamecity5_14
- Postal code5_14
- Elector signature5_14
- Witness initials5_14
- Internal use only5_14
- Printed name of elector6_14
- Full residential address street numbernamecity6_14
- Postal code6_14
- Elector signature6_14
- Witness initials6_14
- Internal use only6_14
- Printed name of elector7_14
- Full residential address street numbernamecity7_14
- Postal code7_14
- Elector signature7_14
- Witness initials7_14
- Internal use only7_14
- Printed name of elector8_14
- Full residential address street numbernamecity8_14
- Postal code8_14
- Elector signature8_14
- Witness initials8_14
- Internal use only8_14
- Printed name of elector9_14
- Full residential address street numbernamecity9_14
- Postal code9_14
- Elector signature9_14
- Witness initials9_14
- Internal use only9_14
- Printed name of elector10_14
- Full residential address street numbernamecity10_14
- Postal code10_14
- Elector signature10_14
- Witness initials10_14
- Internal use only10_14
- Printed name of elector1_15
- Full residential address street numbernamecity1_15
- Postal code1_15
- Elector signature1_15
- Witness initials1_15
- Internal use only1_15
- Printed name of elector2_15
- Full residential address street numbernamecity2_15
- Postal code2_15
- Elector signature2_15
- Witness initials2_15
- Internal use only2_15
- Printed name of elector3_15
- Full residential address street numbernamecity3_15
- Postal code3_15
- Elector signature3_15
- Witness initials3_15
- Internal use only3_15
- Printed name of elector4_15
- Full residential address street numbernamecity4_15
- Postal code4_15
- Elector signature4_15
- Witness initials4_15
- Internal use only4_15
- Printed name of elector5_15
- Full residential address street numbernamecity5_15
- Postal code5_15
- Elector signature5_15
- Witness initials5_15
- Internal use only5_15
- Printed name of elector6_15
- Full residential address street numbernamecity6_15
- Postal code6_15
- Elector signature6_15
- Witness initials6_15
- Internal use only6_15
- Printed name of elector7_15
- Full residential address street numbernamecity7_15
- Postal code7_15
- Elector signature7_15
- Witness initials7_15
- Internal use only7_15
- Printed name of elector8_15
- Full residential address street numbernamecity8_15
- Postal code8_15
- Elector signature8_15
- Witness initials8_15
- Internal use only8_15
- Printed name of elector9_15
- Full residential address street numbernamecity9_15
- Postal code9_15
- Elector signature9_15
- Witness initials9_15
- Internal use only9_15
- Printed name of elector10_15
- Full residential address street numbernamecity10_15
- Postal code10_15
- Elector signature10_15
- Witness initials10_15
- Internal use only10_15
- Printed name of elector1_16
- Full residential address street numbernamecity1_16
- Postal code1_16
- Elector signature1_16
- Witness initials1_16
- Internal use only1_16
- Printed name of elector2_16
- Full residential address street numbernamecity2_16
- Postal code2_16
- Elector signature2_16
- Witness initials2_16
- Internal use only2_16
- Printed name of elector3_16
- Full residential address street numbernamecity3_16
- Postal code3_16
- Elector signature3_16
- Witness initials3_16
- Internal use only3_16
- Printed name of elector4_16
- Full residential address street numbernamecity4_16
- Postal code4_16
- Elector signature4_16
- Witness initials4_16
- Internal use only4_16
- Printed name of elector5_16
- Full residential address street numbernamecity5_16
- Postal code5_16
- Elector signature5_16
- Witness initials5_16
- Internal use only5_16
- Printed name of elector6_16
- Full residential address street numbernamecity6_16
- Postal code6_16
- Elector signature6_16
- Witness initials6_16
- Internal use only6_16
- Printed name of elector7_16
- Full residential address street numbernamecity7_16
- Postal code7_16
- Elector signature7_16
- Witness initials7_16
- Internal use only7_16
- Printed name of elector8_16
- Full residential address street numbernamecity8_16
- Postal code8_16
- Elector signature8_16
- Witness initials8_16
- Internal use only8_16
- Printed name of elector9_16
- Full residential address street numbernamecity9_16
- Postal code9_16
- Elector signature9_16
- Witness initials9_16
- Internal use only9_16
- Printed name of elector10_16
- Full residential address street numbernamecity10_16
- Postal code10_16
- Elector signature10_16
- Witness initials10_16
- Internal use only10_16
- Have you completed the Nomination Paper EC 20010 Off
- Do you have authorized proof of identify Off
- Are you endorsed by a political party Off
- Have you made a nomination appointment Off
- Last name - Candidate Name
- First name - Candidate Name
- Name of electoral district- Candidate Information
- First name - Candidate Information
- Last name - Candidate Information
- Ballot Name Off
- Ballot First name(s)
- Ballot Last name(s)
- Gender -Candidate information
- Date of birth (YYY-MM-DD) - Gender -Candidate information
- language of correspondence - Candidate information Off
- Email -Contact information
- Primary phone number - Contact information
- Ext - Primary phone number
- Alternate phone number - Contact information
- Ext - Alternate phone number
- Fax number- Alternate phone number
- Unit -Residential address
- Street -Residential address
- Street name -Residential address
- City -Residential address
- ProvinceTerritory -Residential address
- Postal code - -Residential address
- Mailing address - same as residential address Off
- Occupation- Candidate occupation
- Sharing of information with the Conflict of Interest and Ethics Commissioner and the House of Commons including the Library of Parliament Off
- where applicable if the returning officer is unable to verify that I have been endorsed by the political party identified in section A of this Nomination Paper I wish to Off
- Date of Signature (YYYY-MM-DD) - Candidate signature
- Date of Signature (YYYY-MM-DD) -Signature of person receiving the solemn declaration
- Campaign delegate information
- First name - Campaign delegate information
- Last name - Campaign delegate information
- Language of correspondence - Campaign delegate information Off
- Email - Contact information -Campaign Delegate
- Primary phone number - Contact information -Campaign Delegate
- Primary phone number EXT - Contact information -Campaign Delegate
- Alternate phone number - Contact information -Campaign Delegate
- Alternate phone number EXT - Contact information -Campaign Delegate
- Fax nmuber- Contact information -Campaign Delegate
- Street - Residential address -Campaign delegate
- Street name - Residential address -Campaign delegate
- City - Residential address -Campaign delegate
- ProvinceTerritory - Residential address -Campaign delegate
- Postal Code - Residential address -Campaign delegate
- Campaign delegate - Mailing address ndash Same as residential address Off
- Unit - Residential address -Campaign delegate
- Date (YYYY-MM-DD) - Candidate authorization Signature
- Date (YYYY-MM-DD) - Candidate campaign Signature
- First name - Official agent information
- Last name - Official agent information
- Language of correspondence - Official agent information Off
- Email - Official agent information
- Primary phone number - Official agent information
- Primary phone number EXT - Official agent information
- Alternate phone number EXT - Official agent information
- Alternate phone number - Official agent information
- Fax number - Official agent information
- Unit -Residential address - Official Agent
- Street name -Residential address - Official Agent
- City -Residential address - Official Agent
- Street -Residential address - Official Agent
- ProvinceTerritory -Residential address - Official Agent
- Postal code-Residential address - Official Agent
- Mailing address ndash Same as residential address- Official Agent Off
- Date (YYYY-MM-DD) - Official agent signature
- First name - Auditor information
- Last name - Auditor information
- Language of correspondence - Auditor information Off
- Email - Auditor information
- Primary phone number - Auditor information
- Primary phone number EXT- Auditor information
- Alternate phone number - Auditor information
- Alternate phone number EXT- Auditor information
- Fax number - Auditor information
- Name of firm- Auditor organizational information
- Occupation of auditor - Auditor organizational information
- Professional designation - Auditor organizational information Off
- Designation registration number
- Make cheque payable to
- Unit - Address (where cheque is sent)
- Street - Address (where cheque is sent)
- Street name - Address (where cheque is sent)
- City - Address (where cheque is sent)
- ProvinceTerritory - Address (where cheque is sent)
- Postal code - Address (where cheque is sent)
- Date (YYY-MM-DD) - Auditor signature
- Unit - Campaign office address (optional)
- Street - Campaign office address (optional)
- Street name - Campaign office address (optional)
- City - Campaign office address (optional)
- ProvinceTerritory- Campaign office address (optional)
- Postal code - Campaign office address (optional)
- Name of witness
- Full address of witness
- Name of candidate
- Electoral district
- Year
- Name of candidate2
- Electoral district2
- Year2
- Name of witness2
- Full address of witness2
- Name of candidate3
- Electoral district3
- Year3
- Full address of witness3
- Name of witness3
- Name of candidate 4
- Electoral district4
- Year4
- Full address of witness 4
- Name of witness 4
- Name of candidate5
- Electoral district5
- Year5
- Full address of witness5
- Name of witness5
- Name of candidate6
- Electoral district6
- Year6
- Name of witness6
- Full address of witness6
- Name of candidate7
- Electoral district7
- Year7
- Full address of witness7
- Name of witness7
- Name of candidate8
- Electoral district8
- Year8
- Full address of witness8
- Name of witness8
- Name of candidate9
- Electoral district9
- Year9
- Full address of witness 9
- Name of witness 9
- Name of candidate10
- Electoral district10
- Year10
- Full address of witness10
- Name of witness10
- Name of candidate11
- Electoral district11
- Year11
- Full address of witness11
- Name of witness11
- Name of candidate12
- Electoral district12
- Year12
- Full address of witness12
- Name of witness12
- Name of candidate13
- Electoral district13
- Year13
- Full address of witness13
- Name of witness13
- Name of candidate14
- Electoral district14
- Year14
- Name of witness14
- Full address of witness14
- Name of candidate1
- Electoral district1
- Year1
- Name of witness1
- Full address of witness1
- Name of candidate15
- Electoral district15
- Year15
- Name of witness15
- Full address of witness15
- unit -Mailing address
- Street -Mailing address
- Street name -Mailing address
- City -Mailing address
- ProvinceTerritory -Mailing address
- Postal code -Mailing address
- Unit - Mailing address -Campaign delegate
- Street - Mailing address -Campaign delegate
- Street name - Mailing address -Campaign delegate
- City - Mailing address -Campaign delegate
- ProvinceTerritory- Mailing address -Campaign delegate
- Postal code- Mailing address -Campaign delegate
- Unit -Mailing address - Official Agent
- Street -Mailing address - Official Agent
- Street name -Mailing address - Official Agent
- city -Mailing address - Official Agent
- ProvinceTerritory-Mailing address - Official Agent
- Postal code-Mailing address - Official Agent
13BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
21
14BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
22
15BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
23
16BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
24
17BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
25
18BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
26
19BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
27
20BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
28
21BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
29
22BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
30
EC 20010 (022019)
SECTION G ndash 23B Are You Ready to Submit Your Nomination
Have you completed the Nomination Paper (EC 20010)
bull Are all mandatory fields in sections AndashE complete
bull Have you collected the required number of signatures from qualified electors in section F
o For most electoral districts 100 electors must consent to your candidacy
o For electoral districts identified in Schedule 3 only 50 electors are required
o To ensure a smooth nomination process Elections Canada recommends collecting signatures from at least 150 electors
Do you have authorized proof of identify
bull For a list of authorized identification visit the Elections Canada website
bull If a campaign delegate is submitting on your behalf they must bring a copy of your identification documents signed by you
bull If you want an alternative name to appear on the ballot additional documentation is required visit electionsca for details
Are you endorsed by a political party
bull Make sure your party has submitted the required documentation to Elections Canada attesting your designated political affiliation
Have you made a nomination appointment
bull To facilitate the nomination process make an appointment with the returning officer to finalize the filing of the complete nomination package
bull The nomination period closes 21 days before election day at 200 pm local time
31
- Nomination Paperof a Candidate at a Federal General Election or By-election
- Table of Contents
- General Information
- SECTION A ndash Candidate Information (Mandatory)
- SECTION B ndash Campaign Delegate (Optional)
- SECTION C ndash Official Agent (Mandatory)
- SECTION D ndash Auditor (Optional)
- SECTION E ndash Campaign Office (Optional)
- SECTION F ndash Electors Consenting to Candidacy (Mandatory)
-
- Name of electoral district
- Political affiliation
- Telephone number to be posted on electionsca
- Website to be posted on electionsca including prefix http https
- Printed name of elector1
- Full residential address street numbernamecity1
- Postal code1
- Elector signature1
- Witness initials1
- Internal use only1
- Printed name of elector2
- Full residential address street numbernamecity2
- Postal code2
- Elector signature2
- Witness initials2
- Internal use only2
- Printed name of elector3
- Full residential address street numbernamecity3
- Postal code3
- Elector signature3
- Witness initials3
- Internal use only3
- Printed name of elector4
- Full residential address street numbernamecity4
- Postal code4
- Elector signature4
- Witness initials4
- Internal use only4
- Printed name of elector5
- Full residential address street numbernamecity5
- Postal code5
- Elector signature5
- Witness initials5
- Internal use only5
- Printed name of elector6
- Full residential address street numbernamecity6
- Postal code6
- Elector signature6
- Witness initials6
- Internal use only6
- Printed name of elector7
- Full residential address street numbernamecity7
- Postal code7
- Elector signature7
- Witness initials7
- Internal use only7
- Printed name of elector8
- Full residential address street numbernamecity8
- Postal code8
- Elector signature8
- Witness initials8
- Internal use only8
- Printed name of elector9
- Full residential address street numbernamecity9
- Postal code9
- Elector signature9
- Witness initials9
- Internal use only9
- Printed name of elector10
- Full residential address street numbernamecity10
- Postal code10
- Elector signature10
- Witness initials10
- Internal use only10
- Printed name of elector1_2
- Full residential address street numbernamecity1_2
- Postal code1_2
- Elector signature1_2
- Witness initials1_2
- Internal use only1_2
- Printed name of elector2_2
- Full residential address street numbernamecity2_2
- Postal code2_2
- Elector signature2_2
- Witness initials2_2
- Internal use only2_2
- Printed name of elector3_2
- Full residential address street numbernamecity3_2
- Postal code3_2
- Elector signature3_2
- Witness initials3_2
- Internal use only3_2
- Printed name of elector4_2
- Full residential address street numbernamecity4_2
- Postal code4_2
- Elector signature4_2
- Witness initials4_2
- Internal use only4_2
- Printed name of elector5_2
- Full residential address street numbernamecity5_2
- Postal code5_2
- Elector signature5_2
- Witness initials5_2
- Internal use only5_2
- Printed name of elector6_2
- Full residential address street numbernamecity6_2
- Postal code6_2
- Elector signature6_2
- Witness initials6_2
- Internal use only6_2
- Printed name of elector7_2
- Full residential address street numbernamecity7_2
- Postal code7_2
- Elector signature7_2
- Witness initials7_2
- Internal use only7_2
- Printed name of elector8_2
- Full residential address street numbernamecity8_2
- Postal code8_2
- Elector signature8_2
- Witness initials8_2
- Internal use only8_2
- Printed name of elector9_2
- Full residential address street numbernamecity9_2
- Postal code9_2
- Elector signature9_2
- Witness initials9_2
- Internal use only9_2
- Printed name of elector10_2
- Full residential address street numbernamecity10_2
- Postal code10_2
- Elector signature10_2
- Witness initials10_2
- Internal use only10_2
- Printed name of elector1_3
- Full residential address street numbernamecity1_3
- Postal code1_3
- Elector signature1_3
- Witness initials1_3
- Internal use only1_3
- Printed name of elector2_3
- Full residential address street numbernamecity2_3
- Postal code2_3
- Elector signature2_3
- Witness initials2_3
- Internal use only2_3
- Printed name of elector3_3
- Full residential address street numbernamecity3_3
- Postal code3_3
- Elector signature3_3
- Witness initials3_3
- Internal use only3_3
- Printed name of elector4_3
- Full residential address street numbernamecity4_3
- Postal code4_3
- Elector signature4_3
- Witness initials4_3
- Internal use only4_3
- Printed name of elector5_3
- Full residential address street numbernamecity5_3
- Postal code5_3
- Elector signature5_3
- Witness initials5_3
- Internal use only5_3
- Printed name of elector6_3
- Full residential address street numbernamecity6_3
- Postal code6_3
- Elector signature6_3
- Witness initials6_3
- Internal use only6_3
- Printed name of elector7_3
- Full residential address street numbernamecity7_3
- Postal code7_3
- Elector signature7_3
- Witness initials7_3
- Internal use only7_3
- Printed name of elector8_3
- Full residential address street numbernamecity8_3
- Postal code8_3
- Elector signature8_3
- Witness initials8_3
- Internal use only8_3
- Printed name of elector9_3
- Full residential address street numbernamecity9_3
- Postal code9_3
- Elector signature9_3
- Witness initials9_3
- Internal use only9_3
- Printed name of elector10_3
- Full residential address street numbernamecity10_3
- Postal code10_3
- Elector signature10_3
- Witness initials10_3
- Internal use only10_3
- Printed name of elector1_4
- Full residential address street numbernamecity1_4
- Postal code1_4
- Elector signature1_4
- Witness initials1_4
- Internal use only1_4
- Printed name of elector2_4
- Full residential address street numbernamecity2_4
- Postal code2_4
- Elector signature2_4
- Witness initials2_4
- Internal use only2_4
- Printed name of elector3_4
- Full residential address street numbernamecity3_4
- Postal code3_4
- Elector signature3_4
- Witness initials3_4
- Internal use only3_4
- Printed name of elector4_4
- Full residential address street numbernamecity4_4
- Postal code4_4
- Elector signature4_4
- Witness initials4_4
- Internal use only4_4
- Printed name of elector5_4
- Full residential address street numbernamecity5_4
- Postal code5_4
- Elector signature5_4
- Witness initials5_4
- Internal use only5_4
- Printed name of elector6_4
- Full residential address street numbernamecity6_4
- Postal code6_4
- Elector signature6_4
- Witness initials6_4
- Internal use only6_4
- Printed name of elector7_4
- Full residential address street numbernamecity7_4
- Postal code7_4
- Elector signature7_4
- Witness initials7_4
- Internal use only7_4
- Printed name of elector8_4
- Full residential address street numbernamecity8_4
- Postal code8_4
- Elector signature8_4
- Witness initials8_4
- Internal use only8_4
- Printed name of elector9_4
- Full residential address street numbernamecity9_4
- Postal code9_4
- Elector signature9_4
- Witness initials9_4
- Internal use only9_4
- Printed name of elector10_4
- Full residential address street numbernamecity10_4
- Postal code10_4
- Elector signature10_4
- Witness initials10_4
- Internal use only10_4
- Printed name of elector1_5
- Full residential address street numbernamecity1_5
- Postal code1_5
- Elector signature1_5
- Witness initials1_5
- Internal use only1_5
- Printed name of elector2_5
- Full residential address street numbernamecity2_5
- Postal code2_5
- Elector signature2_5
- Witness initials2_5
- Internal use only2_5
- Printed name of elector3_5
- Full residential address street numbernamecity3_5
- Postal code3_5
- Elector signature3_5
- Witness initials3_5
- Internal use only3_5
- Printed name of elector4_5
- Full residential address street numbernamecity4_5
- Postal code4_5
- Elector signature4_5
- Witness initials4_5
- Internal use only4_5
- Printed name of elector5_5
- Full residential address street numbernamecity5_5
- Postal code5_5
- Elector signature5_5
- Witness initials5_5
- Internal use only5_5
- Printed name of elector6_5
- Full residential address street numbernamecity6_5
- Postal code6_5
- Elector signature6_5
- Witness initials6_5
- Internal use only6_5
- Printed name of elector7_5
- Full residential address street numbernamecity7_5
- Postal code7_5
- Elector signature7_5
- Witness initials7_5
- Internal use only7_5
- Printed name of elector8_5
- Full residential address street numbernamecity8_5
- Postal code8_5
- Elector signature8_5
- Witness initials8_5
- Internal use only8_5
- Printed name of elector9_5
- Full residential address street numbernamecity9_5
- Postal code9_5
- Elector signature9_5
- Witness initials9_5
- Internal use only9_5
- Printed name of elector10_5
- Full residential address street numbernamecity10_5
- Postal code10_5
- Elector signature10_5
- Witness initials10_5
- Internal use only10_5
- Printed name of elector1_6
- Full residential address street numbernamecity1_6
- Postal code1_6
- Elector signature1_6
- Witness initials1_6
- Internal use only1_6
- Printed name of elector2_6
- Full residential address street numbernamecity2_6
- Postal code2_6
- Elector signature2_6
- Witness initials2_6
- Internal use only2_6
- Printed name of elector3_6
- Full residential address street numbernamecity3_6
- Postal code3_6
- Elector signature3_6
- Witness initials3_6
- Internal use only3_6
- Printed name of elector4_6
- Full residential address street numbernamecity4_6
- Postal code4_6
- Elector signature4_6
- Witness initials4_6
- Internal use only4_6
- Printed name of elector5_6
- Full residential address street numbernamecity5_6
- Postal code5_6
- Elector signature5_6
- Witness initials5_6
- Internal use only5_6
- Printed name of elector6_6
- Full residential address street numbernamecity6_6
- Postal code6_6
- Elector signature6_6
- Witness initials6_6
- Internal use only6_6
- Printed name of elector7_6
- Full residential address street numbernamecity7_6
- Postal code7_6
- Elector signature7_6
- Witness initials7_6
- Internal use only7_6
- Printed name of elector8_6
- Full residential address street numbernamecity8_6
- Postal code8_6
- Elector signature8_6
- Witness initials8_6
- Internal use only8_6
- Printed name of elector9_6
- Full residential address street numbernamecity9_6
- Postal code9_6
- Elector signature9_6
- Witness initials9_6
- Internal use only9_6
- Printed name of elector10_6
- Full residential address street numbernamecity10_6
- Postal code10_6
- Elector signature10_6
- Witness initials10_6
- Internal use only10_6
- Printed name of elector1_7
- Full residential address street numbernamecity1_7
- Postal code1_7
- Elector signature1_7
- Witness initials1_7
- Internal use only1_7
- Printed name of elector2_7
- Full residential address street numbernamecity2_7
- Postal code2_7
- Elector signature2_7
- Witness initials2_7
- Internal use only2_7
- Printed name of elector3_7
- Full residential address street numbernamecity3_7
- Postal code3_7
- Elector signature3_7
- Witness initials3_7
- Internal use only3_7
- Printed name of elector4_7
- Full residential address street numbernamecity4_7
- Postal code4_7
- Elector signature4_7
- Witness initials4_7
- Internal use only4_7
- Printed name of elector5_7
- Full residential address street numbernamecity5_7
- Postal code5_7
- Elector signature5_7
- Witness initials5_7
- Internal use only5_7
- Printed name of elector6_7
- Full residential address street numbernamecity6_7
- Postal code6_7
- Elector signature6_7
- Witness initials6_7
- Internal use only6_7
- Printed name of elector7_7
- Full residential address street numbernamecity7_7
- Postal code7_7
- Elector signature7_7
- Witness initials7_7
- Internal use only7_7
- Printed name of elector8_7
- Full residential address street numbernamecity8_7
- Postal code8_7
- Elector signature8_7
- Witness initials8_7
- Internal use only8_7
- Printed name of elector9_7
- Full residential address street numbernamecity9_7
- Postal code9_7
- Elector signature9_7
- Witness initials9_7
- Internal use only9_7
- Printed name of elector10_7
- Full residential address street numbernamecity10_7
- Postal code10_7
- Elector signature10_7
- Witness initials10_7
- Internal use only10_7
- Printed name of elector1_8
- Full residential address street numbernamecity1_8
- Postal code1_8
- Elector signature1_8
- Witness initials1_8
- Internal use only1_8
- Printed name of elector2_8
- Full residential address street numbernamecity2_8
- Postal code2_8
- Elector signature2_8
- Witness initials2_8
- Internal use only2_8
- Printed name of elector3_8
- Full residential address street numbernamecity3_8
- Postal code3_8
- Elector signature3_8
- Witness initials3_8
- Internal use only3_8
- Printed name of elector4_8
- Full residential address street numbernamecity4_8
- Postal code4_8
- Elector signature4_8
- Witness initials4_8
- Internal use only4_8
- Printed name of elector5_8
- Full residential address street numbernamecity5_8
- Postal code5_8
- Elector signature5_8
- Witness initials5_8
- Internal use only5_8
- Printed name of elector6_8
- Full residential address street numbernamecity6_8
- Postal code6_8
- Elector signature6_8
- Witness initials6_8
- Internal use only6_8
- Printed name of elector7_8
- Full residential address street numbernamecity7_8
- Postal code7_8
- Elector signature7_8
- Witness initials7_8
- Internal use only7_8
- Printed name of elector8_8
- Full residential address street numbernamecity8_8
- Postal code8_8
- Elector signature8_8
- Witness initials8_8
- Internal use only8_8
- Printed name of elector9_8
- Full residential address street numbernamecity9_8
- Postal code9_8
- Elector signature9_8
- Witness initials9_8
- Internal use only9_8
- Printed name of elector10_8
- Full residential address street numbernamecity10_8
- Postal code10_8
- Elector signature10_8
- Witness initials10_8
- Internal use only10_8
- Printed name of elector1_9
- Full residential address street numbernamecity1_9
- Postal code1_9
- Elector signature1_9
- Witness initials1_9
- Internal use only1_9
- Printed name of elector2_9
- Full residential address street numbernamecity2_9
- Postal code2_9
- Elector signature2_9
- Witness initials2_9
- Internal use only2_9
- Printed name of elector3_9
- Full residential address street numbernamecity3_9
- Postal code3_9
- Elector signature3_9
- Witness initials3_9
- Internal use only3_9
- Printed name of elector4_9
- Full residential address street numbernamecity4_9
- Postal code4_9
- Elector signature4_9
- Witness initials4_9
- Internal use only4_9
- Printed name of elector5_9
- Full residential address street numbernamecity5_9
- Postal code5_9
- Elector signature5_9
- Witness initials5_9
- Internal use only5_9
- Printed name of elector6_9
- Full residential address street numbernamecity6_9
- Postal code6_9
- Elector signature6_9
- Witness initials6_9
- Internal use only6_9
- Printed name of elector7_9
- Full residential address street numbernamecity7_9
- Postal code7_9
- Elector signature7_9
- Witness initials7_9
- Internal use only7_9
- Printed name of elector8_9
- Full residential address street numbernamecity8_9
- Postal code8_9
- Elector signature8_9
- Witness initials8_9
- Internal use only8_9
- Printed name of elector9_9
- Full residential address street numbernamecity9_9
- Postal code9_9
- Elector signature9_9
- Witness initials9_9
- Internal use only9_9
- Printed name of elector10_9
- Full residential address street numbernamecity10_9
- Postal code10_9
- Elector signature10_9
- Witness initials10_9
- Internal use only10_9
- Printed name of elector1_10
- Full residential address street numbernamecity1_10
- Postal code1_10
- Elector signature1_10
- Witness initials1_10
- Internal use only1_10
- Printed name of elector2_10
- Full residential address street numbernamecity2_10
- Postal code2_10
- Elector signature2_10
- Witness initials2_10
- Internal use only2_10
- Printed name of elector3_10
- Full residential address street numbernamecity3_10
- Postal code3_10
- Elector signature3_10
- Witness initials3_10
- Internal use only3_10
- Printed name of elector4_10
- Full residential address street numbernamecity4_10
- Postal code4_10
- Elector signature4_10
- Witness initials4_10
- Internal use only4_10
- Printed name of elector5_10
- Full residential address street numbernamecity5_10
- Postal code5_10
- Elector signature5_10
- Witness initials5_10
- Internal use only5_10
- Printed name of elector6_10
- Full residential address street numbernamecity6_10
- Postal code6_10
- Elector signature6_10
- Witness initials6_10
- Internal use only6_10
- Printed name of elector7_10
- Full residential address street numbernamecity7_10
- Postal code7_10
- Elector signature7_10
- Witness initials7_10
- Internal use only7_10
- Printed name of elector8_10
- Full residential address street numbernamecity8_10
- Postal code8_10
- Elector signature8_10
- Witness initials8_10
- Internal use only8_10
- Printed name of elector9_10
- Full residential address street numbernamecity9_10
- Postal code9_10
- Elector signature9_10
- Witness initials9_10
- Internal use only9_10
- Printed name of elector10_10
- Full residential address street numbernamecity10_10
- Postal code10_10
- Elector signature10_10
- Witness initials10_10
- Internal use only10_10
- Printed name of elector1_11
- Full residential address street numbernamecity1_11
- Postal code1_11
- Elector signature1_11
- Witness initials1_11
- Internal use only1_11
- Printed name of elector2_11
- Full residential address street numbernamecity2_11
- Postal code2_11
- Elector signature2_11
- Witness initials2_11
- Internal use only2_11
- Printed name of elector3_11
- Full residential address street numbernamecity3_11
- Postal code3_11
- Elector signature3_11
- Witness initials3_11
- Internal use only3_11
- Printed name of elector4_11
- Full residential address street numbernamecity4_11
- Postal code4_11
- Elector signature4_11
- Witness initials4_11
- Internal use only4_11
- Printed name of elector5_11
- Full residential address street numbernamecity5_11
- Postal code5_11
- Elector signature5_11
- Witness initials5_11
- Internal use only5_11
- Printed name of elector6_11
- Full residential address street numbernamecity6_11
- Postal code6_11
- Elector signature6_11
- Witness initials6_11
- Internal use only6_11
- Printed name of elector7_11
- Full residential address street numbernamecity7_11
- Postal code7_11
- Elector signature7_11
- Witness initials7_11
- Internal use only7_11
- Printed name of elector8_11
- Full residential address street numbernamecity8_11
- Postal code8_11
- Elector signature8_11
- Witness initials8_11
- Internal use only8_11
- Printed name of elector9_11
- Full residential address street numbernamecity9_11
- Postal code9_11
- Elector signature9_11
- Witness initials9_11
- Internal use only9_11
- Printed name of elector10_11
- Full residential address street numbernamecity10_11
- Postal code10_11
- Elector signature10_11
- Witness initials10_11
- Internal use only10_11
- Printed name of elector1_12
- Full residential address street numbernamecity1_12
- Postal code1_12
- Elector signature1_12
- Witness initials1_12
- Internal use only1_12
- Printed name of elector2_12
- Full residential address street numbernamecity2_12
- Postal code2_12
- Elector signature2_12
- Witness initials2_12
- Internal use only2_12
- Printed name of elector3_12
- Full residential address street numbernamecity3_12
- Postal code3_12
- Elector signature3_12
- Witness initials3_12
- Internal use only3_12
- Printed name of elector4_12
- Full residential address street numbernamecity4_12
- Postal code4_12
- Elector signature4_12
- Witness initials4_12
- Internal use only4_12
- Printed name of elector5_12
- Full residential address street numbernamecity5_12
- Postal code5_12
- Elector signature5_12
- Witness initials5_12
- Internal use only5_12
- Printed name of elector6_12
- Full residential address street numbernamecity6_12
- Postal code6_12
- Elector signature6_12
- Witness initials6_12
- Internal use only6_12
- Printed name of elector7_12
- Full residential address street numbernamecity7_12
- Postal code7_12
- Elector signature7_12
- Witness initials7_12
- Internal use only7_12
- Printed name of elector8_12
- Full residential address street numbernamecity8_12
- Postal code8_12
- Elector signature8_12
- Witness initials8_12
- Internal use only8_12
- Printed name of elector9_12
- Full residential address street numbernamecity9_12
- Postal code9_12
- Elector signature9_12
- Witness initials9_12
- Internal use only9_12
- Printed name of elector10_12
- Full residential address street numbernamecity10_12
- Postal code10_12
- Elector signature10_12
- Witness initials10_12
- Internal use only10_12
- Printed name of elector1_13
- Full residential address street numbernamecity1_13
- Postal code1_13
- Elector signature1_13
- Witness initials1_13
- Internal use only1_13
- Printed name of elector2_13
- Full residential address street numbernamecity2_13
- Postal code2_13
- Elector signature2_13
- Witness initials2_13
- Internal use only2_13
- Printed name of elector3_13
- Full residential address street numbernamecity3_13
- Postal code3_13
- Elector signature3_13
- Witness initials3_13
- Internal use only3_13
- Printed name of elector4_13
- Full residential address street numbernamecity4_13
- Postal code4_13
- Elector signature4_13
- Witness initials4_13
- Internal use only4_13
- Printed name of elector5_13
- Full residential address street numbernamecity5_13
- Postal code5_13
- Elector signature5_13
- Witness initials5_13
- Internal use only5_13
- Printed name of elector6_13
- Full residential address street numbernamecity6_13
- Postal code6_13
- Elector signature6_13
- Witness initials6_13
- Internal use only6_13
- Printed name of elector7_13
- Full residential address street numbernamecity7_13
- Postal code7_13
- Elector signature7_13
- Witness initials7_13
- Internal use only7_13
- Printed name of elector8_13
- Full residential address street numbernamecity8_13
- Postal code8_13
- Elector signature8_13
- Witness initials8_13
- Internal use only8_13
- Printed name of elector9_13
- Full residential address street numbernamecity9_13
- Postal code9_13
- Elector signature9_13
- Witness initials9_13
- Internal use only9_13
- Printed name of elector10_13
- Full residential address street numbernamecity10_13
- Postal code10_13
- Elector signature10_13
- Witness initials10_13
- Internal use only10_13
- Printed name of elector1_14
- Full residential address street numbernamecity1_14
- Postal code1_14
- Elector signature1_14
- Witness initials1_14
- Internal use only1_14
- Printed name of elector2_14
- Full residential address street numbernamecity2_14
- Postal code2_14
- Elector signature2_14
- Witness initials2_14
- Internal use only2_14
- Printed name of elector3_14
- Full residential address street numbernamecity3_14
- Postal code3_14
- Elector signature3_14
- Witness initials3_14
- Internal use only3_14
- Printed name of elector4_14
- Full residential address street numbernamecity4_14
- Postal code4_14
- Elector signature4_14
- Witness initials4_14
- Internal use only4_14
- Printed name of elector5_14
- Full residential address street numbernamecity5_14
- Postal code5_14
- Elector signature5_14
- Witness initials5_14
- Internal use only5_14
- Printed name of elector6_14
- Full residential address street numbernamecity6_14
- Postal code6_14
- Elector signature6_14
- Witness initials6_14
- Internal use only6_14
- Printed name of elector7_14
- Full residential address street numbernamecity7_14
- Postal code7_14
- Elector signature7_14
- Witness initials7_14
- Internal use only7_14
- Printed name of elector8_14
- Full residential address street numbernamecity8_14
- Postal code8_14
- Elector signature8_14
- Witness initials8_14
- Internal use only8_14
- Printed name of elector9_14
- Full residential address street numbernamecity9_14
- Postal code9_14
- Elector signature9_14
- Witness initials9_14
- Internal use only9_14
- Printed name of elector10_14
- Full residential address street numbernamecity10_14
- Postal code10_14
- Elector signature10_14
- Witness initials10_14
- Internal use only10_14
- Printed name of elector1_15
- Full residential address street numbernamecity1_15
- Postal code1_15
- Elector signature1_15
- Witness initials1_15
- Internal use only1_15
- Printed name of elector2_15
- Full residential address street numbernamecity2_15
- Postal code2_15
- Elector signature2_15
- Witness initials2_15
- Internal use only2_15
- Printed name of elector3_15
- Full residential address street numbernamecity3_15
- Postal code3_15
- Elector signature3_15
- Witness initials3_15
- Internal use only3_15
- Printed name of elector4_15
- Full residential address street numbernamecity4_15
- Postal code4_15
- Elector signature4_15
- Witness initials4_15
- Internal use only4_15
- Printed name of elector5_15
- Full residential address street numbernamecity5_15
- Postal code5_15
- Elector signature5_15
- Witness initials5_15
- Internal use only5_15
- Printed name of elector6_15
- Full residential address street numbernamecity6_15
- Postal code6_15
- Elector signature6_15
- Witness initials6_15
- Internal use only6_15
- Printed name of elector7_15
- Full residential address street numbernamecity7_15
- Postal code7_15
- Elector signature7_15
- Witness initials7_15
- Internal use only7_15
- Printed name of elector8_15
- Full residential address street numbernamecity8_15
- Postal code8_15
- Elector signature8_15
- Witness initials8_15
- Internal use only8_15
- Printed name of elector9_15
- Full residential address street numbernamecity9_15
- Postal code9_15
- Elector signature9_15
- Witness initials9_15
- Internal use only9_15
- Printed name of elector10_15
- Full residential address street numbernamecity10_15
- Postal code10_15
- Elector signature10_15
- Witness initials10_15
- Internal use only10_15
- Printed name of elector1_16
- Full residential address street numbernamecity1_16
- Postal code1_16
- Elector signature1_16
- Witness initials1_16
- Internal use only1_16
- Printed name of elector2_16
- Full residential address street numbernamecity2_16
- Postal code2_16
- Elector signature2_16
- Witness initials2_16
- Internal use only2_16
- Printed name of elector3_16
- Full residential address street numbernamecity3_16
- Postal code3_16
- Elector signature3_16
- Witness initials3_16
- Internal use only3_16
- Printed name of elector4_16
- Full residential address street numbernamecity4_16
- Postal code4_16
- Elector signature4_16
- Witness initials4_16
- Internal use only4_16
- Printed name of elector5_16
- Full residential address street numbernamecity5_16
- Postal code5_16
- Elector signature5_16
- Witness initials5_16
- Internal use only5_16
- Printed name of elector6_16
- Full residential address street numbernamecity6_16
- Postal code6_16
- Elector signature6_16
- Witness initials6_16
- Internal use only6_16
- Printed name of elector7_16
- Full residential address street numbernamecity7_16
- Postal code7_16
- Elector signature7_16
- Witness initials7_16
- Internal use only7_16
- Printed name of elector8_16
- Full residential address street numbernamecity8_16
- Postal code8_16
- Elector signature8_16
- Witness initials8_16
- Internal use only8_16
- Printed name of elector9_16
- Full residential address street numbernamecity9_16
- Postal code9_16
- Elector signature9_16
- Witness initials9_16
- Internal use only9_16
- Printed name of elector10_16
- Full residential address street numbernamecity10_16
- Postal code10_16
- Elector signature10_16
- Witness initials10_16
- Internal use only10_16
- Have you completed the Nomination Paper EC 20010 Off
- Do you have authorized proof of identify Off
- Are you endorsed by a political party Off
- Have you made a nomination appointment Off
- Last name - Candidate Name
- First name - Candidate Name
- Name of electoral district- Candidate Information
- First name - Candidate Information
- Last name - Candidate Information
- Ballot Name Off
- Ballot First name(s)
- Ballot Last name(s)
- Gender -Candidate information
- Date of birth (YYY-MM-DD) - Gender -Candidate information
- language of correspondence - Candidate information Off
- Email -Contact information
- Primary phone number - Contact information
- Ext - Primary phone number
- Alternate phone number - Contact information
- Ext - Alternate phone number
- Fax number- Alternate phone number
- Unit -Residential address
- Street -Residential address
- Street name -Residential address
- City -Residential address
- ProvinceTerritory -Residential address
- Postal code - -Residential address
- Mailing address - same as residential address Off
- Occupation- Candidate occupation
- Sharing of information with the Conflict of Interest and Ethics Commissioner and the House of Commons including the Library of Parliament Off
- where applicable if the returning officer is unable to verify that I have been endorsed by the political party identified in section A of this Nomination Paper I wish to Off
- Date of Signature (YYYY-MM-DD) - Candidate signature
- Date of Signature (YYYY-MM-DD) -Signature of person receiving the solemn declaration
- Campaign delegate information
- First name - Campaign delegate information
- Last name - Campaign delegate information
- Language of correspondence - Campaign delegate information Off
- Email - Contact information -Campaign Delegate
- Primary phone number - Contact information -Campaign Delegate
- Primary phone number EXT - Contact information -Campaign Delegate
- Alternate phone number - Contact information -Campaign Delegate
- Alternate phone number EXT - Contact information -Campaign Delegate
- Fax nmuber- Contact information -Campaign Delegate
- Street - Residential address -Campaign delegate
- Street name - Residential address -Campaign delegate
- City - Residential address -Campaign delegate
- ProvinceTerritory - Residential address -Campaign delegate
- Postal Code - Residential address -Campaign delegate
- Campaign delegate - Mailing address ndash Same as residential address Off
- Unit - Residential address -Campaign delegate
- Date (YYYY-MM-DD) - Candidate authorization Signature
- Date (YYYY-MM-DD) - Candidate campaign Signature
- First name - Official agent information
- Last name - Official agent information
- Language of correspondence - Official agent information Off
- Email - Official agent information
- Primary phone number - Official agent information
- Primary phone number EXT - Official agent information
- Alternate phone number EXT - Official agent information
- Alternate phone number - Official agent information
- Fax number - Official agent information
- Unit -Residential address - Official Agent
- Street name -Residential address - Official Agent
- City -Residential address - Official Agent
- Street -Residential address - Official Agent
- ProvinceTerritory -Residential address - Official Agent
- Postal code-Residential address - Official Agent
- Mailing address ndash Same as residential address- Official Agent Off
- Date (YYYY-MM-DD) - Official agent signature
- First name - Auditor information
- Last name - Auditor information
- Language of correspondence - Auditor information Off
- Email - Auditor information
- Primary phone number - Auditor information
- Primary phone number EXT- Auditor information
- Alternate phone number - Auditor information
- Alternate phone number EXT- Auditor information
- Fax number - Auditor information
- Name of firm- Auditor organizational information
- Occupation of auditor - Auditor organizational information
- Professional designation - Auditor organizational information Off
- Designation registration number
- Make cheque payable to
- Unit - Address (where cheque is sent)
- Street - Address (where cheque is sent)
- Street name - Address (where cheque is sent)
- City - Address (where cheque is sent)
- ProvinceTerritory - Address (where cheque is sent)
- Postal code - Address (where cheque is sent)
- Date (YYY-MM-DD) - Auditor signature
- Unit - Campaign office address (optional)
- Street - Campaign office address (optional)
- Street name - Campaign office address (optional)
- City - Campaign office address (optional)
- ProvinceTerritory- Campaign office address (optional)
- Postal code - Campaign office address (optional)
- Name of witness
- Full address of witness
- Name of candidate
- Electoral district
- Year
- Name of candidate2
- Electoral district2
- Year2
- Name of witness2
- Full address of witness2
- Name of candidate3
- Electoral district3
- Year3
- Full address of witness3
- Name of witness3
- Name of candidate 4
- Electoral district4
- Year4
- Full address of witness 4
- Name of witness 4
- Name of candidate5
- Electoral district5
- Year5
- Full address of witness5
- Name of witness5
- Name of candidate6
- Electoral district6
- Year6
- Name of witness6
- Full address of witness6
- Name of candidate7
- Electoral district7
- Year7
- Full address of witness7
- Name of witness7
- Name of candidate8
- Electoral district8
- Year8
- Full address of witness8
- Name of witness8
- Name of candidate9
- Electoral district9
- Year9
- Full address of witness 9
- Name of witness 9
- Name of candidate10
- Electoral district10
- Year10
- Full address of witness10
- Name of witness10
- Name of candidate11
- Electoral district11
- Year11
- Full address of witness11
- Name of witness11
- Name of candidate12
- Electoral district12
- Year12
- Full address of witness12
- Name of witness12
- Name of candidate13
- Electoral district13
- Year13
- Full address of witness13
- Name of witness13
- Name of candidate14
- Electoral district14
- Year14
- Name of witness14
- Full address of witness14
- Name of candidate1
- Electoral district1
- Year1
- Name of witness1
- Full address of witness1
- Name of candidate15
- Electoral district15
- Year15
- Name of witness15
- Full address of witness15
- unit -Mailing address
- Street -Mailing address
- Street name -Mailing address
- City -Mailing address
- ProvinceTerritory -Mailing address
- Postal code -Mailing address
- Unit - Mailing address -Campaign delegate
- Street - Mailing address -Campaign delegate
- Street name - Mailing address -Campaign delegate
- City - Mailing address -Campaign delegate
- ProvinceTerritory- Mailing address -Campaign delegate
- Postal code- Mailing address -Campaign delegate
- Unit -Mailing address - Official Agent
- Street -Mailing address - Official Agent
- Street name -Mailing address - Official Agent
- city -Mailing address - Official Agent
- ProvinceTerritory-Mailing address - Official Agent
- Postal code-Mailing address - Official Agent
14BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
22
15BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
23
16BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
24
17BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
25
18BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
26
19BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
27
20BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
28
21BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
29
22BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
30
EC 20010 (022019)
SECTION G ndash 23B Are You Ready to Submit Your Nomination
Have you completed the Nomination Paper (EC 20010)
bull Are all mandatory fields in sections AndashE complete
bull Have you collected the required number of signatures from qualified electors in section F
o For most electoral districts 100 electors must consent to your candidacy
o For electoral districts identified in Schedule 3 only 50 electors are required
o To ensure a smooth nomination process Elections Canada recommends collecting signatures from at least 150 electors
Do you have authorized proof of identify
bull For a list of authorized identification visit the Elections Canada website
bull If a campaign delegate is submitting on your behalf they must bring a copy of your identification documents signed by you
bull If you want an alternative name to appear on the ballot additional documentation is required visit electionsca for details
Are you endorsed by a political party
bull Make sure your party has submitted the required documentation to Elections Canada attesting your designated political affiliation
Have you made a nomination appointment
bull To facilitate the nomination process make an appointment with the returning officer to finalize the filing of the complete nomination package
bull The nomination period closes 21 days before election day at 200 pm local time
31
- Nomination Paperof a Candidate at a Federal General Election or By-election
- Table of Contents
- General Information
- SECTION A ndash Candidate Information (Mandatory)
- SECTION B ndash Campaign Delegate (Optional)
- SECTION C ndash Official Agent (Mandatory)
- SECTION D ndash Auditor (Optional)
- SECTION E ndash Campaign Office (Optional)
- SECTION F ndash Electors Consenting to Candidacy (Mandatory)
-
- Name of electoral district
- Political affiliation
- Telephone number to be posted on electionsca
- Website to be posted on electionsca including prefix http https
- Printed name of elector1
- Full residential address street numbernamecity1
- Postal code1
- Elector signature1
- Witness initials1
- Internal use only1
- Printed name of elector2
- Full residential address street numbernamecity2
- Postal code2
- Elector signature2
- Witness initials2
- Internal use only2
- Printed name of elector3
- Full residential address street numbernamecity3
- Postal code3
- Elector signature3
- Witness initials3
- Internal use only3
- Printed name of elector4
- Full residential address street numbernamecity4
- Postal code4
- Elector signature4
- Witness initials4
- Internal use only4
- Printed name of elector5
- Full residential address street numbernamecity5
- Postal code5
- Elector signature5
- Witness initials5
- Internal use only5
- Printed name of elector6
- Full residential address street numbernamecity6
- Postal code6
- Elector signature6
- Witness initials6
- Internal use only6
- Printed name of elector7
- Full residential address street numbernamecity7
- Postal code7
- Elector signature7
- Witness initials7
- Internal use only7
- Printed name of elector8
- Full residential address street numbernamecity8
- Postal code8
- Elector signature8
- Witness initials8
- Internal use only8
- Printed name of elector9
- Full residential address street numbernamecity9
- Postal code9
- Elector signature9
- Witness initials9
- Internal use only9
- Printed name of elector10
- Full residential address street numbernamecity10
- Postal code10
- Elector signature10
- Witness initials10
- Internal use only10
- Printed name of elector1_2
- Full residential address street numbernamecity1_2
- Postal code1_2
- Elector signature1_2
- Witness initials1_2
- Internal use only1_2
- Printed name of elector2_2
- Full residential address street numbernamecity2_2
- Postal code2_2
- Elector signature2_2
- Witness initials2_2
- Internal use only2_2
- Printed name of elector3_2
- Full residential address street numbernamecity3_2
- Postal code3_2
- Elector signature3_2
- Witness initials3_2
- Internal use only3_2
- Printed name of elector4_2
- Full residential address street numbernamecity4_2
- Postal code4_2
- Elector signature4_2
- Witness initials4_2
- Internal use only4_2
- Printed name of elector5_2
- Full residential address street numbernamecity5_2
- Postal code5_2
- Elector signature5_2
- Witness initials5_2
- Internal use only5_2
- Printed name of elector6_2
- Full residential address street numbernamecity6_2
- Postal code6_2
- Elector signature6_2
- Witness initials6_2
- Internal use only6_2
- Printed name of elector7_2
- Full residential address street numbernamecity7_2
- Postal code7_2
- Elector signature7_2
- Witness initials7_2
- Internal use only7_2
- Printed name of elector8_2
- Full residential address street numbernamecity8_2
- Postal code8_2
- Elector signature8_2
- Witness initials8_2
- Internal use only8_2
- Printed name of elector9_2
- Full residential address street numbernamecity9_2
- Postal code9_2
- Elector signature9_2
- Witness initials9_2
- Internal use only9_2
- Printed name of elector10_2
- Full residential address street numbernamecity10_2
- Postal code10_2
- Elector signature10_2
- Witness initials10_2
- Internal use only10_2
- Printed name of elector1_3
- Full residential address street numbernamecity1_3
- Postal code1_3
- Elector signature1_3
- Witness initials1_3
- Internal use only1_3
- Printed name of elector2_3
- Full residential address street numbernamecity2_3
- Postal code2_3
- Elector signature2_3
- Witness initials2_3
- Internal use only2_3
- Printed name of elector3_3
- Full residential address street numbernamecity3_3
- Postal code3_3
- Elector signature3_3
- Witness initials3_3
- Internal use only3_3
- Printed name of elector4_3
- Full residential address street numbernamecity4_3
- Postal code4_3
- Elector signature4_3
- Witness initials4_3
- Internal use only4_3
- Printed name of elector5_3
- Full residential address street numbernamecity5_3
- Postal code5_3
- Elector signature5_3
- Witness initials5_3
- Internal use only5_3
- Printed name of elector6_3
- Full residential address street numbernamecity6_3
- Postal code6_3
- Elector signature6_3
- Witness initials6_3
- Internal use only6_3
- Printed name of elector7_3
- Full residential address street numbernamecity7_3
- Postal code7_3
- Elector signature7_3
- Witness initials7_3
- Internal use only7_3
- Printed name of elector8_3
- Full residential address street numbernamecity8_3
- Postal code8_3
- Elector signature8_3
- Witness initials8_3
- Internal use only8_3
- Printed name of elector9_3
- Full residential address street numbernamecity9_3
- Postal code9_3
- Elector signature9_3
- Witness initials9_3
- Internal use only9_3
- Printed name of elector10_3
- Full residential address street numbernamecity10_3
- Postal code10_3
- Elector signature10_3
- Witness initials10_3
- Internal use only10_3
- Printed name of elector1_4
- Full residential address street numbernamecity1_4
- Postal code1_4
- Elector signature1_4
- Witness initials1_4
- Internal use only1_4
- Printed name of elector2_4
- Full residential address street numbernamecity2_4
- Postal code2_4
- Elector signature2_4
- Witness initials2_4
- Internal use only2_4
- Printed name of elector3_4
- Full residential address street numbernamecity3_4
- Postal code3_4
- Elector signature3_4
- Witness initials3_4
- Internal use only3_4
- Printed name of elector4_4
- Full residential address street numbernamecity4_4
- Postal code4_4
- Elector signature4_4
- Witness initials4_4
- Internal use only4_4
- Printed name of elector5_4
- Full residential address street numbernamecity5_4
- Postal code5_4
- Elector signature5_4
- Witness initials5_4
- Internal use only5_4
- Printed name of elector6_4
- Full residential address street numbernamecity6_4
- Postal code6_4
- Elector signature6_4
- Witness initials6_4
- Internal use only6_4
- Printed name of elector7_4
- Full residential address street numbernamecity7_4
- Postal code7_4
- Elector signature7_4
- Witness initials7_4
- Internal use only7_4
- Printed name of elector8_4
- Full residential address street numbernamecity8_4
- Postal code8_4
- Elector signature8_4
- Witness initials8_4
- Internal use only8_4
- Printed name of elector9_4
- Full residential address street numbernamecity9_4
- Postal code9_4
- Elector signature9_4
- Witness initials9_4
- Internal use only9_4
- Printed name of elector10_4
- Full residential address street numbernamecity10_4
- Postal code10_4
- Elector signature10_4
- Witness initials10_4
- Internal use only10_4
- Printed name of elector1_5
- Full residential address street numbernamecity1_5
- Postal code1_5
- Elector signature1_5
- Witness initials1_5
- Internal use only1_5
- Printed name of elector2_5
- Full residential address street numbernamecity2_5
- Postal code2_5
- Elector signature2_5
- Witness initials2_5
- Internal use only2_5
- Printed name of elector3_5
- Full residential address street numbernamecity3_5
- Postal code3_5
- Elector signature3_5
- Witness initials3_5
- Internal use only3_5
- Printed name of elector4_5
- Full residential address street numbernamecity4_5
- Postal code4_5
- Elector signature4_5
- Witness initials4_5
- Internal use only4_5
- Printed name of elector5_5
- Full residential address street numbernamecity5_5
- Postal code5_5
- Elector signature5_5
- Witness initials5_5
- Internal use only5_5
- Printed name of elector6_5
- Full residential address street numbernamecity6_5
- Postal code6_5
- Elector signature6_5
- Witness initials6_5
- Internal use only6_5
- Printed name of elector7_5
- Full residential address street numbernamecity7_5
- Postal code7_5
- Elector signature7_5
- Witness initials7_5
- Internal use only7_5
- Printed name of elector8_5
- Full residential address street numbernamecity8_5
- Postal code8_5
- Elector signature8_5
- Witness initials8_5
- Internal use only8_5
- Printed name of elector9_5
- Full residential address street numbernamecity9_5
- Postal code9_5
- Elector signature9_5
- Witness initials9_5
- Internal use only9_5
- Printed name of elector10_5
- Full residential address street numbernamecity10_5
- Postal code10_5
- Elector signature10_5
- Witness initials10_5
- Internal use only10_5
- Printed name of elector1_6
- Full residential address street numbernamecity1_6
- Postal code1_6
- Elector signature1_6
- Witness initials1_6
- Internal use only1_6
- Printed name of elector2_6
- Full residential address street numbernamecity2_6
- Postal code2_6
- Elector signature2_6
- Witness initials2_6
- Internal use only2_6
- Printed name of elector3_6
- Full residential address street numbernamecity3_6
- Postal code3_6
- Elector signature3_6
- Witness initials3_6
- Internal use only3_6
- Printed name of elector4_6
- Full residential address street numbernamecity4_6
- Postal code4_6
- Elector signature4_6
- Witness initials4_6
- Internal use only4_6
- Printed name of elector5_6
- Full residential address street numbernamecity5_6
- Postal code5_6
- Elector signature5_6
- Witness initials5_6
- Internal use only5_6
- Printed name of elector6_6
- Full residential address street numbernamecity6_6
- Postal code6_6
- Elector signature6_6
- Witness initials6_6
- Internal use only6_6
- Printed name of elector7_6
- Full residential address street numbernamecity7_6
- Postal code7_6
- Elector signature7_6
- Witness initials7_6
- Internal use only7_6
- Printed name of elector8_6
- Full residential address street numbernamecity8_6
- Postal code8_6
- Elector signature8_6
- Witness initials8_6
- Internal use only8_6
- Printed name of elector9_6
- Full residential address street numbernamecity9_6
- Postal code9_6
- Elector signature9_6
- Witness initials9_6
- Internal use only9_6
- Printed name of elector10_6
- Full residential address street numbernamecity10_6
- Postal code10_6
- Elector signature10_6
- Witness initials10_6
- Internal use only10_6
- Printed name of elector1_7
- Full residential address street numbernamecity1_7
- Postal code1_7
- Elector signature1_7
- Witness initials1_7
- Internal use only1_7
- Printed name of elector2_7
- Full residential address street numbernamecity2_7
- Postal code2_7
- Elector signature2_7
- Witness initials2_7
- Internal use only2_7
- Printed name of elector3_7
- Full residential address street numbernamecity3_7
- Postal code3_7
- Elector signature3_7
- Witness initials3_7
- Internal use only3_7
- Printed name of elector4_7
- Full residential address street numbernamecity4_7
- Postal code4_7
- Elector signature4_7
- Witness initials4_7
- Internal use only4_7
- Printed name of elector5_7
- Full residential address street numbernamecity5_7
- Postal code5_7
- Elector signature5_7
- Witness initials5_7
- Internal use only5_7
- Printed name of elector6_7
- Full residential address street numbernamecity6_7
- Postal code6_7
- Elector signature6_7
- Witness initials6_7
- Internal use only6_7
- Printed name of elector7_7
- Full residential address street numbernamecity7_7
- Postal code7_7
- Elector signature7_7
- Witness initials7_7
- Internal use only7_7
- Printed name of elector8_7
- Full residential address street numbernamecity8_7
- Postal code8_7
- Elector signature8_7
- Witness initials8_7
- Internal use only8_7
- Printed name of elector9_7
- Full residential address street numbernamecity9_7
- Postal code9_7
- Elector signature9_7
- Witness initials9_7
- Internal use only9_7
- Printed name of elector10_7
- Full residential address street numbernamecity10_7
- Postal code10_7
- Elector signature10_7
- Witness initials10_7
- Internal use only10_7
- Printed name of elector1_8
- Full residential address street numbernamecity1_8
- Postal code1_8
- Elector signature1_8
- Witness initials1_8
- Internal use only1_8
- Printed name of elector2_8
- Full residential address street numbernamecity2_8
- Postal code2_8
- Elector signature2_8
- Witness initials2_8
- Internal use only2_8
- Printed name of elector3_8
- Full residential address street numbernamecity3_8
- Postal code3_8
- Elector signature3_8
- Witness initials3_8
- Internal use only3_8
- Printed name of elector4_8
- Full residential address street numbernamecity4_8
- Postal code4_8
- Elector signature4_8
- Witness initials4_8
- Internal use only4_8
- Printed name of elector5_8
- Full residential address street numbernamecity5_8
- Postal code5_8
- Elector signature5_8
- Witness initials5_8
- Internal use only5_8
- Printed name of elector6_8
- Full residential address street numbernamecity6_8
- Postal code6_8
- Elector signature6_8
- Witness initials6_8
- Internal use only6_8
- Printed name of elector7_8
- Full residential address street numbernamecity7_8
- Postal code7_8
- Elector signature7_8
- Witness initials7_8
- Internal use only7_8
- Printed name of elector8_8
- Full residential address street numbernamecity8_8
- Postal code8_8
- Elector signature8_8
- Witness initials8_8
- Internal use only8_8
- Printed name of elector9_8
- Full residential address street numbernamecity9_8
- Postal code9_8
- Elector signature9_8
- Witness initials9_8
- Internal use only9_8
- Printed name of elector10_8
- Full residential address street numbernamecity10_8
- Postal code10_8
- Elector signature10_8
- Witness initials10_8
- Internal use only10_8
- Printed name of elector1_9
- Full residential address street numbernamecity1_9
- Postal code1_9
- Elector signature1_9
- Witness initials1_9
- Internal use only1_9
- Printed name of elector2_9
- Full residential address street numbernamecity2_9
- Postal code2_9
- Elector signature2_9
- Witness initials2_9
- Internal use only2_9
- Printed name of elector3_9
- Full residential address street numbernamecity3_9
- Postal code3_9
- Elector signature3_9
- Witness initials3_9
- Internal use only3_9
- Printed name of elector4_9
- Full residential address street numbernamecity4_9
- Postal code4_9
- Elector signature4_9
- Witness initials4_9
- Internal use only4_9
- Printed name of elector5_9
- Full residential address street numbernamecity5_9
- Postal code5_9
- Elector signature5_9
- Witness initials5_9
- Internal use only5_9
- Printed name of elector6_9
- Full residential address street numbernamecity6_9
- Postal code6_9
- Elector signature6_9
- Witness initials6_9
- Internal use only6_9
- Printed name of elector7_9
- Full residential address street numbernamecity7_9
- Postal code7_9
- Elector signature7_9
- Witness initials7_9
- Internal use only7_9
- Printed name of elector8_9
- Full residential address street numbernamecity8_9
- Postal code8_9
- Elector signature8_9
- Witness initials8_9
- Internal use only8_9
- Printed name of elector9_9
- Full residential address street numbernamecity9_9
- Postal code9_9
- Elector signature9_9
- Witness initials9_9
- Internal use only9_9
- Printed name of elector10_9
- Full residential address street numbernamecity10_9
- Postal code10_9
- Elector signature10_9
- Witness initials10_9
- Internal use only10_9
- Printed name of elector1_10
- Full residential address street numbernamecity1_10
- Postal code1_10
- Elector signature1_10
- Witness initials1_10
- Internal use only1_10
- Printed name of elector2_10
- Full residential address street numbernamecity2_10
- Postal code2_10
- Elector signature2_10
- Witness initials2_10
- Internal use only2_10
- Printed name of elector3_10
- Full residential address street numbernamecity3_10
- Postal code3_10
- Elector signature3_10
- Witness initials3_10
- Internal use only3_10
- Printed name of elector4_10
- Full residential address street numbernamecity4_10
- Postal code4_10
- Elector signature4_10
- Witness initials4_10
- Internal use only4_10
- Printed name of elector5_10
- Full residential address street numbernamecity5_10
- Postal code5_10
- Elector signature5_10
- Witness initials5_10
- Internal use only5_10
- Printed name of elector6_10
- Full residential address street numbernamecity6_10
- Postal code6_10
- Elector signature6_10
- Witness initials6_10
- Internal use only6_10
- Printed name of elector7_10
- Full residential address street numbernamecity7_10
- Postal code7_10
- Elector signature7_10
- Witness initials7_10
- Internal use only7_10
- Printed name of elector8_10
- Full residential address street numbernamecity8_10
- Postal code8_10
- Elector signature8_10
- Witness initials8_10
- Internal use only8_10
- Printed name of elector9_10
- Full residential address street numbernamecity9_10
- Postal code9_10
- Elector signature9_10
- Witness initials9_10
- Internal use only9_10
- Printed name of elector10_10
- Full residential address street numbernamecity10_10
- Postal code10_10
- Elector signature10_10
- Witness initials10_10
- Internal use only10_10
- Printed name of elector1_11
- Full residential address street numbernamecity1_11
- Postal code1_11
- Elector signature1_11
- Witness initials1_11
- Internal use only1_11
- Printed name of elector2_11
- Full residential address street numbernamecity2_11
- Postal code2_11
- Elector signature2_11
- Witness initials2_11
- Internal use only2_11
- Printed name of elector3_11
- Full residential address street numbernamecity3_11
- Postal code3_11
- Elector signature3_11
- Witness initials3_11
- Internal use only3_11
- Printed name of elector4_11
- Full residential address street numbernamecity4_11
- Postal code4_11
- Elector signature4_11
- Witness initials4_11
- Internal use only4_11
- Printed name of elector5_11
- Full residential address street numbernamecity5_11
- Postal code5_11
- Elector signature5_11
- Witness initials5_11
- Internal use only5_11
- Printed name of elector6_11
- Full residential address street numbernamecity6_11
- Postal code6_11
- Elector signature6_11
- Witness initials6_11
- Internal use only6_11
- Printed name of elector7_11
- Full residential address street numbernamecity7_11
- Postal code7_11
- Elector signature7_11
- Witness initials7_11
- Internal use only7_11
- Printed name of elector8_11
- Full residential address street numbernamecity8_11
- Postal code8_11
- Elector signature8_11
- Witness initials8_11
- Internal use only8_11
- Printed name of elector9_11
- Full residential address street numbernamecity9_11
- Postal code9_11
- Elector signature9_11
- Witness initials9_11
- Internal use only9_11
- Printed name of elector10_11
- Full residential address street numbernamecity10_11
- Postal code10_11
- Elector signature10_11
- Witness initials10_11
- Internal use only10_11
- Printed name of elector1_12
- Full residential address street numbernamecity1_12
- Postal code1_12
- Elector signature1_12
- Witness initials1_12
- Internal use only1_12
- Printed name of elector2_12
- Full residential address street numbernamecity2_12
- Postal code2_12
- Elector signature2_12
- Witness initials2_12
- Internal use only2_12
- Printed name of elector3_12
- Full residential address street numbernamecity3_12
- Postal code3_12
- Elector signature3_12
- Witness initials3_12
- Internal use only3_12
- Printed name of elector4_12
- Full residential address street numbernamecity4_12
- Postal code4_12
- Elector signature4_12
- Witness initials4_12
- Internal use only4_12
- Printed name of elector5_12
- Full residential address street numbernamecity5_12
- Postal code5_12
- Elector signature5_12
- Witness initials5_12
- Internal use only5_12
- Printed name of elector6_12
- Full residential address street numbernamecity6_12
- Postal code6_12
- Elector signature6_12
- Witness initials6_12
- Internal use only6_12
- Printed name of elector7_12
- Full residential address street numbernamecity7_12
- Postal code7_12
- Elector signature7_12
- Witness initials7_12
- Internal use only7_12
- Printed name of elector8_12
- Full residential address street numbernamecity8_12
- Postal code8_12
- Elector signature8_12
- Witness initials8_12
- Internal use only8_12
- Printed name of elector9_12
- Full residential address street numbernamecity9_12
- Postal code9_12
- Elector signature9_12
- Witness initials9_12
- Internal use only9_12
- Printed name of elector10_12
- Full residential address street numbernamecity10_12
- Postal code10_12
- Elector signature10_12
- Witness initials10_12
- Internal use only10_12
- Printed name of elector1_13
- Full residential address street numbernamecity1_13
- Postal code1_13
- Elector signature1_13
- Witness initials1_13
- Internal use only1_13
- Printed name of elector2_13
- Full residential address street numbernamecity2_13
- Postal code2_13
- Elector signature2_13
- Witness initials2_13
- Internal use only2_13
- Printed name of elector3_13
- Full residential address street numbernamecity3_13
- Postal code3_13
- Elector signature3_13
- Witness initials3_13
- Internal use only3_13
- Printed name of elector4_13
- Full residential address street numbernamecity4_13
- Postal code4_13
- Elector signature4_13
- Witness initials4_13
- Internal use only4_13
- Printed name of elector5_13
- Full residential address street numbernamecity5_13
- Postal code5_13
- Elector signature5_13
- Witness initials5_13
- Internal use only5_13
- Printed name of elector6_13
- Full residential address street numbernamecity6_13
- Postal code6_13
- Elector signature6_13
- Witness initials6_13
- Internal use only6_13
- Printed name of elector7_13
- Full residential address street numbernamecity7_13
- Postal code7_13
- Elector signature7_13
- Witness initials7_13
- Internal use only7_13
- Printed name of elector8_13
- Full residential address street numbernamecity8_13
- Postal code8_13
- Elector signature8_13
- Witness initials8_13
- Internal use only8_13
- Printed name of elector9_13
- Full residential address street numbernamecity9_13
- Postal code9_13
- Elector signature9_13
- Witness initials9_13
- Internal use only9_13
- Printed name of elector10_13
- Full residential address street numbernamecity10_13
- Postal code10_13
- Elector signature10_13
- Witness initials10_13
- Internal use only10_13
- Printed name of elector1_14
- Full residential address street numbernamecity1_14
- Postal code1_14
- Elector signature1_14
- Witness initials1_14
- Internal use only1_14
- Printed name of elector2_14
- Full residential address street numbernamecity2_14
- Postal code2_14
- Elector signature2_14
- Witness initials2_14
- Internal use only2_14
- Printed name of elector3_14
- Full residential address street numbernamecity3_14
- Postal code3_14
- Elector signature3_14
- Witness initials3_14
- Internal use only3_14
- Printed name of elector4_14
- Full residential address street numbernamecity4_14
- Postal code4_14
- Elector signature4_14
- Witness initials4_14
- Internal use only4_14
- Printed name of elector5_14
- Full residential address street numbernamecity5_14
- Postal code5_14
- Elector signature5_14
- Witness initials5_14
- Internal use only5_14
- Printed name of elector6_14
- Full residential address street numbernamecity6_14
- Postal code6_14
- Elector signature6_14
- Witness initials6_14
- Internal use only6_14
- Printed name of elector7_14
- Full residential address street numbernamecity7_14
- Postal code7_14
- Elector signature7_14
- Witness initials7_14
- Internal use only7_14
- Printed name of elector8_14
- Full residential address street numbernamecity8_14
- Postal code8_14
- Elector signature8_14
- Witness initials8_14
- Internal use only8_14
- Printed name of elector9_14
- Full residential address street numbernamecity9_14
- Postal code9_14
- Elector signature9_14
- Witness initials9_14
- Internal use only9_14
- Printed name of elector10_14
- Full residential address street numbernamecity10_14
- Postal code10_14
- Elector signature10_14
- Witness initials10_14
- Internal use only10_14
- Printed name of elector1_15
- Full residential address street numbernamecity1_15
- Postal code1_15
- Elector signature1_15
- Witness initials1_15
- Internal use only1_15
- Printed name of elector2_15
- Full residential address street numbernamecity2_15
- Postal code2_15
- Elector signature2_15
- Witness initials2_15
- Internal use only2_15
- Printed name of elector3_15
- Full residential address street numbernamecity3_15
- Postal code3_15
- Elector signature3_15
- Witness initials3_15
- Internal use only3_15
- Printed name of elector4_15
- Full residential address street numbernamecity4_15
- Postal code4_15
- Elector signature4_15
- Witness initials4_15
- Internal use only4_15
- Printed name of elector5_15
- Full residential address street numbernamecity5_15
- Postal code5_15
- Elector signature5_15
- Witness initials5_15
- Internal use only5_15
- Printed name of elector6_15
- Full residential address street numbernamecity6_15
- Postal code6_15
- Elector signature6_15
- Witness initials6_15
- Internal use only6_15
- Printed name of elector7_15
- Full residential address street numbernamecity7_15
- Postal code7_15
- Elector signature7_15
- Witness initials7_15
- Internal use only7_15
- Printed name of elector8_15
- Full residential address street numbernamecity8_15
- Postal code8_15
- Elector signature8_15
- Witness initials8_15
- Internal use only8_15
- Printed name of elector9_15
- Full residential address street numbernamecity9_15
- Postal code9_15
- Elector signature9_15
- Witness initials9_15
- Internal use only9_15
- Printed name of elector10_15
- Full residential address street numbernamecity10_15
- Postal code10_15
- Elector signature10_15
- Witness initials10_15
- Internal use only10_15
- Printed name of elector1_16
- Full residential address street numbernamecity1_16
- Postal code1_16
- Elector signature1_16
- Witness initials1_16
- Internal use only1_16
- Printed name of elector2_16
- Full residential address street numbernamecity2_16
- Postal code2_16
- Elector signature2_16
- Witness initials2_16
- Internal use only2_16
- Printed name of elector3_16
- Full residential address street numbernamecity3_16
- Postal code3_16
- Elector signature3_16
- Witness initials3_16
- Internal use only3_16
- Printed name of elector4_16
- Full residential address street numbernamecity4_16
- Postal code4_16
- Elector signature4_16
- Witness initials4_16
- Internal use only4_16
- Printed name of elector5_16
- Full residential address street numbernamecity5_16
- Postal code5_16
- Elector signature5_16
- Witness initials5_16
- Internal use only5_16
- Printed name of elector6_16
- Full residential address street numbernamecity6_16
- Postal code6_16
- Elector signature6_16
- Witness initials6_16
- Internal use only6_16
- Printed name of elector7_16
- Full residential address street numbernamecity7_16
- Postal code7_16
- Elector signature7_16
- Witness initials7_16
- Internal use only7_16
- Printed name of elector8_16
- Full residential address street numbernamecity8_16
- Postal code8_16
- Elector signature8_16
- Witness initials8_16
- Internal use only8_16
- Printed name of elector9_16
- Full residential address street numbernamecity9_16
- Postal code9_16
- Elector signature9_16
- Witness initials9_16
- Internal use only9_16
- Printed name of elector10_16
- Full residential address street numbernamecity10_16
- Postal code10_16
- Elector signature10_16
- Witness initials10_16
- Internal use only10_16
- Have you completed the Nomination Paper EC 20010 Off
- Do you have authorized proof of identify Off
- Are you endorsed by a political party Off
- Have you made a nomination appointment Off
- Last name - Candidate Name
- First name - Candidate Name
- Name of electoral district- Candidate Information
- First name - Candidate Information
- Last name - Candidate Information
- Ballot Name Off
- Ballot First name(s)
- Ballot Last name(s)
- Gender -Candidate information
- Date of birth (YYY-MM-DD) - Gender -Candidate information
- language of correspondence - Candidate information Off
- Email -Contact information
- Primary phone number - Contact information
- Ext - Primary phone number
- Alternate phone number - Contact information
- Ext - Alternate phone number
- Fax number- Alternate phone number
- Unit -Residential address
- Street -Residential address
- Street name -Residential address
- City -Residential address
- ProvinceTerritory -Residential address
- Postal code - -Residential address
- Mailing address - same as residential address Off
- Occupation- Candidate occupation
- Sharing of information with the Conflict of Interest and Ethics Commissioner and the House of Commons including the Library of Parliament Off
- where applicable if the returning officer is unable to verify that I have been endorsed by the political party identified in section A of this Nomination Paper I wish to Off
- Date of Signature (YYYY-MM-DD) - Candidate signature
- Date of Signature (YYYY-MM-DD) -Signature of person receiving the solemn declaration
- Campaign delegate information
- First name - Campaign delegate information
- Last name - Campaign delegate information
- Language of correspondence - Campaign delegate information Off
- Email - Contact information -Campaign Delegate
- Primary phone number - Contact information -Campaign Delegate
- Primary phone number EXT - Contact information -Campaign Delegate
- Alternate phone number - Contact information -Campaign Delegate
- Alternate phone number EXT - Contact information -Campaign Delegate
- Fax nmuber- Contact information -Campaign Delegate
- Street - Residential address -Campaign delegate
- Street name - Residential address -Campaign delegate
- City - Residential address -Campaign delegate
- ProvinceTerritory - Residential address -Campaign delegate
- Postal Code - Residential address -Campaign delegate
- Campaign delegate - Mailing address ndash Same as residential address Off
- Unit - Residential address -Campaign delegate
- Date (YYYY-MM-DD) - Candidate authorization Signature
- Date (YYYY-MM-DD) - Candidate campaign Signature
- First name - Official agent information
- Last name - Official agent information
- Language of correspondence - Official agent information Off
- Email - Official agent information
- Primary phone number - Official agent information
- Primary phone number EXT - Official agent information
- Alternate phone number EXT - Official agent information
- Alternate phone number - Official agent information
- Fax number - Official agent information
- Unit -Residential address - Official Agent
- Street name -Residential address - Official Agent
- City -Residential address - Official Agent
- Street -Residential address - Official Agent
- ProvinceTerritory -Residential address - Official Agent
- Postal code-Residential address - Official Agent
- Mailing address ndash Same as residential address- Official Agent Off
- Date (YYYY-MM-DD) - Official agent signature
- First name - Auditor information
- Last name - Auditor information
- Language of correspondence - Auditor information Off
- Email - Auditor information
- Primary phone number - Auditor information
- Primary phone number EXT- Auditor information
- Alternate phone number - Auditor information
- Alternate phone number EXT- Auditor information
- Fax number - Auditor information
- Name of firm- Auditor organizational information
- Occupation of auditor - Auditor organizational information
- Professional designation - Auditor organizational information Off
- Designation registration number
- Make cheque payable to
- Unit - Address (where cheque is sent)
- Street - Address (where cheque is sent)
- Street name - Address (where cheque is sent)
- City - Address (where cheque is sent)
- ProvinceTerritory - Address (where cheque is sent)
- Postal code - Address (where cheque is sent)
- Date (YYY-MM-DD) - Auditor signature
- Unit - Campaign office address (optional)
- Street - Campaign office address (optional)
- Street name - Campaign office address (optional)
- City - Campaign office address (optional)
- ProvinceTerritory- Campaign office address (optional)
- Postal code - Campaign office address (optional)
- Name of witness
- Full address of witness
- Name of candidate
- Electoral district
- Year
- Name of candidate2
- Electoral district2
- Year2
- Name of witness2
- Full address of witness2
- Name of candidate3
- Electoral district3
- Year3
- Full address of witness3
- Name of witness3
- Name of candidate 4
- Electoral district4
- Year4
- Full address of witness 4
- Name of witness 4
- Name of candidate5
- Electoral district5
- Year5
- Full address of witness5
- Name of witness5
- Name of candidate6
- Electoral district6
- Year6
- Name of witness6
- Full address of witness6
- Name of candidate7
- Electoral district7
- Year7
- Full address of witness7
- Name of witness7
- Name of candidate8
- Electoral district8
- Year8
- Full address of witness8
- Name of witness8
- Name of candidate9
- Electoral district9
- Year9
- Full address of witness 9
- Name of witness 9
- Name of candidate10
- Electoral district10
- Year10
- Full address of witness10
- Name of witness10
- Name of candidate11
- Electoral district11
- Year11
- Full address of witness11
- Name of witness11
- Name of candidate12
- Electoral district12
- Year12
- Full address of witness12
- Name of witness12
- Name of candidate13
- Electoral district13
- Year13
- Full address of witness13
- Name of witness13
- Name of candidate14
- Electoral district14
- Year14
- Name of witness14
- Full address of witness14
- Name of candidate1
- Electoral district1
- Year1
- Name of witness1
- Full address of witness1
- Name of candidate15
- Electoral district15
- Year15
- Name of witness15
- Full address of witness15
- unit -Mailing address
- Street -Mailing address
- Street name -Mailing address
- City -Mailing address
- ProvinceTerritory -Mailing address
- Postal code -Mailing address
- Unit - Mailing address -Campaign delegate
- Street - Mailing address -Campaign delegate
- Street name - Mailing address -Campaign delegate
- City - Mailing address -Campaign delegate
- ProvinceTerritory- Mailing address -Campaign delegate
- Postal code- Mailing address -Campaign delegate
- Unit -Mailing address - Official Agent
- Street -Mailing address - Official Agent
- Street name -Mailing address - Official Agent
- city -Mailing address - Official Agent
- ProvinceTerritory-Mailing address - Official Agent
- Postal code-Mailing address - Official Agent
15BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
23
16BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
24
17BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
25
18BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
26
19BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
27
20BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
28
21BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
29
22BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
30
EC 20010 (022019)
SECTION G ndash 23B Are You Ready to Submit Your Nomination
Have you completed the Nomination Paper (EC 20010)
bull Are all mandatory fields in sections AndashE complete
bull Have you collected the required number of signatures from qualified electors in section F
o For most electoral districts 100 electors must consent to your candidacy
o For electoral districts identified in Schedule 3 only 50 electors are required
o To ensure a smooth nomination process Elections Canada recommends collecting signatures from at least 150 electors
Do you have authorized proof of identify
bull For a list of authorized identification visit the Elections Canada website
bull If a campaign delegate is submitting on your behalf they must bring a copy of your identification documents signed by you
bull If you want an alternative name to appear on the ballot additional documentation is required visit electionsca for details
Are you endorsed by a political party
bull Make sure your party has submitted the required documentation to Elections Canada attesting your designated political affiliation
Have you made a nomination appointment
bull To facilitate the nomination process make an appointment with the returning officer to finalize the filing of the complete nomination package
bull The nomination period closes 21 days before election day at 200 pm local time
31
- Nomination Paperof a Candidate at a Federal General Election or By-election
- Table of Contents
- General Information
- SECTION A ndash Candidate Information (Mandatory)
- SECTION B ndash Campaign Delegate (Optional)
- SECTION C ndash Official Agent (Mandatory)
- SECTION D ndash Auditor (Optional)
- SECTION E ndash Campaign Office (Optional)
- SECTION F ndash Electors Consenting to Candidacy (Mandatory)
-
- Name of electoral district
- Political affiliation
- Telephone number to be posted on electionsca
- Website to be posted on electionsca including prefix http https
- Printed name of elector1
- Full residential address street numbernamecity1
- Postal code1
- Elector signature1
- Witness initials1
- Internal use only1
- Printed name of elector2
- Full residential address street numbernamecity2
- Postal code2
- Elector signature2
- Witness initials2
- Internal use only2
- Printed name of elector3
- Full residential address street numbernamecity3
- Postal code3
- Elector signature3
- Witness initials3
- Internal use only3
- Printed name of elector4
- Full residential address street numbernamecity4
- Postal code4
- Elector signature4
- Witness initials4
- Internal use only4
- Printed name of elector5
- Full residential address street numbernamecity5
- Postal code5
- Elector signature5
- Witness initials5
- Internal use only5
- Printed name of elector6
- Full residential address street numbernamecity6
- Postal code6
- Elector signature6
- Witness initials6
- Internal use only6
- Printed name of elector7
- Full residential address street numbernamecity7
- Postal code7
- Elector signature7
- Witness initials7
- Internal use only7
- Printed name of elector8
- Full residential address street numbernamecity8
- Postal code8
- Elector signature8
- Witness initials8
- Internal use only8
- Printed name of elector9
- Full residential address street numbernamecity9
- Postal code9
- Elector signature9
- Witness initials9
- Internal use only9
- Printed name of elector10
- Full residential address street numbernamecity10
- Postal code10
- Elector signature10
- Witness initials10
- Internal use only10
- Printed name of elector1_2
- Full residential address street numbernamecity1_2
- Postal code1_2
- Elector signature1_2
- Witness initials1_2
- Internal use only1_2
- Printed name of elector2_2
- Full residential address street numbernamecity2_2
- Postal code2_2
- Elector signature2_2
- Witness initials2_2
- Internal use only2_2
- Printed name of elector3_2
- Full residential address street numbernamecity3_2
- Postal code3_2
- Elector signature3_2
- Witness initials3_2
- Internal use only3_2
- Printed name of elector4_2
- Full residential address street numbernamecity4_2
- Postal code4_2
- Elector signature4_2
- Witness initials4_2
- Internal use only4_2
- Printed name of elector5_2
- Full residential address street numbernamecity5_2
- Postal code5_2
- Elector signature5_2
- Witness initials5_2
- Internal use only5_2
- Printed name of elector6_2
- Full residential address street numbernamecity6_2
- Postal code6_2
- Elector signature6_2
- Witness initials6_2
- Internal use only6_2
- Printed name of elector7_2
- Full residential address street numbernamecity7_2
- Postal code7_2
- Elector signature7_2
- Witness initials7_2
- Internal use only7_2
- Printed name of elector8_2
- Full residential address street numbernamecity8_2
- Postal code8_2
- Elector signature8_2
- Witness initials8_2
- Internal use only8_2
- Printed name of elector9_2
- Full residential address street numbernamecity9_2
- Postal code9_2
- Elector signature9_2
- Witness initials9_2
- Internal use only9_2
- Printed name of elector10_2
- Full residential address street numbernamecity10_2
- Postal code10_2
- Elector signature10_2
- Witness initials10_2
- Internal use only10_2
- Printed name of elector1_3
- Full residential address street numbernamecity1_3
- Postal code1_3
- Elector signature1_3
- Witness initials1_3
- Internal use only1_3
- Printed name of elector2_3
- Full residential address street numbernamecity2_3
- Postal code2_3
- Elector signature2_3
- Witness initials2_3
- Internal use only2_3
- Printed name of elector3_3
- Full residential address street numbernamecity3_3
- Postal code3_3
- Elector signature3_3
- Witness initials3_3
- Internal use only3_3
- Printed name of elector4_3
- Full residential address street numbernamecity4_3
- Postal code4_3
- Elector signature4_3
- Witness initials4_3
- Internal use only4_3
- Printed name of elector5_3
- Full residential address street numbernamecity5_3
- Postal code5_3
- Elector signature5_3
- Witness initials5_3
- Internal use only5_3
- Printed name of elector6_3
- Full residential address street numbernamecity6_3
- Postal code6_3
- Elector signature6_3
- Witness initials6_3
- Internal use only6_3
- Printed name of elector7_3
- Full residential address street numbernamecity7_3
- Postal code7_3
- Elector signature7_3
- Witness initials7_3
- Internal use only7_3
- Printed name of elector8_3
- Full residential address street numbernamecity8_3
- Postal code8_3
- Elector signature8_3
- Witness initials8_3
- Internal use only8_3
- Printed name of elector9_3
- Full residential address street numbernamecity9_3
- Postal code9_3
- Elector signature9_3
- Witness initials9_3
- Internal use only9_3
- Printed name of elector10_3
- Full residential address street numbernamecity10_3
- Postal code10_3
- Elector signature10_3
- Witness initials10_3
- Internal use only10_3
- Printed name of elector1_4
- Full residential address street numbernamecity1_4
- Postal code1_4
- Elector signature1_4
- Witness initials1_4
- Internal use only1_4
- Printed name of elector2_4
- Full residential address street numbernamecity2_4
- Postal code2_4
- Elector signature2_4
- Witness initials2_4
- Internal use only2_4
- Printed name of elector3_4
- Full residential address street numbernamecity3_4
- Postal code3_4
- Elector signature3_4
- Witness initials3_4
- Internal use only3_4
- Printed name of elector4_4
- Full residential address street numbernamecity4_4
- Postal code4_4
- Elector signature4_4
- Witness initials4_4
- Internal use only4_4
- Printed name of elector5_4
- Full residential address street numbernamecity5_4
- Postal code5_4
- Elector signature5_4
- Witness initials5_4
- Internal use only5_4
- Printed name of elector6_4
- Full residential address street numbernamecity6_4
- Postal code6_4
- Elector signature6_4
- Witness initials6_4
- Internal use only6_4
- Printed name of elector7_4
- Full residential address street numbernamecity7_4
- Postal code7_4
- Elector signature7_4
- Witness initials7_4
- Internal use only7_4
- Printed name of elector8_4
- Full residential address street numbernamecity8_4
- Postal code8_4
- Elector signature8_4
- Witness initials8_4
- Internal use only8_4
- Printed name of elector9_4
- Full residential address street numbernamecity9_4
- Postal code9_4
- Elector signature9_4
- Witness initials9_4
- Internal use only9_4
- Printed name of elector10_4
- Full residential address street numbernamecity10_4
- Postal code10_4
- Elector signature10_4
- Witness initials10_4
- Internal use only10_4
- Printed name of elector1_5
- Full residential address street numbernamecity1_5
- Postal code1_5
- Elector signature1_5
- Witness initials1_5
- Internal use only1_5
- Printed name of elector2_5
- Full residential address street numbernamecity2_5
- Postal code2_5
- Elector signature2_5
- Witness initials2_5
- Internal use only2_5
- Printed name of elector3_5
- Full residential address street numbernamecity3_5
- Postal code3_5
- Elector signature3_5
- Witness initials3_5
- Internal use only3_5
- Printed name of elector4_5
- Full residential address street numbernamecity4_5
- Postal code4_5
- Elector signature4_5
- Witness initials4_5
- Internal use only4_5
- Printed name of elector5_5
- Full residential address street numbernamecity5_5
- Postal code5_5
- Elector signature5_5
- Witness initials5_5
- Internal use only5_5
- Printed name of elector6_5
- Full residential address street numbernamecity6_5
- Postal code6_5
- Elector signature6_5
- Witness initials6_5
- Internal use only6_5
- Printed name of elector7_5
- Full residential address street numbernamecity7_5
- Postal code7_5
- Elector signature7_5
- Witness initials7_5
- Internal use only7_5
- Printed name of elector8_5
- Full residential address street numbernamecity8_5
- Postal code8_5
- Elector signature8_5
- Witness initials8_5
- Internal use only8_5
- Printed name of elector9_5
- Full residential address street numbernamecity9_5
- Postal code9_5
- Elector signature9_5
- Witness initials9_5
- Internal use only9_5
- Printed name of elector10_5
- Full residential address street numbernamecity10_5
- Postal code10_5
- Elector signature10_5
- Witness initials10_5
- Internal use only10_5
- Printed name of elector1_6
- Full residential address street numbernamecity1_6
- Postal code1_6
- Elector signature1_6
- Witness initials1_6
- Internal use only1_6
- Printed name of elector2_6
- Full residential address street numbernamecity2_6
- Postal code2_6
- Elector signature2_6
- Witness initials2_6
- Internal use only2_6
- Printed name of elector3_6
- Full residential address street numbernamecity3_6
- Postal code3_6
- Elector signature3_6
- Witness initials3_6
- Internal use only3_6
- Printed name of elector4_6
- Full residential address street numbernamecity4_6
- Postal code4_6
- Elector signature4_6
- Witness initials4_6
- Internal use only4_6
- Printed name of elector5_6
- Full residential address street numbernamecity5_6
- Postal code5_6
- Elector signature5_6
- Witness initials5_6
- Internal use only5_6
- Printed name of elector6_6
- Full residential address street numbernamecity6_6
- Postal code6_6
- Elector signature6_6
- Witness initials6_6
- Internal use only6_6
- Printed name of elector7_6
- Full residential address street numbernamecity7_6
- Postal code7_6
- Elector signature7_6
- Witness initials7_6
- Internal use only7_6
- Printed name of elector8_6
- Full residential address street numbernamecity8_6
- Postal code8_6
- Elector signature8_6
- Witness initials8_6
- Internal use only8_6
- Printed name of elector9_6
- Full residential address street numbernamecity9_6
- Postal code9_6
- Elector signature9_6
- Witness initials9_6
- Internal use only9_6
- Printed name of elector10_6
- Full residential address street numbernamecity10_6
- Postal code10_6
- Elector signature10_6
- Witness initials10_6
- Internal use only10_6
- Printed name of elector1_7
- Full residential address street numbernamecity1_7
- Postal code1_7
- Elector signature1_7
- Witness initials1_7
- Internal use only1_7
- Printed name of elector2_7
- Full residential address street numbernamecity2_7
- Postal code2_7
- Elector signature2_7
- Witness initials2_7
- Internal use only2_7
- Printed name of elector3_7
- Full residential address street numbernamecity3_7
- Postal code3_7
- Elector signature3_7
- Witness initials3_7
- Internal use only3_7
- Printed name of elector4_7
- Full residential address street numbernamecity4_7
- Postal code4_7
- Elector signature4_7
- Witness initials4_7
- Internal use only4_7
- Printed name of elector5_7
- Full residential address street numbernamecity5_7
- Postal code5_7
- Elector signature5_7
- Witness initials5_7
- Internal use only5_7
- Printed name of elector6_7
- Full residential address street numbernamecity6_7
- Postal code6_7
- Elector signature6_7
- Witness initials6_7
- Internal use only6_7
- Printed name of elector7_7
- Full residential address street numbernamecity7_7
- Postal code7_7
- Elector signature7_7
- Witness initials7_7
- Internal use only7_7
- Printed name of elector8_7
- Full residential address street numbernamecity8_7
- Postal code8_7
- Elector signature8_7
- Witness initials8_7
- Internal use only8_7
- Printed name of elector9_7
- Full residential address street numbernamecity9_7
- Postal code9_7
- Elector signature9_7
- Witness initials9_7
- Internal use only9_7
- Printed name of elector10_7
- Full residential address street numbernamecity10_7
- Postal code10_7
- Elector signature10_7
- Witness initials10_7
- Internal use only10_7
- Printed name of elector1_8
- Full residential address street numbernamecity1_8
- Postal code1_8
- Elector signature1_8
- Witness initials1_8
- Internal use only1_8
- Printed name of elector2_8
- Full residential address street numbernamecity2_8
- Postal code2_8
- Elector signature2_8
- Witness initials2_8
- Internal use only2_8
- Printed name of elector3_8
- Full residential address street numbernamecity3_8
- Postal code3_8
- Elector signature3_8
- Witness initials3_8
- Internal use only3_8
- Printed name of elector4_8
- Full residential address street numbernamecity4_8
- Postal code4_8
- Elector signature4_8
- Witness initials4_8
- Internal use only4_8
- Printed name of elector5_8
- Full residential address street numbernamecity5_8
- Postal code5_8
- Elector signature5_8
- Witness initials5_8
- Internal use only5_8
- Printed name of elector6_8
- Full residential address street numbernamecity6_8
- Postal code6_8
- Elector signature6_8
- Witness initials6_8
- Internal use only6_8
- Printed name of elector7_8
- Full residential address street numbernamecity7_8
- Postal code7_8
- Elector signature7_8
- Witness initials7_8
- Internal use only7_8
- Printed name of elector8_8
- Full residential address street numbernamecity8_8
- Postal code8_8
- Elector signature8_8
- Witness initials8_8
- Internal use only8_8
- Printed name of elector9_8
- Full residential address street numbernamecity9_8
- Postal code9_8
- Elector signature9_8
- Witness initials9_8
- Internal use only9_8
- Printed name of elector10_8
- Full residential address street numbernamecity10_8
- Postal code10_8
- Elector signature10_8
- Witness initials10_8
- Internal use only10_8
- Printed name of elector1_9
- Full residential address street numbernamecity1_9
- Postal code1_9
- Elector signature1_9
- Witness initials1_9
- Internal use only1_9
- Printed name of elector2_9
- Full residential address street numbernamecity2_9
- Postal code2_9
- Elector signature2_9
- Witness initials2_9
- Internal use only2_9
- Printed name of elector3_9
- Full residential address street numbernamecity3_9
- Postal code3_9
- Elector signature3_9
- Witness initials3_9
- Internal use only3_9
- Printed name of elector4_9
- Full residential address street numbernamecity4_9
- Postal code4_9
- Elector signature4_9
- Witness initials4_9
- Internal use only4_9
- Printed name of elector5_9
- Full residential address street numbernamecity5_9
- Postal code5_9
- Elector signature5_9
- Witness initials5_9
- Internal use only5_9
- Printed name of elector6_9
- Full residential address street numbernamecity6_9
- Postal code6_9
- Elector signature6_9
- Witness initials6_9
- Internal use only6_9
- Printed name of elector7_9
- Full residential address street numbernamecity7_9
- Postal code7_9
- Elector signature7_9
- Witness initials7_9
- Internal use only7_9
- Printed name of elector8_9
- Full residential address street numbernamecity8_9
- Postal code8_9
- Elector signature8_9
- Witness initials8_9
- Internal use only8_9
- Printed name of elector9_9
- Full residential address street numbernamecity9_9
- Postal code9_9
- Elector signature9_9
- Witness initials9_9
- Internal use only9_9
- Printed name of elector10_9
- Full residential address street numbernamecity10_9
- Postal code10_9
- Elector signature10_9
- Witness initials10_9
- Internal use only10_9
- Printed name of elector1_10
- Full residential address street numbernamecity1_10
- Postal code1_10
- Elector signature1_10
- Witness initials1_10
- Internal use only1_10
- Printed name of elector2_10
- Full residential address street numbernamecity2_10
- Postal code2_10
- Elector signature2_10
- Witness initials2_10
- Internal use only2_10
- Printed name of elector3_10
- Full residential address street numbernamecity3_10
- Postal code3_10
- Elector signature3_10
- Witness initials3_10
- Internal use only3_10
- Printed name of elector4_10
- Full residential address street numbernamecity4_10
- Postal code4_10
- Elector signature4_10
- Witness initials4_10
- Internal use only4_10
- Printed name of elector5_10
- Full residential address street numbernamecity5_10
- Postal code5_10
- Elector signature5_10
- Witness initials5_10
- Internal use only5_10
- Printed name of elector6_10
- Full residential address street numbernamecity6_10
- Postal code6_10
- Elector signature6_10
- Witness initials6_10
- Internal use only6_10
- Printed name of elector7_10
- Full residential address street numbernamecity7_10
- Postal code7_10
- Elector signature7_10
- Witness initials7_10
- Internal use only7_10
- Printed name of elector8_10
- Full residential address street numbernamecity8_10
- Postal code8_10
- Elector signature8_10
- Witness initials8_10
- Internal use only8_10
- Printed name of elector9_10
- Full residential address street numbernamecity9_10
- Postal code9_10
- Elector signature9_10
- Witness initials9_10
- Internal use only9_10
- Printed name of elector10_10
- Full residential address street numbernamecity10_10
- Postal code10_10
- Elector signature10_10
- Witness initials10_10
- Internal use only10_10
- Printed name of elector1_11
- Full residential address street numbernamecity1_11
- Postal code1_11
- Elector signature1_11
- Witness initials1_11
- Internal use only1_11
- Printed name of elector2_11
- Full residential address street numbernamecity2_11
- Postal code2_11
- Elector signature2_11
- Witness initials2_11
- Internal use only2_11
- Printed name of elector3_11
- Full residential address street numbernamecity3_11
- Postal code3_11
- Elector signature3_11
- Witness initials3_11
- Internal use only3_11
- Printed name of elector4_11
- Full residential address street numbernamecity4_11
- Postal code4_11
- Elector signature4_11
- Witness initials4_11
- Internal use only4_11
- Printed name of elector5_11
- Full residential address street numbernamecity5_11
- Postal code5_11
- Elector signature5_11
- Witness initials5_11
- Internal use only5_11
- Printed name of elector6_11
- Full residential address street numbernamecity6_11
- Postal code6_11
- Elector signature6_11
- Witness initials6_11
- Internal use only6_11
- Printed name of elector7_11
- Full residential address street numbernamecity7_11
- Postal code7_11
- Elector signature7_11
- Witness initials7_11
- Internal use only7_11
- Printed name of elector8_11
- Full residential address street numbernamecity8_11
- Postal code8_11
- Elector signature8_11
- Witness initials8_11
- Internal use only8_11
- Printed name of elector9_11
- Full residential address street numbernamecity9_11
- Postal code9_11
- Elector signature9_11
- Witness initials9_11
- Internal use only9_11
- Printed name of elector10_11
- Full residential address street numbernamecity10_11
- Postal code10_11
- Elector signature10_11
- Witness initials10_11
- Internal use only10_11
- Printed name of elector1_12
- Full residential address street numbernamecity1_12
- Postal code1_12
- Elector signature1_12
- Witness initials1_12
- Internal use only1_12
- Printed name of elector2_12
- Full residential address street numbernamecity2_12
- Postal code2_12
- Elector signature2_12
- Witness initials2_12
- Internal use only2_12
- Printed name of elector3_12
- Full residential address street numbernamecity3_12
- Postal code3_12
- Elector signature3_12
- Witness initials3_12
- Internal use only3_12
- Printed name of elector4_12
- Full residential address street numbernamecity4_12
- Postal code4_12
- Elector signature4_12
- Witness initials4_12
- Internal use only4_12
- Printed name of elector5_12
- Full residential address street numbernamecity5_12
- Postal code5_12
- Elector signature5_12
- Witness initials5_12
- Internal use only5_12
- Printed name of elector6_12
- Full residential address street numbernamecity6_12
- Postal code6_12
- Elector signature6_12
- Witness initials6_12
- Internal use only6_12
- Printed name of elector7_12
- Full residential address street numbernamecity7_12
- Postal code7_12
- Elector signature7_12
- Witness initials7_12
- Internal use only7_12
- Printed name of elector8_12
- Full residential address street numbernamecity8_12
- Postal code8_12
- Elector signature8_12
- Witness initials8_12
- Internal use only8_12
- Printed name of elector9_12
- Full residential address street numbernamecity9_12
- Postal code9_12
- Elector signature9_12
- Witness initials9_12
- Internal use only9_12
- Printed name of elector10_12
- Full residential address street numbernamecity10_12
- Postal code10_12
- Elector signature10_12
- Witness initials10_12
- Internal use only10_12
- Printed name of elector1_13
- Full residential address street numbernamecity1_13
- Postal code1_13
- Elector signature1_13
- Witness initials1_13
- Internal use only1_13
- Printed name of elector2_13
- Full residential address street numbernamecity2_13
- Postal code2_13
- Elector signature2_13
- Witness initials2_13
- Internal use only2_13
- Printed name of elector3_13
- Full residential address street numbernamecity3_13
- Postal code3_13
- Elector signature3_13
- Witness initials3_13
- Internal use only3_13
- Printed name of elector4_13
- Full residential address street numbernamecity4_13
- Postal code4_13
- Elector signature4_13
- Witness initials4_13
- Internal use only4_13
- Printed name of elector5_13
- Full residential address street numbernamecity5_13
- Postal code5_13
- Elector signature5_13
- Witness initials5_13
- Internal use only5_13
- Printed name of elector6_13
- Full residential address street numbernamecity6_13
- Postal code6_13
- Elector signature6_13
- Witness initials6_13
- Internal use only6_13
- Printed name of elector7_13
- Full residential address street numbernamecity7_13
- Postal code7_13
- Elector signature7_13
- Witness initials7_13
- Internal use only7_13
- Printed name of elector8_13
- Full residential address street numbernamecity8_13
- Postal code8_13
- Elector signature8_13
- Witness initials8_13
- Internal use only8_13
- Printed name of elector9_13
- Full residential address street numbernamecity9_13
- Postal code9_13
- Elector signature9_13
- Witness initials9_13
- Internal use only9_13
- Printed name of elector10_13
- Full residential address street numbernamecity10_13
- Postal code10_13
- Elector signature10_13
- Witness initials10_13
- Internal use only10_13
- Printed name of elector1_14
- Full residential address street numbernamecity1_14
- Postal code1_14
- Elector signature1_14
- Witness initials1_14
- Internal use only1_14
- Printed name of elector2_14
- Full residential address street numbernamecity2_14
- Postal code2_14
- Elector signature2_14
- Witness initials2_14
- Internal use only2_14
- Printed name of elector3_14
- Full residential address street numbernamecity3_14
- Postal code3_14
- Elector signature3_14
- Witness initials3_14
- Internal use only3_14
- Printed name of elector4_14
- Full residential address street numbernamecity4_14
- Postal code4_14
- Elector signature4_14
- Witness initials4_14
- Internal use only4_14
- Printed name of elector5_14
- Full residential address street numbernamecity5_14
- Postal code5_14
- Elector signature5_14
- Witness initials5_14
- Internal use only5_14
- Printed name of elector6_14
- Full residential address street numbernamecity6_14
- Postal code6_14
- Elector signature6_14
- Witness initials6_14
- Internal use only6_14
- Printed name of elector7_14
- Full residential address street numbernamecity7_14
- Postal code7_14
- Elector signature7_14
- Witness initials7_14
- Internal use only7_14
- Printed name of elector8_14
- Full residential address street numbernamecity8_14
- Postal code8_14
- Elector signature8_14
- Witness initials8_14
- Internal use only8_14
- Printed name of elector9_14
- Full residential address street numbernamecity9_14
- Postal code9_14
- Elector signature9_14
- Witness initials9_14
- Internal use only9_14
- Printed name of elector10_14
- Full residential address street numbernamecity10_14
- Postal code10_14
- Elector signature10_14
- Witness initials10_14
- Internal use only10_14
- Printed name of elector1_15
- Full residential address street numbernamecity1_15
- Postal code1_15
- Elector signature1_15
- Witness initials1_15
- Internal use only1_15
- Printed name of elector2_15
- Full residential address street numbernamecity2_15
- Postal code2_15
- Elector signature2_15
- Witness initials2_15
- Internal use only2_15
- Printed name of elector3_15
- Full residential address street numbernamecity3_15
- Postal code3_15
- Elector signature3_15
- Witness initials3_15
- Internal use only3_15
- Printed name of elector4_15
- Full residential address street numbernamecity4_15
- Postal code4_15
- Elector signature4_15
- Witness initials4_15
- Internal use only4_15
- Printed name of elector5_15
- Full residential address street numbernamecity5_15
- Postal code5_15
- Elector signature5_15
- Witness initials5_15
- Internal use only5_15
- Printed name of elector6_15
- Full residential address street numbernamecity6_15
- Postal code6_15
- Elector signature6_15
- Witness initials6_15
- Internal use only6_15
- Printed name of elector7_15
- Full residential address street numbernamecity7_15
- Postal code7_15
- Elector signature7_15
- Witness initials7_15
- Internal use only7_15
- Printed name of elector8_15
- Full residential address street numbernamecity8_15
- Postal code8_15
- Elector signature8_15
- Witness initials8_15
- Internal use only8_15
- Printed name of elector9_15
- Full residential address street numbernamecity9_15
- Postal code9_15
- Elector signature9_15
- Witness initials9_15
- Internal use only9_15
- Printed name of elector10_15
- Full residential address street numbernamecity10_15
- Postal code10_15
- Elector signature10_15
- Witness initials10_15
- Internal use only10_15
- Printed name of elector1_16
- Full residential address street numbernamecity1_16
- Postal code1_16
- Elector signature1_16
- Witness initials1_16
- Internal use only1_16
- Printed name of elector2_16
- Full residential address street numbernamecity2_16
- Postal code2_16
- Elector signature2_16
- Witness initials2_16
- Internal use only2_16
- Printed name of elector3_16
- Full residential address street numbernamecity3_16
- Postal code3_16
- Elector signature3_16
- Witness initials3_16
- Internal use only3_16
- Printed name of elector4_16
- Full residential address street numbernamecity4_16
- Postal code4_16
- Elector signature4_16
- Witness initials4_16
- Internal use only4_16
- Printed name of elector5_16
- Full residential address street numbernamecity5_16
- Postal code5_16
- Elector signature5_16
- Witness initials5_16
- Internal use only5_16
- Printed name of elector6_16
- Full residential address street numbernamecity6_16
- Postal code6_16
- Elector signature6_16
- Witness initials6_16
- Internal use only6_16
- Printed name of elector7_16
- Full residential address street numbernamecity7_16
- Postal code7_16
- Elector signature7_16
- Witness initials7_16
- Internal use only7_16
- Printed name of elector8_16
- Full residential address street numbernamecity8_16
- Postal code8_16
- Elector signature8_16
- Witness initials8_16
- Internal use only8_16
- Printed name of elector9_16
- Full residential address street numbernamecity9_16
- Postal code9_16
- Elector signature9_16
- Witness initials9_16
- Internal use only9_16
- Printed name of elector10_16
- Full residential address street numbernamecity10_16
- Postal code10_16
- Elector signature10_16
- Witness initials10_16
- Internal use only10_16
- Have you completed the Nomination Paper EC 20010 Off
- Do you have authorized proof of identify Off
- Are you endorsed by a political party Off
- Have you made a nomination appointment Off
- Last name - Candidate Name
- First name - Candidate Name
- Name of electoral district- Candidate Information
- First name - Candidate Information
- Last name - Candidate Information
- Ballot Name Off
- Ballot First name(s)
- Ballot Last name(s)
- Gender -Candidate information
- Date of birth (YYY-MM-DD) - Gender -Candidate information
- language of correspondence - Candidate information Off
- Email -Contact information
- Primary phone number - Contact information
- Ext - Primary phone number
- Alternate phone number - Contact information
- Ext - Alternate phone number
- Fax number- Alternate phone number
- Unit -Residential address
- Street -Residential address
- Street name -Residential address
- City -Residential address
- ProvinceTerritory -Residential address
- Postal code - -Residential address
- Mailing address - same as residential address Off
- Occupation- Candidate occupation
- Sharing of information with the Conflict of Interest and Ethics Commissioner and the House of Commons including the Library of Parliament Off
- where applicable if the returning officer is unable to verify that I have been endorsed by the political party identified in section A of this Nomination Paper I wish to Off
- Date of Signature (YYYY-MM-DD) - Candidate signature
- Date of Signature (YYYY-MM-DD) -Signature of person receiving the solemn declaration
- Campaign delegate information
- First name - Campaign delegate information
- Last name - Campaign delegate information
- Language of correspondence - Campaign delegate information Off
- Email - Contact information -Campaign Delegate
- Primary phone number - Contact information -Campaign Delegate
- Primary phone number EXT - Contact information -Campaign Delegate
- Alternate phone number - Contact information -Campaign Delegate
- Alternate phone number EXT - Contact information -Campaign Delegate
- Fax nmuber- Contact information -Campaign Delegate
- Street - Residential address -Campaign delegate
- Street name - Residential address -Campaign delegate
- City - Residential address -Campaign delegate
- ProvinceTerritory - Residential address -Campaign delegate
- Postal Code - Residential address -Campaign delegate
- Campaign delegate - Mailing address ndash Same as residential address Off
- Unit - Residential address -Campaign delegate
- Date (YYYY-MM-DD) - Candidate authorization Signature
- Date (YYYY-MM-DD) - Candidate campaign Signature
- First name - Official agent information
- Last name - Official agent information
- Language of correspondence - Official agent information Off
- Email - Official agent information
- Primary phone number - Official agent information
- Primary phone number EXT - Official agent information
- Alternate phone number EXT - Official agent information
- Alternate phone number - Official agent information
- Fax number - Official agent information
- Unit -Residential address - Official Agent
- Street name -Residential address - Official Agent
- City -Residential address - Official Agent
- Street -Residential address - Official Agent
- ProvinceTerritory -Residential address - Official Agent
- Postal code-Residential address - Official Agent
- Mailing address ndash Same as residential address- Official Agent Off
- Date (YYYY-MM-DD) - Official agent signature
- First name - Auditor information
- Last name - Auditor information
- Language of correspondence - Auditor information Off
- Email - Auditor information
- Primary phone number - Auditor information
- Primary phone number EXT- Auditor information
- Alternate phone number - Auditor information
- Alternate phone number EXT- Auditor information
- Fax number - Auditor information
- Name of firm- Auditor organizational information
- Occupation of auditor - Auditor organizational information
- Professional designation - Auditor organizational information Off
- Designation registration number
- Make cheque payable to
- Unit - Address (where cheque is sent)
- Street - Address (where cheque is sent)
- Street name - Address (where cheque is sent)
- City - Address (where cheque is sent)
- ProvinceTerritory - Address (where cheque is sent)
- Postal code - Address (where cheque is sent)
- Date (YYY-MM-DD) - Auditor signature
- Unit - Campaign office address (optional)
- Street - Campaign office address (optional)
- Street name - Campaign office address (optional)
- City - Campaign office address (optional)
- ProvinceTerritory- Campaign office address (optional)
- Postal code - Campaign office address (optional)
- Name of witness
- Full address of witness
- Name of candidate
- Electoral district
- Year
- Name of candidate2
- Electoral district2
- Year2
- Name of witness2
- Full address of witness2
- Name of candidate3
- Electoral district3
- Year3
- Full address of witness3
- Name of witness3
- Name of candidate 4
- Electoral district4
- Year4
- Full address of witness 4
- Name of witness 4
- Name of candidate5
- Electoral district5
- Year5
- Full address of witness5
- Name of witness5
- Name of candidate6
- Electoral district6
- Year6
- Name of witness6
- Full address of witness6
- Name of candidate7
- Electoral district7
- Year7
- Full address of witness7
- Name of witness7
- Name of candidate8
- Electoral district8
- Year8
- Full address of witness8
- Name of witness8
- Name of candidate9
- Electoral district9
- Year9
- Full address of witness 9
- Name of witness 9
- Name of candidate10
- Electoral district10
- Year10
- Full address of witness10
- Name of witness10
- Name of candidate11
- Electoral district11
- Year11
- Full address of witness11
- Name of witness11
- Name of candidate12
- Electoral district12
- Year12
- Full address of witness12
- Name of witness12
- Name of candidate13
- Electoral district13
- Year13
- Full address of witness13
- Name of witness13
- Name of candidate14
- Electoral district14
- Year14
- Name of witness14
- Full address of witness14
- Name of candidate1
- Electoral district1
- Year1
- Name of witness1
- Full address of witness1
- Name of candidate15
- Electoral district15
- Year15
- Name of witness15
- Full address of witness15
- unit -Mailing address
- Street -Mailing address
- Street name -Mailing address
- City -Mailing address
- ProvinceTerritory -Mailing address
- Postal code -Mailing address
- Unit - Mailing address -Campaign delegate
- Street - Mailing address -Campaign delegate
- Street name - Mailing address -Campaign delegate
- City - Mailing address -Campaign delegate
- ProvinceTerritory- Mailing address -Campaign delegate
- Postal code- Mailing address -Campaign delegate
- Unit -Mailing address - Official Agent
- Street -Mailing address - Official Agent
- Street name -Mailing address - Official Agent
- city -Mailing address - Official Agent
- ProvinceTerritory-Mailing address - Official Agent
- Postal code-Mailing address - Official Agent
16BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
24
17BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
25
18BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
26
19BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
27
20BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
28
21BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
29
22BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
30
EC 20010 (022019)
SECTION G ndash 23B Are You Ready to Submit Your Nomination
Have you completed the Nomination Paper (EC 20010)
bull Are all mandatory fields in sections AndashE complete
bull Have you collected the required number of signatures from qualified electors in section F
o For most electoral districts 100 electors must consent to your candidacy
o For electoral districts identified in Schedule 3 only 50 electors are required
o To ensure a smooth nomination process Elections Canada recommends collecting signatures from at least 150 electors
Do you have authorized proof of identify
bull For a list of authorized identification visit the Elections Canada website
bull If a campaign delegate is submitting on your behalf they must bring a copy of your identification documents signed by you
bull If you want an alternative name to appear on the ballot additional documentation is required visit electionsca for details
Are you endorsed by a political party
bull Make sure your party has submitted the required documentation to Elections Canada attesting your designated political affiliation
Have you made a nomination appointment
bull To facilitate the nomination process make an appointment with the returning officer to finalize the filing of the complete nomination package
bull The nomination period closes 21 days before election day at 200 pm local time
31
- Nomination Paperof a Candidate at a Federal General Election or By-election
- Table of Contents
- General Information
- SECTION A ndash Candidate Information (Mandatory)
- SECTION B ndash Campaign Delegate (Optional)
- SECTION C ndash Official Agent (Mandatory)
- SECTION D ndash Auditor (Optional)
- SECTION E ndash Campaign Office (Optional)
- SECTION F ndash Electors Consenting to Candidacy (Mandatory)
-
- Name of electoral district
- Political affiliation
- Telephone number to be posted on electionsca
- Website to be posted on electionsca including prefix http https
- Printed name of elector1
- Full residential address street numbernamecity1
- Postal code1
- Elector signature1
- Witness initials1
- Internal use only1
- Printed name of elector2
- Full residential address street numbernamecity2
- Postal code2
- Elector signature2
- Witness initials2
- Internal use only2
- Printed name of elector3
- Full residential address street numbernamecity3
- Postal code3
- Elector signature3
- Witness initials3
- Internal use only3
- Printed name of elector4
- Full residential address street numbernamecity4
- Postal code4
- Elector signature4
- Witness initials4
- Internal use only4
- Printed name of elector5
- Full residential address street numbernamecity5
- Postal code5
- Elector signature5
- Witness initials5
- Internal use only5
- Printed name of elector6
- Full residential address street numbernamecity6
- Postal code6
- Elector signature6
- Witness initials6
- Internal use only6
- Printed name of elector7
- Full residential address street numbernamecity7
- Postal code7
- Elector signature7
- Witness initials7
- Internal use only7
- Printed name of elector8
- Full residential address street numbernamecity8
- Postal code8
- Elector signature8
- Witness initials8
- Internal use only8
- Printed name of elector9
- Full residential address street numbernamecity9
- Postal code9
- Elector signature9
- Witness initials9
- Internal use only9
- Printed name of elector10
- Full residential address street numbernamecity10
- Postal code10
- Elector signature10
- Witness initials10
- Internal use only10
- Printed name of elector1_2
- Full residential address street numbernamecity1_2
- Postal code1_2
- Elector signature1_2
- Witness initials1_2
- Internal use only1_2
- Printed name of elector2_2
- Full residential address street numbernamecity2_2
- Postal code2_2
- Elector signature2_2
- Witness initials2_2
- Internal use only2_2
- Printed name of elector3_2
- Full residential address street numbernamecity3_2
- Postal code3_2
- Elector signature3_2
- Witness initials3_2
- Internal use only3_2
- Printed name of elector4_2
- Full residential address street numbernamecity4_2
- Postal code4_2
- Elector signature4_2
- Witness initials4_2
- Internal use only4_2
- Printed name of elector5_2
- Full residential address street numbernamecity5_2
- Postal code5_2
- Elector signature5_2
- Witness initials5_2
- Internal use only5_2
- Printed name of elector6_2
- Full residential address street numbernamecity6_2
- Postal code6_2
- Elector signature6_2
- Witness initials6_2
- Internal use only6_2
- Printed name of elector7_2
- Full residential address street numbernamecity7_2
- Postal code7_2
- Elector signature7_2
- Witness initials7_2
- Internal use only7_2
- Printed name of elector8_2
- Full residential address street numbernamecity8_2
- Postal code8_2
- Elector signature8_2
- Witness initials8_2
- Internal use only8_2
- Printed name of elector9_2
- Full residential address street numbernamecity9_2
- Postal code9_2
- Elector signature9_2
- Witness initials9_2
- Internal use only9_2
- Printed name of elector10_2
- Full residential address street numbernamecity10_2
- Postal code10_2
- Elector signature10_2
- Witness initials10_2
- Internal use only10_2
- Printed name of elector1_3
- Full residential address street numbernamecity1_3
- Postal code1_3
- Elector signature1_3
- Witness initials1_3
- Internal use only1_3
- Printed name of elector2_3
- Full residential address street numbernamecity2_3
- Postal code2_3
- Elector signature2_3
- Witness initials2_3
- Internal use only2_3
- Printed name of elector3_3
- Full residential address street numbernamecity3_3
- Postal code3_3
- Elector signature3_3
- Witness initials3_3
- Internal use only3_3
- Printed name of elector4_3
- Full residential address street numbernamecity4_3
- Postal code4_3
- Elector signature4_3
- Witness initials4_3
- Internal use only4_3
- Printed name of elector5_3
- Full residential address street numbernamecity5_3
- Postal code5_3
- Elector signature5_3
- Witness initials5_3
- Internal use only5_3
- Printed name of elector6_3
- Full residential address street numbernamecity6_3
- Postal code6_3
- Elector signature6_3
- Witness initials6_3
- Internal use only6_3
- Printed name of elector7_3
- Full residential address street numbernamecity7_3
- Postal code7_3
- Elector signature7_3
- Witness initials7_3
- Internal use only7_3
- Printed name of elector8_3
- Full residential address street numbernamecity8_3
- Postal code8_3
- Elector signature8_3
- Witness initials8_3
- Internal use only8_3
- Printed name of elector9_3
- Full residential address street numbernamecity9_3
- Postal code9_3
- Elector signature9_3
- Witness initials9_3
- Internal use only9_3
- Printed name of elector10_3
- Full residential address street numbernamecity10_3
- Postal code10_3
- Elector signature10_3
- Witness initials10_3
- Internal use only10_3
- Printed name of elector1_4
- Full residential address street numbernamecity1_4
- Postal code1_4
- Elector signature1_4
- Witness initials1_4
- Internal use only1_4
- Printed name of elector2_4
- Full residential address street numbernamecity2_4
- Postal code2_4
- Elector signature2_4
- Witness initials2_4
- Internal use only2_4
- Printed name of elector3_4
- Full residential address street numbernamecity3_4
- Postal code3_4
- Elector signature3_4
- Witness initials3_4
- Internal use only3_4
- Printed name of elector4_4
- Full residential address street numbernamecity4_4
- Postal code4_4
- Elector signature4_4
- Witness initials4_4
- Internal use only4_4
- Printed name of elector5_4
- Full residential address street numbernamecity5_4
- Postal code5_4
- Elector signature5_4
- Witness initials5_4
- Internal use only5_4
- Printed name of elector6_4
- Full residential address street numbernamecity6_4
- Postal code6_4
- Elector signature6_4
- Witness initials6_4
- Internal use only6_4
- Printed name of elector7_4
- Full residential address street numbernamecity7_4
- Postal code7_4
- Elector signature7_4
- Witness initials7_4
- Internal use only7_4
- Printed name of elector8_4
- Full residential address street numbernamecity8_4
- Postal code8_4
- Elector signature8_4
- Witness initials8_4
- Internal use only8_4
- Printed name of elector9_4
- Full residential address street numbernamecity9_4
- Postal code9_4
- Elector signature9_4
- Witness initials9_4
- Internal use only9_4
- Printed name of elector10_4
- Full residential address street numbernamecity10_4
- Postal code10_4
- Elector signature10_4
- Witness initials10_4
- Internal use only10_4
- Printed name of elector1_5
- Full residential address street numbernamecity1_5
- Postal code1_5
- Elector signature1_5
- Witness initials1_5
- Internal use only1_5
- Printed name of elector2_5
- Full residential address street numbernamecity2_5
- Postal code2_5
- Elector signature2_5
- Witness initials2_5
- Internal use only2_5
- Printed name of elector3_5
- Full residential address street numbernamecity3_5
- Postal code3_5
- Elector signature3_5
- Witness initials3_5
- Internal use only3_5
- Printed name of elector4_5
- Full residential address street numbernamecity4_5
- Postal code4_5
- Elector signature4_5
- Witness initials4_5
- Internal use only4_5
- Printed name of elector5_5
- Full residential address street numbernamecity5_5
- Postal code5_5
- Elector signature5_5
- Witness initials5_5
- Internal use only5_5
- Printed name of elector6_5
- Full residential address street numbernamecity6_5
- Postal code6_5
- Elector signature6_5
- Witness initials6_5
- Internal use only6_5
- Printed name of elector7_5
- Full residential address street numbernamecity7_5
- Postal code7_5
- Elector signature7_5
- Witness initials7_5
- Internal use only7_5
- Printed name of elector8_5
- Full residential address street numbernamecity8_5
- Postal code8_5
- Elector signature8_5
- Witness initials8_5
- Internal use only8_5
- Printed name of elector9_5
- Full residential address street numbernamecity9_5
- Postal code9_5
- Elector signature9_5
- Witness initials9_5
- Internal use only9_5
- Printed name of elector10_5
- Full residential address street numbernamecity10_5
- Postal code10_5
- Elector signature10_5
- Witness initials10_5
- Internal use only10_5
- Printed name of elector1_6
- Full residential address street numbernamecity1_6
- Postal code1_6
- Elector signature1_6
- Witness initials1_6
- Internal use only1_6
- Printed name of elector2_6
- Full residential address street numbernamecity2_6
- Postal code2_6
- Elector signature2_6
- Witness initials2_6
- Internal use only2_6
- Printed name of elector3_6
- Full residential address street numbernamecity3_6
- Postal code3_6
- Elector signature3_6
- Witness initials3_6
- Internal use only3_6
- Printed name of elector4_6
- Full residential address street numbernamecity4_6
- Postal code4_6
- Elector signature4_6
- Witness initials4_6
- Internal use only4_6
- Printed name of elector5_6
- Full residential address street numbernamecity5_6
- Postal code5_6
- Elector signature5_6
- Witness initials5_6
- Internal use only5_6
- Printed name of elector6_6
- Full residential address street numbernamecity6_6
- Postal code6_6
- Elector signature6_6
- Witness initials6_6
- Internal use only6_6
- Printed name of elector7_6
- Full residential address street numbernamecity7_6
- Postal code7_6
- Elector signature7_6
- Witness initials7_6
- Internal use only7_6
- Printed name of elector8_6
- Full residential address street numbernamecity8_6
- Postal code8_6
- Elector signature8_6
- Witness initials8_6
- Internal use only8_6
- Printed name of elector9_6
- Full residential address street numbernamecity9_6
- Postal code9_6
- Elector signature9_6
- Witness initials9_6
- Internal use only9_6
- Printed name of elector10_6
- Full residential address street numbernamecity10_6
- Postal code10_6
- Elector signature10_6
- Witness initials10_6
- Internal use only10_6
- Printed name of elector1_7
- Full residential address street numbernamecity1_7
- Postal code1_7
- Elector signature1_7
- Witness initials1_7
- Internal use only1_7
- Printed name of elector2_7
- Full residential address street numbernamecity2_7
- Postal code2_7
- Elector signature2_7
- Witness initials2_7
- Internal use only2_7
- Printed name of elector3_7
- Full residential address street numbernamecity3_7
- Postal code3_7
- Elector signature3_7
- Witness initials3_7
- Internal use only3_7
- Printed name of elector4_7
- Full residential address street numbernamecity4_7
- Postal code4_7
- Elector signature4_7
- Witness initials4_7
- Internal use only4_7
- Printed name of elector5_7
- Full residential address street numbernamecity5_7
- Postal code5_7
- Elector signature5_7
- Witness initials5_7
- Internal use only5_7
- Printed name of elector6_7
- Full residential address street numbernamecity6_7
- Postal code6_7
- Elector signature6_7
- Witness initials6_7
- Internal use only6_7
- Printed name of elector7_7
- Full residential address street numbernamecity7_7
- Postal code7_7
- Elector signature7_7
- Witness initials7_7
- Internal use only7_7
- Printed name of elector8_7
- Full residential address street numbernamecity8_7
- Postal code8_7
- Elector signature8_7
- Witness initials8_7
- Internal use only8_7
- Printed name of elector9_7
- Full residential address street numbernamecity9_7
- Postal code9_7
- Elector signature9_7
- Witness initials9_7
- Internal use only9_7
- Printed name of elector10_7
- Full residential address street numbernamecity10_7
- Postal code10_7
- Elector signature10_7
- Witness initials10_7
- Internal use only10_7
- Printed name of elector1_8
- Full residential address street numbernamecity1_8
- Postal code1_8
- Elector signature1_8
- Witness initials1_8
- Internal use only1_8
- Printed name of elector2_8
- Full residential address street numbernamecity2_8
- Postal code2_8
- Elector signature2_8
- Witness initials2_8
- Internal use only2_8
- Printed name of elector3_8
- Full residential address street numbernamecity3_8
- Postal code3_8
- Elector signature3_8
- Witness initials3_8
- Internal use only3_8
- Printed name of elector4_8
- Full residential address street numbernamecity4_8
- Postal code4_8
- Elector signature4_8
- Witness initials4_8
- Internal use only4_8
- Printed name of elector5_8
- Full residential address street numbernamecity5_8
- Postal code5_8
- Elector signature5_8
- Witness initials5_8
- Internal use only5_8
- Printed name of elector6_8
- Full residential address street numbernamecity6_8
- Postal code6_8
- Elector signature6_8
- Witness initials6_8
- Internal use only6_8
- Printed name of elector7_8
- Full residential address street numbernamecity7_8
- Postal code7_8
- Elector signature7_8
- Witness initials7_8
- Internal use only7_8
- Printed name of elector8_8
- Full residential address street numbernamecity8_8
- Postal code8_8
- Elector signature8_8
- Witness initials8_8
- Internal use only8_8
- Printed name of elector9_8
- Full residential address street numbernamecity9_8
- Postal code9_8
- Elector signature9_8
- Witness initials9_8
- Internal use only9_8
- Printed name of elector10_8
- Full residential address street numbernamecity10_8
- Postal code10_8
- Elector signature10_8
- Witness initials10_8
- Internal use only10_8
- Printed name of elector1_9
- Full residential address street numbernamecity1_9
- Postal code1_9
- Elector signature1_9
- Witness initials1_9
- Internal use only1_9
- Printed name of elector2_9
- Full residential address street numbernamecity2_9
- Postal code2_9
- Elector signature2_9
- Witness initials2_9
- Internal use only2_9
- Printed name of elector3_9
- Full residential address street numbernamecity3_9
- Postal code3_9
- Elector signature3_9
- Witness initials3_9
- Internal use only3_9
- Printed name of elector4_9
- Full residential address street numbernamecity4_9
- Postal code4_9
- Elector signature4_9
- Witness initials4_9
- Internal use only4_9
- Printed name of elector5_9
- Full residential address street numbernamecity5_9
- Postal code5_9
- Elector signature5_9
- Witness initials5_9
- Internal use only5_9
- Printed name of elector6_9
- Full residential address street numbernamecity6_9
- Postal code6_9
- Elector signature6_9
- Witness initials6_9
- Internal use only6_9
- Printed name of elector7_9
- Full residential address street numbernamecity7_9
- Postal code7_9
- Elector signature7_9
- Witness initials7_9
- Internal use only7_9
- Printed name of elector8_9
- Full residential address street numbernamecity8_9
- Postal code8_9
- Elector signature8_9
- Witness initials8_9
- Internal use only8_9
- Printed name of elector9_9
- Full residential address street numbernamecity9_9
- Postal code9_9
- Elector signature9_9
- Witness initials9_9
- Internal use only9_9
- Printed name of elector10_9
- Full residential address street numbernamecity10_9
- Postal code10_9
- Elector signature10_9
- Witness initials10_9
- Internal use only10_9
- Printed name of elector1_10
- Full residential address street numbernamecity1_10
- Postal code1_10
- Elector signature1_10
- Witness initials1_10
- Internal use only1_10
- Printed name of elector2_10
- Full residential address street numbernamecity2_10
- Postal code2_10
- Elector signature2_10
- Witness initials2_10
- Internal use only2_10
- Printed name of elector3_10
- Full residential address street numbernamecity3_10
- Postal code3_10
- Elector signature3_10
- Witness initials3_10
- Internal use only3_10
- Printed name of elector4_10
- Full residential address street numbernamecity4_10
- Postal code4_10
- Elector signature4_10
- Witness initials4_10
- Internal use only4_10
- Printed name of elector5_10
- Full residential address street numbernamecity5_10
- Postal code5_10
- Elector signature5_10
- Witness initials5_10
- Internal use only5_10
- Printed name of elector6_10
- Full residential address street numbernamecity6_10
- Postal code6_10
- Elector signature6_10
- Witness initials6_10
- Internal use only6_10
- Printed name of elector7_10
- Full residential address street numbernamecity7_10
- Postal code7_10
- Elector signature7_10
- Witness initials7_10
- Internal use only7_10
- Printed name of elector8_10
- Full residential address street numbernamecity8_10
- Postal code8_10
- Elector signature8_10
- Witness initials8_10
- Internal use only8_10
- Printed name of elector9_10
- Full residential address street numbernamecity9_10
- Postal code9_10
- Elector signature9_10
- Witness initials9_10
- Internal use only9_10
- Printed name of elector10_10
- Full residential address street numbernamecity10_10
- Postal code10_10
- Elector signature10_10
- Witness initials10_10
- Internal use only10_10
- Printed name of elector1_11
- Full residential address street numbernamecity1_11
- Postal code1_11
- Elector signature1_11
- Witness initials1_11
- Internal use only1_11
- Printed name of elector2_11
- Full residential address street numbernamecity2_11
- Postal code2_11
- Elector signature2_11
- Witness initials2_11
- Internal use only2_11
- Printed name of elector3_11
- Full residential address street numbernamecity3_11
- Postal code3_11
- Elector signature3_11
- Witness initials3_11
- Internal use only3_11
- Printed name of elector4_11
- Full residential address street numbernamecity4_11
- Postal code4_11
- Elector signature4_11
- Witness initials4_11
- Internal use only4_11
- Printed name of elector5_11
- Full residential address street numbernamecity5_11
- Postal code5_11
- Elector signature5_11
- Witness initials5_11
- Internal use only5_11
- Printed name of elector6_11
- Full residential address street numbernamecity6_11
- Postal code6_11
- Elector signature6_11
- Witness initials6_11
- Internal use only6_11
- Printed name of elector7_11
- Full residential address street numbernamecity7_11
- Postal code7_11
- Elector signature7_11
- Witness initials7_11
- Internal use only7_11
- Printed name of elector8_11
- Full residential address street numbernamecity8_11
- Postal code8_11
- Elector signature8_11
- Witness initials8_11
- Internal use only8_11
- Printed name of elector9_11
- Full residential address street numbernamecity9_11
- Postal code9_11
- Elector signature9_11
- Witness initials9_11
- Internal use only9_11
- Printed name of elector10_11
- Full residential address street numbernamecity10_11
- Postal code10_11
- Elector signature10_11
- Witness initials10_11
- Internal use only10_11
- Printed name of elector1_12
- Full residential address street numbernamecity1_12
- Postal code1_12
- Elector signature1_12
- Witness initials1_12
- Internal use only1_12
- Printed name of elector2_12
- Full residential address street numbernamecity2_12
- Postal code2_12
- Elector signature2_12
- Witness initials2_12
- Internal use only2_12
- Printed name of elector3_12
- Full residential address street numbernamecity3_12
- Postal code3_12
- Elector signature3_12
- Witness initials3_12
- Internal use only3_12
- Printed name of elector4_12
- Full residential address street numbernamecity4_12
- Postal code4_12
- Elector signature4_12
- Witness initials4_12
- Internal use only4_12
- Printed name of elector5_12
- Full residential address street numbernamecity5_12
- Postal code5_12
- Elector signature5_12
- Witness initials5_12
- Internal use only5_12
- Printed name of elector6_12
- Full residential address street numbernamecity6_12
- Postal code6_12
- Elector signature6_12
- Witness initials6_12
- Internal use only6_12
- Printed name of elector7_12
- Full residential address street numbernamecity7_12
- Postal code7_12
- Elector signature7_12
- Witness initials7_12
- Internal use only7_12
- Printed name of elector8_12
- Full residential address street numbernamecity8_12
- Postal code8_12
- Elector signature8_12
- Witness initials8_12
- Internal use only8_12
- Printed name of elector9_12
- Full residential address street numbernamecity9_12
- Postal code9_12
- Elector signature9_12
- Witness initials9_12
- Internal use only9_12
- Printed name of elector10_12
- Full residential address street numbernamecity10_12
- Postal code10_12
- Elector signature10_12
- Witness initials10_12
- Internal use only10_12
- Printed name of elector1_13
- Full residential address street numbernamecity1_13
- Postal code1_13
- Elector signature1_13
- Witness initials1_13
- Internal use only1_13
- Printed name of elector2_13
- Full residential address street numbernamecity2_13
- Postal code2_13
- Elector signature2_13
- Witness initials2_13
- Internal use only2_13
- Printed name of elector3_13
- Full residential address street numbernamecity3_13
- Postal code3_13
- Elector signature3_13
- Witness initials3_13
- Internal use only3_13
- Printed name of elector4_13
- Full residential address street numbernamecity4_13
- Postal code4_13
- Elector signature4_13
- Witness initials4_13
- Internal use only4_13
- Printed name of elector5_13
- Full residential address street numbernamecity5_13
- Postal code5_13
- Elector signature5_13
- Witness initials5_13
- Internal use only5_13
- Printed name of elector6_13
- Full residential address street numbernamecity6_13
- Postal code6_13
- Elector signature6_13
- Witness initials6_13
- Internal use only6_13
- Printed name of elector7_13
- Full residential address street numbernamecity7_13
- Postal code7_13
- Elector signature7_13
- Witness initials7_13
- Internal use only7_13
- Printed name of elector8_13
- Full residential address street numbernamecity8_13
- Postal code8_13
- Elector signature8_13
- Witness initials8_13
- Internal use only8_13
- Printed name of elector9_13
- Full residential address street numbernamecity9_13
- Postal code9_13
- Elector signature9_13
- Witness initials9_13
- Internal use only9_13
- Printed name of elector10_13
- Full residential address street numbernamecity10_13
- Postal code10_13
- Elector signature10_13
- Witness initials10_13
- Internal use only10_13
- Printed name of elector1_14
- Full residential address street numbernamecity1_14
- Postal code1_14
- Elector signature1_14
- Witness initials1_14
- Internal use only1_14
- Printed name of elector2_14
- Full residential address street numbernamecity2_14
- Postal code2_14
- Elector signature2_14
- Witness initials2_14
- Internal use only2_14
- Printed name of elector3_14
- Full residential address street numbernamecity3_14
- Postal code3_14
- Elector signature3_14
- Witness initials3_14
- Internal use only3_14
- Printed name of elector4_14
- Full residential address street numbernamecity4_14
- Postal code4_14
- Elector signature4_14
- Witness initials4_14
- Internal use only4_14
- Printed name of elector5_14
- Full residential address street numbernamecity5_14
- Postal code5_14
- Elector signature5_14
- Witness initials5_14
- Internal use only5_14
- Printed name of elector6_14
- Full residential address street numbernamecity6_14
- Postal code6_14
- Elector signature6_14
- Witness initials6_14
- Internal use only6_14
- Printed name of elector7_14
- Full residential address street numbernamecity7_14
- Postal code7_14
- Elector signature7_14
- Witness initials7_14
- Internal use only7_14
- Printed name of elector8_14
- Full residential address street numbernamecity8_14
- Postal code8_14
- Elector signature8_14
- Witness initials8_14
- Internal use only8_14
- Printed name of elector9_14
- Full residential address street numbernamecity9_14
- Postal code9_14
- Elector signature9_14
- Witness initials9_14
- Internal use only9_14
- Printed name of elector10_14
- Full residential address street numbernamecity10_14
- Postal code10_14
- Elector signature10_14
- Witness initials10_14
- Internal use only10_14
- Printed name of elector1_15
- Full residential address street numbernamecity1_15
- Postal code1_15
- Elector signature1_15
- Witness initials1_15
- Internal use only1_15
- Printed name of elector2_15
- Full residential address street numbernamecity2_15
- Postal code2_15
- Elector signature2_15
- Witness initials2_15
- Internal use only2_15
- Printed name of elector3_15
- Full residential address street numbernamecity3_15
- Postal code3_15
- Elector signature3_15
- Witness initials3_15
- Internal use only3_15
- Printed name of elector4_15
- Full residential address street numbernamecity4_15
- Postal code4_15
- Elector signature4_15
- Witness initials4_15
- Internal use only4_15
- Printed name of elector5_15
- Full residential address street numbernamecity5_15
- Postal code5_15
- Elector signature5_15
- Witness initials5_15
- Internal use only5_15
- Printed name of elector6_15
- Full residential address street numbernamecity6_15
- Postal code6_15
- Elector signature6_15
- Witness initials6_15
- Internal use only6_15
- Printed name of elector7_15
- Full residential address street numbernamecity7_15
- Postal code7_15
- Elector signature7_15
- Witness initials7_15
- Internal use only7_15
- Printed name of elector8_15
- Full residential address street numbernamecity8_15
- Postal code8_15
- Elector signature8_15
- Witness initials8_15
- Internal use only8_15
- Printed name of elector9_15
- Full residential address street numbernamecity9_15
- Postal code9_15
- Elector signature9_15
- Witness initials9_15
- Internal use only9_15
- Printed name of elector10_15
- Full residential address street numbernamecity10_15
- Postal code10_15
- Elector signature10_15
- Witness initials10_15
- Internal use only10_15
- Printed name of elector1_16
- Full residential address street numbernamecity1_16
- Postal code1_16
- Elector signature1_16
- Witness initials1_16
- Internal use only1_16
- Printed name of elector2_16
- Full residential address street numbernamecity2_16
- Postal code2_16
- Elector signature2_16
- Witness initials2_16
- Internal use only2_16
- Printed name of elector3_16
- Full residential address street numbernamecity3_16
- Postal code3_16
- Elector signature3_16
- Witness initials3_16
- Internal use only3_16
- Printed name of elector4_16
- Full residential address street numbernamecity4_16
- Postal code4_16
- Elector signature4_16
- Witness initials4_16
- Internal use only4_16
- Printed name of elector5_16
- Full residential address street numbernamecity5_16
- Postal code5_16
- Elector signature5_16
- Witness initials5_16
- Internal use only5_16
- Printed name of elector6_16
- Full residential address street numbernamecity6_16
- Postal code6_16
- Elector signature6_16
- Witness initials6_16
- Internal use only6_16
- Printed name of elector7_16
- Full residential address street numbernamecity7_16
- Postal code7_16
- Elector signature7_16
- Witness initials7_16
- Internal use only7_16
- Printed name of elector8_16
- Full residential address street numbernamecity8_16
- Postal code8_16
- Elector signature8_16
- Witness initials8_16
- Internal use only8_16
- Printed name of elector9_16
- Full residential address street numbernamecity9_16
- Postal code9_16
- Elector signature9_16
- Witness initials9_16
- Internal use only9_16
- Printed name of elector10_16
- Full residential address street numbernamecity10_16
- Postal code10_16
- Elector signature10_16
- Witness initials10_16
- Internal use only10_16
- Have you completed the Nomination Paper EC 20010 Off
- Do you have authorized proof of identify Off
- Are you endorsed by a political party Off
- Have you made a nomination appointment Off
- Last name - Candidate Name
- First name - Candidate Name
- Name of electoral district- Candidate Information
- First name - Candidate Information
- Last name - Candidate Information
- Ballot Name Off
- Ballot First name(s)
- Ballot Last name(s)
- Gender -Candidate information
- Date of birth (YYY-MM-DD) - Gender -Candidate information
- language of correspondence - Candidate information Off
- Email -Contact information
- Primary phone number - Contact information
- Ext - Primary phone number
- Alternate phone number - Contact information
- Ext - Alternate phone number
- Fax number- Alternate phone number
- Unit -Residential address
- Street -Residential address
- Street name -Residential address
- City -Residential address
- ProvinceTerritory -Residential address
- Postal code - -Residential address
- Mailing address - same as residential address Off
- Occupation- Candidate occupation
- Sharing of information with the Conflict of Interest and Ethics Commissioner and the House of Commons including the Library of Parliament Off
- where applicable if the returning officer is unable to verify that I have been endorsed by the political party identified in section A of this Nomination Paper I wish to Off
- Date of Signature (YYYY-MM-DD) - Candidate signature
- Date of Signature (YYYY-MM-DD) -Signature of person receiving the solemn declaration
- Campaign delegate information
- First name - Campaign delegate information
- Last name - Campaign delegate information
- Language of correspondence - Campaign delegate information Off
- Email - Contact information -Campaign Delegate
- Primary phone number - Contact information -Campaign Delegate
- Primary phone number EXT - Contact information -Campaign Delegate
- Alternate phone number - Contact information -Campaign Delegate
- Alternate phone number EXT - Contact information -Campaign Delegate
- Fax nmuber- Contact information -Campaign Delegate
- Street - Residential address -Campaign delegate
- Street name - Residential address -Campaign delegate
- City - Residential address -Campaign delegate
- ProvinceTerritory - Residential address -Campaign delegate
- Postal Code - Residential address -Campaign delegate
- Campaign delegate - Mailing address ndash Same as residential address Off
- Unit - Residential address -Campaign delegate
- Date (YYYY-MM-DD) - Candidate authorization Signature
- Date (YYYY-MM-DD) - Candidate campaign Signature
- First name - Official agent information
- Last name - Official agent information
- Language of correspondence - Official agent information Off
- Email - Official agent information
- Primary phone number - Official agent information
- Primary phone number EXT - Official agent information
- Alternate phone number EXT - Official agent information
- Alternate phone number - Official agent information
- Fax number - Official agent information
- Unit -Residential address - Official Agent
- Street name -Residential address - Official Agent
- City -Residential address - Official Agent
- Street -Residential address - Official Agent
- ProvinceTerritory -Residential address - Official Agent
- Postal code-Residential address - Official Agent
- Mailing address ndash Same as residential address- Official Agent Off
- Date (YYYY-MM-DD) - Official agent signature
- First name - Auditor information
- Last name - Auditor information
- Language of correspondence - Auditor information Off
- Email - Auditor information
- Primary phone number - Auditor information
- Primary phone number EXT- Auditor information
- Alternate phone number - Auditor information
- Alternate phone number EXT- Auditor information
- Fax number - Auditor information
- Name of firm- Auditor organizational information
- Occupation of auditor - Auditor organizational information
- Professional designation - Auditor organizational information Off
- Designation registration number
- Make cheque payable to
- Unit - Address (where cheque is sent)
- Street - Address (where cheque is sent)
- Street name - Address (where cheque is sent)
- City - Address (where cheque is sent)
- ProvinceTerritory - Address (where cheque is sent)
- Postal code - Address (where cheque is sent)
- Date (YYY-MM-DD) - Auditor signature
- Unit - Campaign office address (optional)
- Street - Campaign office address (optional)
- Street name - Campaign office address (optional)
- City - Campaign office address (optional)
- ProvinceTerritory- Campaign office address (optional)
- Postal code - Campaign office address (optional)
- Name of witness
- Full address of witness
- Name of candidate
- Electoral district
- Year
- Name of candidate2
- Electoral district2
- Year2
- Name of witness2
- Full address of witness2
- Name of candidate3
- Electoral district3
- Year3
- Full address of witness3
- Name of witness3
- Name of candidate 4
- Electoral district4
- Year4
- Full address of witness 4
- Name of witness 4
- Name of candidate5
- Electoral district5
- Year5
- Full address of witness5
- Name of witness5
- Name of candidate6
- Electoral district6
- Year6
- Name of witness6
- Full address of witness6
- Name of candidate7
- Electoral district7
- Year7
- Full address of witness7
- Name of witness7
- Name of candidate8
- Electoral district8
- Year8
- Full address of witness8
- Name of witness8
- Name of candidate9
- Electoral district9
- Year9
- Full address of witness 9
- Name of witness 9
- Name of candidate10
- Electoral district10
- Year10
- Full address of witness10
- Name of witness10
- Name of candidate11
- Electoral district11
- Year11
- Full address of witness11
- Name of witness11
- Name of candidate12
- Electoral district12
- Year12
- Full address of witness12
- Name of witness12
- Name of candidate13
- Electoral district13
- Year13
- Full address of witness13
- Name of witness13
- Name of candidate14
- Electoral district14
- Year14
- Name of witness14
- Full address of witness14
- Name of candidate1
- Electoral district1
- Year1
- Name of witness1
- Full address of witness1
- Name of candidate15
- Electoral district15
- Year15
- Name of witness15
- Full address of witness15
- unit -Mailing address
- Street -Mailing address
- Street name -Mailing address
- City -Mailing address
- ProvinceTerritory -Mailing address
- Postal code -Mailing address
- Unit - Mailing address -Campaign delegate
- Street - Mailing address -Campaign delegate
- Street name - Mailing address -Campaign delegate
- City - Mailing address -Campaign delegate
- ProvinceTerritory- Mailing address -Campaign delegate
- Postal code- Mailing address -Campaign delegate
- Unit -Mailing address - Official Agent
- Street -Mailing address - Official Agent
- Street name -Mailing address - Official Agent
- city -Mailing address - Official Agent
- ProvinceTerritory-Mailing address - Official Agent
- Postal code-Mailing address - Official Agent
17BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
25
18BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
26
19BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
27
20BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
28
21BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
29
22BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
30
EC 20010 (022019)
SECTION G ndash 23B Are You Ready to Submit Your Nomination
Have you completed the Nomination Paper (EC 20010)
bull Are all mandatory fields in sections AndashE complete
bull Have you collected the required number of signatures from qualified electors in section F
o For most electoral districts 100 electors must consent to your candidacy
o For electoral districts identified in Schedule 3 only 50 electors are required
o To ensure a smooth nomination process Elections Canada recommends collecting signatures from at least 150 electors
Do you have authorized proof of identify
bull For a list of authorized identification visit the Elections Canada website
bull If a campaign delegate is submitting on your behalf they must bring a copy of your identification documents signed by you
bull If you want an alternative name to appear on the ballot additional documentation is required visit electionsca for details
Are you endorsed by a political party
bull Make sure your party has submitted the required documentation to Elections Canada attesting your designated political affiliation
Have you made a nomination appointment
bull To facilitate the nomination process make an appointment with the returning officer to finalize the filing of the complete nomination package
bull The nomination period closes 21 days before election day at 200 pm local time
31
- Nomination Paperof a Candidate at a Federal General Election or By-election
- Table of Contents
- General Information
- SECTION A ndash Candidate Information (Mandatory)
- SECTION B ndash Campaign Delegate (Optional)
- SECTION C ndash Official Agent (Mandatory)
- SECTION D ndash Auditor (Optional)
- SECTION E ndash Campaign Office (Optional)
- SECTION F ndash Electors Consenting to Candidacy (Mandatory)
-
- Name of electoral district
- Political affiliation
- Telephone number to be posted on electionsca
- Website to be posted on electionsca including prefix http https
- Printed name of elector1
- Full residential address street numbernamecity1
- Postal code1
- Elector signature1
- Witness initials1
- Internal use only1
- Printed name of elector2
- Full residential address street numbernamecity2
- Postal code2
- Elector signature2
- Witness initials2
- Internal use only2
- Printed name of elector3
- Full residential address street numbernamecity3
- Postal code3
- Elector signature3
- Witness initials3
- Internal use only3
- Printed name of elector4
- Full residential address street numbernamecity4
- Postal code4
- Elector signature4
- Witness initials4
- Internal use only4
- Printed name of elector5
- Full residential address street numbernamecity5
- Postal code5
- Elector signature5
- Witness initials5
- Internal use only5
- Printed name of elector6
- Full residential address street numbernamecity6
- Postal code6
- Elector signature6
- Witness initials6
- Internal use only6
- Printed name of elector7
- Full residential address street numbernamecity7
- Postal code7
- Elector signature7
- Witness initials7
- Internal use only7
- Printed name of elector8
- Full residential address street numbernamecity8
- Postal code8
- Elector signature8
- Witness initials8
- Internal use only8
- Printed name of elector9
- Full residential address street numbernamecity9
- Postal code9
- Elector signature9
- Witness initials9
- Internal use only9
- Printed name of elector10
- Full residential address street numbernamecity10
- Postal code10
- Elector signature10
- Witness initials10
- Internal use only10
- Printed name of elector1_2
- Full residential address street numbernamecity1_2
- Postal code1_2
- Elector signature1_2
- Witness initials1_2
- Internal use only1_2
- Printed name of elector2_2
- Full residential address street numbernamecity2_2
- Postal code2_2
- Elector signature2_2
- Witness initials2_2
- Internal use only2_2
- Printed name of elector3_2
- Full residential address street numbernamecity3_2
- Postal code3_2
- Elector signature3_2
- Witness initials3_2
- Internal use only3_2
- Printed name of elector4_2
- Full residential address street numbernamecity4_2
- Postal code4_2
- Elector signature4_2
- Witness initials4_2
- Internal use only4_2
- Printed name of elector5_2
- Full residential address street numbernamecity5_2
- Postal code5_2
- Elector signature5_2
- Witness initials5_2
- Internal use only5_2
- Printed name of elector6_2
- Full residential address street numbernamecity6_2
- Postal code6_2
- Elector signature6_2
- Witness initials6_2
- Internal use only6_2
- Printed name of elector7_2
- Full residential address street numbernamecity7_2
- Postal code7_2
- Elector signature7_2
- Witness initials7_2
- Internal use only7_2
- Printed name of elector8_2
- Full residential address street numbernamecity8_2
- Postal code8_2
- Elector signature8_2
- Witness initials8_2
- Internal use only8_2
- Printed name of elector9_2
- Full residential address street numbernamecity9_2
- Postal code9_2
- Elector signature9_2
- Witness initials9_2
- Internal use only9_2
- Printed name of elector10_2
- Full residential address street numbernamecity10_2
- Postal code10_2
- Elector signature10_2
- Witness initials10_2
- Internal use only10_2
- Printed name of elector1_3
- Full residential address street numbernamecity1_3
- Postal code1_3
- Elector signature1_3
- Witness initials1_3
- Internal use only1_3
- Printed name of elector2_3
- Full residential address street numbernamecity2_3
- Postal code2_3
- Elector signature2_3
- Witness initials2_3
- Internal use only2_3
- Printed name of elector3_3
- Full residential address street numbernamecity3_3
- Postal code3_3
- Elector signature3_3
- Witness initials3_3
- Internal use only3_3
- Printed name of elector4_3
- Full residential address street numbernamecity4_3
- Postal code4_3
- Elector signature4_3
- Witness initials4_3
- Internal use only4_3
- Printed name of elector5_3
- Full residential address street numbernamecity5_3
- Postal code5_3
- Elector signature5_3
- Witness initials5_3
- Internal use only5_3
- Printed name of elector6_3
- Full residential address street numbernamecity6_3
- Postal code6_3
- Elector signature6_3
- Witness initials6_3
- Internal use only6_3
- Printed name of elector7_3
- Full residential address street numbernamecity7_3
- Postal code7_3
- Elector signature7_3
- Witness initials7_3
- Internal use only7_3
- Printed name of elector8_3
- Full residential address street numbernamecity8_3
- Postal code8_3
- Elector signature8_3
- Witness initials8_3
- Internal use only8_3
- Printed name of elector9_3
- Full residential address street numbernamecity9_3
- Postal code9_3
- Elector signature9_3
- Witness initials9_3
- Internal use only9_3
- Printed name of elector10_3
- Full residential address street numbernamecity10_3
- Postal code10_3
- Elector signature10_3
- Witness initials10_3
- Internal use only10_3
- Printed name of elector1_4
- Full residential address street numbernamecity1_4
- Postal code1_4
- Elector signature1_4
- Witness initials1_4
- Internal use only1_4
- Printed name of elector2_4
- Full residential address street numbernamecity2_4
- Postal code2_4
- Elector signature2_4
- Witness initials2_4
- Internal use only2_4
- Printed name of elector3_4
- Full residential address street numbernamecity3_4
- Postal code3_4
- Elector signature3_4
- Witness initials3_4
- Internal use only3_4
- Printed name of elector4_4
- Full residential address street numbernamecity4_4
- Postal code4_4
- Elector signature4_4
- Witness initials4_4
- Internal use only4_4
- Printed name of elector5_4
- Full residential address street numbernamecity5_4
- Postal code5_4
- Elector signature5_4
- Witness initials5_4
- Internal use only5_4
- Printed name of elector6_4
- Full residential address street numbernamecity6_4
- Postal code6_4
- Elector signature6_4
- Witness initials6_4
- Internal use only6_4
- Printed name of elector7_4
- Full residential address street numbernamecity7_4
- Postal code7_4
- Elector signature7_4
- Witness initials7_4
- Internal use only7_4
- Printed name of elector8_4
- Full residential address street numbernamecity8_4
- Postal code8_4
- Elector signature8_4
- Witness initials8_4
- Internal use only8_4
- Printed name of elector9_4
- Full residential address street numbernamecity9_4
- Postal code9_4
- Elector signature9_4
- Witness initials9_4
- Internal use only9_4
- Printed name of elector10_4
- Full residential address street numbernamecity10_4
- Postal code10_4
- Elector signature10_4
- Witness initials10_4
- Internal use only10_4
- Printed name of elector1_5
- Full residential address street numbernamecity1_5
- Postal code1_5
- Elector signature1_5
- Witness initials1_5
- Internal use only1_5
- Printed name of elector2_5
- Full residential address street numbernamecity2_5
- Postal code2_5
- Elector signature2_5
- Witness initials2_5
- Internal use only2_5
- Printed name of elector3_5
- Full residential address street numbernamecity3_5
- Postal code3_5
- Elector signature3_5
- Witness initials3_5
- Internal use only3_5
- Printed name of elector4_5
- Full residential address street numbernamecity4_5
- Postal code4_5
- Elector signature4_5
- Witness initials4_5
- Internal use only4_5
- Printed name of elector5_5
- Full residential address street numbernamecity5_5
- Postal code5_5
- Elector signature5_5
- Witness initials5_5
- Internal use only5_5
- Printed name of elector6_5
- Full residential address street numbernamecity6_5
- Postal code6_5
- Elector signature6_5
- Witness initials6_5
- Internal use only6_5
- Printed name of elector7_5
- Full residential address street numbernamecity7_5
- Postal code7_5
- Elector signature7_5
- Witness initials7_5
- Internal use only7_5
- Printed name of elector8_5
- Full residential address street numbernamecity8_5
- Postal code8_5
- Elector signature8_5
- Witness initials8_5
- Internal use only8_5
- Printed name of elector9_5
- Full residential address street numbernamecity9_5
- Postal code9_5
- Elector signature9_5
- Witness initials9_5
- Internal use only9_5
- Printed name of elector10_5
- Full residential address street numbernamecity10_5
- Postal code10_5
- Elector signature10_5
- Witness initials10_5
- Internal use only10_5
- Printed name of elector1_6
- Full residential address street numbernamecity1_6
- Postal code1_6
- Elector signature1_6
- Witness initials1_6
- Internal use only1_6
- Printed name of elector2_6
- Full residential address street numbernamecity2_6
- Postal code2_6
- Elector signature2_6
- Witness initials2_6
- Internal use only2_6
- Printed name of elector3_6
- Full residential address street numbernamecity3_6
- Postal code3_6
- Elector signature3_6
- Witness initials3_6
- Internal use only3_6
- Printed name of elector4_6
- Full residential address street numbernamecity4_6
- Postal code4_6
- Elector signature4_6
- Witness initials4_6
- Internal use only4_6
- Printed name of elector5_6
- Full residential address street numbernamecity5_6
- Postal code5_6
- Elector signature5_6
- Witness initials5_6
- Internal use only5_6
- Printed name of elector6_6
- Full residential address street numbernamecity6_6
- Postal code6_6
- Elector signature6_6
- Witness initials6_6
- Internal use only6_6
- Printed name of elector7_6
- Full residential address street numbernamecity7_6
- Postal code7_6
- Elector signature7_6
- Witness initials7_6
- Internal use only7_6
- Printed name of elector8_6
- Full residential address street numbernamecity8_6
- Postal code8_6
- Elector signature8_6
- Witness initials8_6
- Internal use only8_6
- Printed name of elector9_6
- Full residential address street numbernamecity9_6
- Postal code9_6
- Elector signature9_6
- Witness initials9_6
- Internal use only9_6
- Printed name of elector10_6
- Full residential address street numbernamecity10_6
- Postal code10_6
- Elector signature10_6
- Witness initials10_6
- Internal use only10_6
- Printed name of elector1_7
- Full residential address street numbernamecity1_7
- Postal code1_7
- Elector signature1_7
- Witness initials1_7
- Internal use only1_7
- Printed name of elector2_7
- Full residential address street numbernamecity2_7
- Postal code2_7
- Elector signature2_7
- Witness initials2_7
- Internal use only2_7
- Printed name of elector3_7
- Full residential address street numbernamecity3_7
- Postal code3_7
- Elector signature3_7
- Witness initials3_7
- Internal use only3_7
- Printed name of elector4_7
- Full residential address street numbernamecity4_7
- Postal code4_7
- Elector signature4_7
- Witness initials4_7
- Internal use only4_7
- Printed name of elector5_7
- Full residential address street numbernamecity5_7
- Postal code5_7
- Elector signature5_7
- Witness initials5_7
- Internal use only5_7
- Printed name of elector6_7
- Full residential address street numbernamecity6_7
- Postal code6_7
- Elector signature6_7
- Witness initials6_7
- Internal use only6_7
- Printed name of elector7_7
- Full residential address street numbernamecity7_7
- Postal code7_7
- Elector signature7_7
- Witness initials7_7
- Internal use only7_7
- Printed name of elector8_7
- Full residential address street numbernamecity8_7
- Postal code8_7
- Elector signature8_7
- Witness initials8_7
- Internal use only8_7
- Printed name of elector9_7
- Full residential address street numbernamecity9_7
- Postal code9_7
- Elector signature9_7
- Witness initials9_7
- Internal use only9_7
- Printed name of elector10_7
- Full residential address street numbernamecity10_7
- Postal code10_7
- Elector signature10_7
- Witness initials10_7
- Internal use only10_7
- Printed name of elector1_8
- Full residential address street numbernamecity1_8
- Postal code1_8
- Elector signature1_8
- Witness initials1_8
- Internal use only1_8
- Printed name of elector2_8
- Full residential address street numbernamecity2_8
- Postal code2_8
- Elector signature2_8
- Witness initials2_8
- Internal use only2_8
- Printed name of elector3_8
- Full residential address street numbernamecity3_8
- Postal code3_8
- Elector signature3_8
- Witness initials3_8
- Internal use only3_8
- Printed name of elector4_8
- Full residential address street numbernamecity4_8
- Postal code4_8
- Elector signature4_8
- Witness initials4_8
- Internal use only4_8
- Printed name of elector5_8
- Full residential address street numbernamecity5_8
- Postal code5_8
- Elector signature5_8
- Witness initials5_8
- Internal use only5_8
- Printed name of elector6_8
- Full residential address street numbernamecity6_8
- Postal code6_8
- Elector signature6_8
- Witness initials6_8
- Internal use only6_8
- Printed name of elector7_8
- Full residential address street numbernamecity7_8
- Postal code7_8
- Elector signature7_8
- Witness initials7_8
- Internal use only7_8
- Printed name of elector8_8
- Full residential address street numbernamecity8_8
- Postal code8_8
- Elector signature8_8
- Witness initials8_8
- Internal use only8_8
- Printed name of elector9_8
- Full residential address street numbernamecity9_8
- Postal code9_8
- Elector signature9_8
- Witness initials9_8
- Internal use only9_8
- Printed name of elector10_8
- Full residential address street numbernamecity10_8
- Postal code10_8
- Elector signature10_8
- Witness initials10_8
- Internal use only10_8
- Printed name of elector1_9
- Full residential address street numbernamecity1_9
- Postal code1_9
- Elector signature1_9
- Witness initials1_9
- Internal use only1_9
- Printed name of elector2_9
- Full residential address street numbernamecity2_9
- Postal code2_9
- Elector signature2_9
- Witness initials2_9
- Internal use only2_9
- Printed name of elector3_9
- Full residential address street numbernamecity3_9
- Postal code3_9
- Elector signature3_9
- Witness initials3_9
- Internal use only3_9
- Printed name of elector4_9
- Full residential address street numbernamecity4_9
- Postal code4_9
- Elector signature4_9
- Witness initials4_9
- Internal use only4_9
- Printed name of elector5_9
- Full residential address street numbernamecity5_9
- Postal code5_9
- Elector signature5_9
- Witness initials5_9
- Internal use only5_9
- Printed name of elector6_9
- Full residential address street numbernamecity6_9
- Postal code6_9
- Elector signature6_9
- Witness initials6_9
- Internal use only6_9
- Printed name of elector7_9
- Full residential address street numbernamecity7_9
- Postal code7_9
- Elector signature7_9
- Witness initials7_9
- Internal use only7_9
- Printed name of elector8_9
- Full residential address street numbernamecity8_9
- Postal code8_9
- Elector signature8_9
- Witness initials8_9
- Internal use only8_9
- Printed name of elector9_9
- Full residential address street numbernamecity9_9
- Postal code9_9
- Elector signature9_9
- Witness initials9_9
- Internal use only9_9
- Printed name of elector10_9
- Full residential address street numbernamecity10_9
- Postal code10_9
- Elector signature10_9
- Witness initials10_9
- Internal use only10_9
- Printed name of elector1_10
- Full residential address street numbernamecity1_10
- Postal code1_10
- Elector signature1_10
- Witness initials1_10
- Internal use only1_10
- Printed name of elector2_10
- Full residential address street numbernamecity2_10
- Postal code2_10
- Elector signature2_10
- Witness initials2_10
- Internal use only2_10
- Printed name of elector3_10
- Full residential address street numbernamecity3_10
- Postal code3_10
- Elector signature3_10
- Witness initials3_10
- Internal use only3_10
- Printed name of elector4_10
- Full residential address street numbernamecity4_10
- Postal code4_10
- Elector signature4_10
- Witness initials4_10
- Internal use only4_10
- Printed name of elector5_10
- Full residential address street numbernamecity5_10
- Postal code5_10
- Elector signature5_10
- Witness initials5_10
- Internal use only5_10
- Printed name of elector6_10
- Full residential address street numbernamecity6_10
- Postal code6_10
- Elector signature6_10
- Witness initials6_10
- Internal use only6_10
- Printed name of elector7_10
- Full residential address street numbernamecity7_10
- Postal code7_10
- Elector signature7_10
- Witness initials7_10
- Internal use only7_10
- Printed name of elector8_10
- Full residential address street numbernamecity8_10
- Postal code8_10
- Elector signature8_10
- Witness initials8_10
- Internal use only8_10
- Printed name of elector9_10
- Full residential address street numbernamecity9_10
- Postal code9_10
- Elector signature9_10
- Witness initials9_10
- Internal use only9_10
- Printed name of elector10_10
- Full residential address street numbernamecity10_10
- Postal code10_10
- Elector signature10_10
- Witness initials10_10
- Internal use only10_10
- Printed name of elector1_11
- Full residential address street numbernamecity1_11
- Postal code1_11
- Elector signature1_11
- Witness initials1_11
- Internal use only1_11
- Printed name of elector2_11
- Full residential address street numbernamecity2_11
- Postal code2_11
- Elector signature2_11
- Witness initials2_11
- Internal use only2_11
- Printed name of elector3_11
- Full residential address street numbernamecity3_11
- Postal code3_11
- Elector signature3_11
- Witness initials3_11
- Internal use only3_11
- Printed name of elector4_11
- Full residential address street numbernamecity4_11
- Postal code4_11
- Elector signature4_11
- Witness initials4_11
- Internal use only4_11
- Printed name of elector5_11
- Full residential address street numbernamecity5_11
- Postal code5_11
- Elector signature5_11
- Witness initials5_11
- Internal use only5_11
- Printed name of elector6_11
- Full residential address street numbernamecity6_11
- Postal code6_11
- Elector signature6_11
- Witness initials6_11
- Internal use only6_11
- Printed name of elector7_11
- Full residential address street numbernamecity7_11
- Postal code7_11
- Elector signature7_11
- Witness initials7_11
- Internal use only7_11
- Printed name of elector8_11
- Full residential address street numbernamecity8_11
- Postal code8_11
- Elector signature8_11
- Witness initials8_11
- Internal use only8_11
- Printed name of elector9_11
- Full residential address street numbernamecity9_11
- Postal code9_11
- Elector signature9_11
- Witness initials9_11
- Internal use only9_11
- Printed name of elector10_11
- Full residential address street numbernamecity10_11
- Postal code10_11
- Elector signature10_11
- Witness initials10_11
- Internal use only10_11
- Printed name of elector1_12
- Full residential address street numbernamecity1_12
- Postal code1_12
- Elector signature1_12
- Witness initials1_12
- Internal use only1_12
- Printed name of elector2_12
- Full residential address street numbernamecity2_12
- Postal code2_12
- Elector signature2_12
- Witness initials2_12
- Internal use only2_12
- Printed name of elector3_12
- Full residential address street numbernamecity3_12
- Postal code3_12
- Elector signature3_12
- Witness initials3_12
- Internal use only3_12
- Printed name of elector4_12
- Full residential address street numbernamecity4_12
- Postal code4_12
- Elector signature4_12
- Witness initials4_12
- Internal use only4_12
- Printed name of elector5_12
- Full residential address street numbernamecity5_12
- Postal code5_12
- Elector signature5_12
- Witness initials5_12
- Internal use only5_12
- Printed name of elector6_12
- Full residential address street numbernamecity6_12
- Postal code6_12
- Elector signature6_12
- Witness initials6_12
- Internal use only6_12
- Printed name of elector7_12
- Full residential address street numbernamecity7_12
- Postal code7_12
- Elector signature7_12
- Witness initials7_12
- Internal use only7_12
- Printed name of elector8_12
- Full residential address street numbernamecity8_12
- Postal code8_12
- Elector signature8_12
- Witness initials8_12
- Internal use only8_12
- Printed name of elector9_12
- Full residential address street numbernamecity9_12
- Postal code9_12
- Elector signature9_12
- Witness initials9_12
- Internal use only9_12
- Printed name of elector10_12
- Full residential address street numbernamecity10_12
- Postal code10_12
- Elector signature10_12
- Witness initials10_12
- Internal use only10_12
- Printed name of elector1_13
- Full residential address street numbernamecity1_13
- Postal code1_13
- Elector signature1_13
- Witness initials1_13
- Internal use only1_13
- Printed name of elector2_13
- Full residential address street numbernamecity2_13
- Postal code2_13
- Elector signature2_13
- Witness initials2_13
- Internal use only2_13
- Printed name of elector3_13
- Full residential address street numbernamecity3_13
- Postal code3_13
- Elector signature3_13
- Witness initials3_13
- Internal use only3_13
- Printed name of elector4_13
- Full residential address street numbernamecity4_13
- Postal code4_13
- Elector signature4_13
- Witness initials4_13
- Internal use only4_13
- Printed name of elector5_13
- Full residential address street numbernamecity5_13
- Postal code5_13
- Elector signature5_13
- Witness initials5_13
- Internal use only5_13
- Printed name of elector6_13
- Full residential address street numbernamecity6_13
- Postal code6_13
- Elector signature6_13
- Witness initials6_13
- Internal use only6_13
- Printed name of elector7_13
- Full residential address street numbernamecity7_13
- Postal code7_13
- Elector signature7_13
- Witness initials7_13
- Internal use only7_13
- Printed name of elector8_13
- Full residential address street numbernamecity8_13
- Postal code8_13
- Elector signature8_13
- Witness initials8_13
- Internal use only8_13
- Printed name of elector9_13
- Full residential address street numbernamecity9_13
- Postal code9_13
- Elector signature9_13
- Witness initials9_13
- Internal use only9_13
- Printed name of elector10_13
- Full residential address street numbernamecity10_13
- Postal code10_13
- Elector signature10_13
- Witness initials10_13
- Internal use only10_13
- Printed name of elector1_14
- Full residential address street numbernamecity1_14
- Postal code1_14
- Elector signature1_14
- Witness initials1_14
- Internal use only1_14
- Printed name of elector2_14
- Full residential address street numbernamecity2_14
- Postal code2_14
- Elector signature2_14
- Witness initials2_14
- Internal use only2_14
- Printed name of elector3_14
- Full residential address street numbernamecity3_14
- Postal code3_14
- Elector signature3_14
- Witness initials3_14
- Internal use only3_14
- Printed name of elector4_14
- Full residential address street numbernamecity4_14
- Postal code4_14
- Elector signature4_14
- Witness initials4_14
- Internal use only4_14
- Printed name of elector5_14
- Full residential address street numbernamecity5_14
- Postal code5_14
- Elector signature5_14
- Witness initials5_14
- Internal use only5_14
- Printed name of elector6_14
- Full residential address street numbernamecity6_14
- Postal code6_14
- Elector signature6_14
- Witness initials6_14
- Internal use only6_14
- Printed name of elector7_14
- Full residential address street numbernamecity7_14
- Postal code7_14
- Elector signature7_14
- Witness initials7_14
- Internal use only7_14
- Printed name of elector8_14
- Full residential address street numbernamecity8_14
- Postal code8_14
- Elector signature8_14
- Witness initials8_14
- Internal use only8_14
- Printed name of elector9_14
- Full residential address street numbernamecity9_14
- Postal code9_14
- Elector signature9_14
- Witness initials9_14
- Internal use only9_14
- Printed name of elector10_14
- Full residential address street numbernamecity10_14
- Postal code10_14
- Elector signature10_14
- Witness initials10_14
- Internal use only10_14
- Printed name of elector1_15
- Full residential address street numbernamecity1_15
- Postal code1_15
- Elector signature1_15
- Witness initials1_15
- Internal use only1_15
- Printed name of elector2_15
- Full residential address street numbernamecity2_15
- Postal code2_15
- Elector signature2_15
- Witness initials2_15
- Internal use only2_15
- Printed name of elector3_15
- Full residential address street numbernamecity3_15
- Postal code3_15
- Elector signature3_15
- Witness initials3_15
- Internal use only3_15
- Printed name of elector4_15
- Full residential address street numbernamecity4_15
- Postal code4_15
- Elector signature4_15
- Witness initials4_15
- Internal use only4_15
- Printed name of elector5_15
- Full residential address street numbernamecity5_15
- Postal code5_15
- Elector signature5_15
- Witness initials5_15
- Internal use only5_15
- Printed name of elector6_15
- Full residential address street numbernamecity6_15
- Postal code6_15
- Elector signature6_15
- Witness initials6_15
- Internal use only6_15
- Printed name of elector7_15
- Full residential address street numbernamecity7_15
- Postal code7_15
- Elector signature7_15
- Witness initials7_15
- Internal use only7_15
- Printed name of elector8_15
- Full residential address street numbernamecity8_15
- Postal code8_15
- Elector signature8_15
- Witness initials8_15
- Internal use only8_15
- Printed name of elector9_15
- Full residential address street numbernamecity9_15
- Postal code9_15
- Elector signature9_15
- Witness initials9_15
- Internal use only9_15
- Printed name of elector10_15
- Full residential address street numbernamecity10_15
- Postal code10_15
- Elector signature10_15
- Witness initials10_15
- Internal use only10_15
- Printed name of elector1_16
- Full residential address street numbernamecity1_16
- Postal code1_16
- Elector signature1_16
- Witness initials1_16
- Internal use only1_16
- Printed name of elector2_16
- Full residential address street numbernamecity2_16
- Postal code2_16
- Elector signature2_16
- Witness initials2_16
- Internal use only2_16
- Printed name of elector3_16
- Full residential address street numbernamecity3_16
- Postal code3_16
- Elector signature3_16
- Witness initials3_16
- Internal use only3_16
- Printed name of elector4_16
- Full residential address street numbernamecity4_16
- Postal code4_16
- Elector signature4_16
- Witness initials4_16
- Internal use only4_16
- Printed name of elector5_16
- Full residential address street numbernamecity5_16
- Postal code5_16
- Elector signature5_16
- Witness initials5_16
- Internal use only5_16
- Printed name of elector6_16
- Full residential address street numbernamecity6_16
- Postal code6_16
- Elector signature6_16
- Witness initials6_16
- Internal use only6_16
- Printed name of elector7_16
- Full residential address street numbernamecity7_16
- Postal code7_16
- Elector signature7_16
- Witness initials7_16
- Internal use only7_16
- Printed name of elector8_16
- Full residential address street numbernamecity8_16
- Postal code8_16
- Elector signature8_16
- Witness initials8_16
- Internal use only8_16
- Printed name of elector9_16
- Full residential address street numbernamecity9_16
- Postal code9_16
- Elector signature9_16
- Witness initials9_16
- Internal use only9_16
- Printed name of elector10_16
- Full residential address street numbernamecity10_16
- Postal code10_16
- Elector signature10_16
- Witness initials10_16
- Internal use only10_16
- Have you completed the Nomination Paper EC 20010 Off
- Do you have authorized proof of identify Off
- Are you endorsed by a political party Off
- Have you made a nomination appointment Off
- Last name - Candidate Name
- First name - Candidate Name
- Name of electoral district- Candidate Information
- First name - Candidate Information
- Last name - Candidate Information
- Ballot Name Off
- Ballot First name(s)
- Ballot Last name(s)
- Gender -Candidate information
- Date of birth (YYY-MM-DD) - Gender -Candidate information
- language of correspondence - Candidate information Off
- Email -Contact information
- Primary phone number - Contact information
- Ext - Primary phone number
- Alternate phone number - Contact information
- Ext - Alternate phone number
- Fax number- Alternate phone number
- Unit -Residential address
- Street -Residential address
- Street name -Residential address
- City -Residential address
- ProvinceTerritory -Residential address
- Postal code - -Residential address
- Mailing address - same as residential address Off
- Occupation- Candidate occupation
- Sharing of information with the Conflict of Interest and Ethics Commissioner and the House of Commons including the Library of Parliament Off
- where applicable if the returning officer is unable to verify that I have been endorsed by the political party identified in section A of this Nomination Paper I wish to Off
- Date of Signature (YYYY-MM-DD) - Candidate signature
- Date of Signature (YYYY-MM-DD) -Signature of person receiving the solemn declaration
- Campaign delegate information
- First name - Campaign delegate information
- Last name - Campaign delegate information
- Language of correspondence - Campaign delegate information Off
- Email - Contact information -Campaign Delegate
- Primary phone number - Contact information -Campaign Delegate
- Primary phone number EXT - Contact information -Campaign Delegate
- Alternate phone number - Contact information -Campaign Delegate
- Alternate phone number EXT - Contact information -Campaign Delegate
- Fax nmuber- Contact information -Campaign Delegate
- Street - Residential address -Campaign delegate
- Street name - Residential address -Campaign delegate
- City - Residential address -Campaign delegate
- ProvinceTerritory - Residential address -Campaign delegate
- Postal Code - Residential address -Campaign delegate
- Campaign delegate - Mailing address ndash Same as residential address Off
- Unit - Residential address -Campaign delegate
- Date (YYYY-MM-DD) - Candidate authorization Signature
- Date (YYYY-MM-DD) - Candidate campaign Signature
- First name - Official agent information
- Last name - Official agent information
- Language of correspondence - Official agent information Off
- Email - Official agent information
- Primary phone number - Official agent information
- Primary phone number EXT - Official agent information
- Alternate phone number EXT - Official agent information
- Alternate phone number - Official agent information
- Fax number - Official agent information
- Unit -Residential address - Official Agent
- Street name -Residential address - Official Agent
- City -Residential address - Official Agent
- Street -Residential address - Official Agent
- ProvinceTerritory -Residential address - Official Agent
- Postal code-Residential address - Official Agent
- Mailing address ndash Same as residential address- Official Agent Off
- Date (YYYY-MM-DD) - Official agent signature
- First name - Auditor information
- Last name - Auditor information
- Language of correspondence - Auditor information Off
- Email - Auditor information
- Primary phone number - Auditor information
- Primary phone number EXT- Auditor information
- Alternate phone number - Auditor information
- Alternate phone number EXT- Auditor information
- Fax number - Auditor information
- Name of firm- Auditor organizational information
- Occupation of auditor - Auditor organizational information
- Professional designation - Auditor organizational information Off
- Designation registration number
- Make cheque payable to
- Unit - Address (where cheque is sent)
- Street - Address (where cheque is sent)
- Street name - Address (where cheque is sent)
- City - Address (where cheque is sent)
- ProvinceTerritory - Address (where cheque is sent)
- Postal code - Address (where cheque is sent)
- Date (YYY-MM-DD) - Auditor signature
- Unit - Campaign office address (optional)
- Street - Campaign office address (optional)
- Street name - Campaign office address (optional)
- City - Campaign office address (optional)
- ProvinceTerritory- Campaign office address (optional)
- Postal code - Campaign office address (optional)
- Name of witness
- Full address of witness
- Name of candidate
- Electoral district
- Year
- Name of candidate2
- Electoral district2
- Year2
- Name of witness2
- Full address of witness2
- Name of candidate3
- Electoral district3
- Year3
- Full address of witness3
- Name of witness3
- Name of candidate 4
- Electoral district4
- Year4
- Full address of witness 4
- Name of witness 4
- Name of candidate5
- Electoral district5
- Year5
- Full address of witness5
- Name of witness5
- Name of candidate6
- Electoral district6
- Year6
- Name of witness6
- Full address of witness6
- Name of candidate7
- Electoral district7
- Year7
- Full address of witness7
- Name of witness7
- Name of candidate8
- Electoral district8
- Year8
- Full address of witness8
- Name of witness8
- Name of candidate9
- Electoral district9
- Year9
- Full address of witness 9
- Name of witness 9
- Name of candidate10
- Electoral district10
- Year10
- Full address of witness10
- Name of witness10
- Name of candidate11
- Electoral district11
- Year11
- Full address of witness11
- Name of witness11
- Name of candidate12
- Electoral district12
- Year12
- Full address of witness12
- Name of witness12
- Name of candidate13
- Electoral district13
- Year13
- Full address of witness13
- Name of witness13
- Name of candidate14
- Electoral district14
- Year14
- Name of witness14
- Full address of witness14
- Name of candidate1
- Electoral district1
- Year1
- Name of witness1
- Full address of witness1
- Name of candidate15
- Electoral district15
- Year15
- Name of witness15
- Full address of witness15
- unit -Mailing address
- Street -Mailing address
- Street name -Mailing address
- City -Mailing address
- ProvinceTerritory -Mailing address
- Postal code -Mailing address
- Unit - Mailing address -Campaign delegate
- Street - Mailing address -Campaign delegate
- Street name - Mailing address -Campaign delegate
- City - Mailing address -Campaign delegate
- ProvinceTerritory- Mailing address -Campaign delegate
- Postal code- Mailing address -Campaign delegate
- Unit -Mailing address - Official Agent
- Street -Mailing address - Official Agent
- Street name -Mailing address - Official Agent
- city -Mailing address - Official Agent
- ProvinceTerritory-Mailing address - Official Agent
- Postal code-Mailing address - Official Agent
18BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
26
19BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
27
20BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
28
21BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
29
22BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
30
EC 20010 (022019)
SECTION G ndash 23B Are You Ready to Submit Your Nomination
Have you completed the Nomination Paper (EC 20010)
bull Are all mandatory fields in sections AndashE complete
bull Have you collected the required number of signatures from qualified electors in section F
o For most electoral districts 100 electors must consent to your candidacy
o For electoral districts identified in Schedule 3 only 50 electors are required
o To ensure a smooth nomination process Elections Canada recommends collecting signatures from at least 150 electors
Do you have authorized proof of identify
bull For a list of authorized identification visit the Elections Canada website
bull If a campaign delegate is submitting on your behalf they must bring a copy of your identification documents signed by you
bull If you want an alternative name to appear on the ballot additional documentation is required visit electionsca for details
Are you endorsed by a political party
bull Make sure your party has submitted the required documentation to Elections Canada attesting your designated political affiliation
Have you made a nomination appointment
bull To facilitate the nomination process make an appointment with the returning officer to finalize the filing of the complete nomination package
bull The nomination period closes 21 days before election day at 200 pm local time
31
- Nomination Paperof a Candidate at a Federal General Election or By-election
- Table of Contents
- General Information
- SECTION A ndash Candidate Information (Mandatory)
- SECTION B ndash Campaign Delegate (Optional)
- SECTION C ndash Official Agent (Mandatory)
- SECTION D ndash Auditor (Optional)
- SECTION E ndash Campaign Office (Optional)
- SECTION F ndash Electors Consenting to Candidacy (Mandatory)
-
- Name of electoral district
- Political affiliation
- Telephone number to be posted on electionsca
- Website to be posted on electionsca including prefix http https
- Printed name of elector1
- Full residential address street numbernamecity1
- Postal code1
- Elector signature1
- Witness initials1
- Internal use only1
- Printed name of elector2
- Full residential address street numbernamecity2
- Postal code2
- Elector signature2
- Witness initials2
- Internal use only2
- Printed name of elector3
- Full residential address street numbernamecity3
- Postal code3
- Elector signature3
- Witness initials3
- Internal use only3
- Printed name of elector4
- Full residential address street numbernamecity4
- Postal code4
- Elector signature4
- Witness initials4
- Internal use only4
- Printed name of elector5
- Full residential address street numbernamecity5
- Postal code5
- Elector signature5
- Witness initials5
- Internal use only5
- Printed name of elector6
- Full residential address street numbernamecity6
- Postal code6
- Elector signature6
- Witness initials6
- Internal use only6
- Printed name of elector7
- Full residential address street numbernamecity7
- Postal code7
- Elector signature7
- Witness initials7
- Internal use only7
- Printed name of elector8
- Full residential address street numbernamecity8
- Postal code8
- Elector signature8
- Witness initials8
- Internal use only8
- Printed name of elector9
- Full residential address street numbernamecity9
- Postal code9
- Elector signature9
- Witness initials9
- Internal use only9
- Printed name of elector10
- Full residential address street numbernamecity10
- Postal code10
- Elector signature10
- Witness initials10
- Internal use only10
- Printed name of elector1_2
- Full residential address street numbernamecity1_2
- Postal code1_2
- Elector signature1_2
- Witness initials1_2
- Internal use only1_2
- Printed name of elector2_2
- Full residential address street numbernamecity2_2
- Postal code2_2
- Elector signature2_2
- Witness initials2_2
- Internal use only2_2
- Printed name of elector3_2
- Full residential address street numbernamecity3_2
- Postal code3_2
- Elector signature3_2
- Witness initials3_2
- Internal use only3_2
- Printed name of elector4_2
- Full residential address street numbernamecity4_2
- Postal code4_2
- Elector signature4_2
- Witness initials4_2
- Internal use only4_2
- Printed name of elector5_2
- Full residential address street numbernamecity5_2
- Postal code5_2
- Elector signature5_2
- Witness initials5_2
- Internal use only5_2
- Printed name of elector6_2
- Full residential address street numbernamecity6_2
- Postal code6_2
- Elector signature6_2
- Witness initials6_2
- Internal use only6_2
- Printed name of elector7_2
- Full residential address street numbernamecity7_2
- Postal code7_2
- Elector signature7_2
- Witness initials7_2
- Internal use only7_2
- Printed name of elector8_2
- Full residential address street numbernamecity8_2
- Postal code8_2
- Elector signature8_2
- Witness initials8_2
- Internal use only8_2
- Printed name of elector9_2
- Full residential address street numbernamecity9_2
- Postal code9_2
- Elector signature9_2
- Witness initials9_2
- Internal use only9_2
- Printed name of elector10_2
- Full residential address street numbernamecity10_2
- Postal code10_2
- Elector signature10_2
- Witness initials10_2
- Internal use only10_2
- Printed name of elector1_3
- Full residential address street numbernamecity1_3
- Postal code1_3
- Elector signature1_3
- Witness initials1_3
- Internal use only1_3
- Printed name of elector2_3
- Full residential address street numbernamecity2_3
- Postal code2_3
- Elector signature2_3
- Witness initials2_3
- Internal use only2_3
- Printed name of elector3_3
- Full residential address street numbernamecity3_3
- Postal code3_3
- Elector signature3_3
- Witness initials3_3
- Internal use only3_3
- Printed name of elector4_3
- Full residential address street numbernamecity4_3
- Postal code4_3
- Elector signature4_3
- Witness initials4_3
- Internal use only4_3
- Printed name of elector5_3
- Full residential address street numbernamecity5_3
- Postal code5_3
- Elector signature5_3
- Witness initials5_3
- Internal use only5_3
- Printed name of elector6_3
- Full residential address street numbernamecity6_3
- Postal code6_3
- Elector signature6_3
- Witness initials6_3
- Internal use only6_3
- Printed name of elector7_3
- Full residential address street numbernamecity7_3
- Postal code7_3
- Elector signature7_3
- Witness initials7_3
- Internal use only7_3
- Printed name of elector8_3
- Full residential address street numbernamecity8_3
- Postal code8_3
- Elector signature8_3
- Witness initials8_3
- Internal use only8_3
- Printed name of elector9_3
- Full residential address street numbernamecity9_3
- Postal code9_3
- Elector signature9_3
- Witness initials9_3
- Internal use only9_3
- Printed name of elector10_3
- Full residential address street numbernamecity10_3
- Postal code10_3
- Elector signature10_3
- Witness initials10_3
- Internal use only10_3
- Printed name of elector1_4
- Full residential address street numbernamecity1_4
- Postal code1_4
- Elector signature1_4
- Witness initials1_4
- Internal use only1_4
- Printed name of elector2_4
- Full residential address street numbernamecity2_4
- Postal code2_4
- Elector signature2_4
- Witness initials2_4
- Internal use only2_4
- Printed name of elector3_4
- Full residential address street numbernamecity3_4
- Postal code3_4
- Elector signature3_4
- Witness initials3_4
- Internal use only3_4
- Printed name of elector4_4
- Full residential address street numbernamecity4_4
- Postal code4_4
- Elector signature4_4
- Witness initials4_4
- Internal use only4_4
- Printed name of elector5_4
- Full residential address street numbernamecity5_4
- Postal code5_4
- Elector signature5_4
- Witness initials5_4
- Internal use only5_4
- Printed name of elector6_4
- Full residential address street numbernamecity6_4
- Postal code6_4
- Elector signature6_4
- Witness initials6_4
- Internal use only6_4
- Printed name of elector7_4
- Full residential address street numbernamecity7_4
- Postal code7_4
- Elector signature7_4
- Witness initials7_4
- Internal use only7_4
- Printed name of elector8_4
- Full residential address street numbernamecity8_4
- Postal code8_4
- Elector signature8_4
- Witness initials8_4
- Internal use only8_4
- Printed name of elector9_4
- Full residential address street numbernamecity9_4
- Postal code9_4
- Elector signature9_4
- Witness initials9_4
- Internal use only9_4
- Printed name of elector10_4
- Full residential address street numbernamecity10_4
- Postal code10_4
- Elector signature10_4
- Witness initials10_4
- Internal use only10_4
- Printed name of elector1_5
- Full residential address street numbernamecity1_5
- Postal code1_5
- Elector signature1_5
- Witness initials1_5
- Internal use only1_5
- Printed name of elector2_5
- Full residential address street numbernamecity2_5
- Postal code2_5
- Elector signature2_5
- Witness initials2_5
- Internal use only2_5
- Printed name of elector3_5
- Full residential address street numbernamecity3_5
- Postal code3_5
- Elector signature3_5
- Witness initials3_5
- Internal use only3_5
- Printed name of elector4_5
- Full residential address street numbernamecity4_5
- Postal code4_5
- Elector signature4_5
- Witness initials4_5
- Internal use only4_5
- Printed name of elector5_5
- Full residential address street numbernamecity5_5
- Postal code5_5
- Elector signature5_5
- Witness initials5_5
- Internal use only5_5
- Printed name of elector6_5
- Full residential address street numbernamecity6_5
- Postal code6_5
- Elector signature6_5
- Witness initials6_5
- Internal use only6_5
- Printed name of elector7_5
- Full residential address street numbernamecity7_5
- Postal code7_5
- Elector signature7_5
- Witness initials7_5
- Internal use only7_5
- Printed name of elector8_5
- Full residential address street numbernamecity8_5
- Postal code8_5
- Elector signature8_5
- Witness initials8_5
- Internal use only8_5
- Printed name of elector9_5
- Full residential address street numbernamecity9_5
- Postal code9_5
- Elector signature9_5
- Witness initials9_5
- Internal use only9_5
- Printed name of elector10_5
- Full residential address street numbernamecity10_5
- Postal code10_5
- Elector signature10_5
- Witness initials10_5
- Internal use only10_5
- Printed name of elector1_6
- Full residential address street numbernamecity1_6
- Postal code1_6
- Elector signature1_6
- Witness initials1_6
- Internal use only1_6
- Printed name of elector2_6
- Full residential address street numbernamecity2_6
- Postal code2_6
- Elector signature2_6
- Witness initials2_6
- Internal use only2_6
- Printed name of elector3_6
- Full residential address street numbernamecity3_6
- Postal code3_6
- Elector signature3_6
- Witness initials3_6
- Internal use only3_6
- Printed name of elector4_6
- Full residential address street numbernamecity4_6
- Postal code4_6
- Elector signature4_6
- Witness initials4_6
- Internal use only4_6
- Printed name of elector5_6
- Full residential address street numbernamecity5_6
- Postal code5_6
- Elector signature5_6
- Witness initials5_6
- Internal use only5_6
- Printed name of elector6_6
- Full residential address street numbernamecity6_6
- Postal code6_6
- Elector signature6_6
- Witness initials6_6
- Internal use only6_6
- Printed name of elector7_6
- Full residential address street numbernamecity7_6
- Postal code7_6
- Elector signature7_6
- Witness initials7_6
- Internal use only7_6
- Printed name of elector8_6
- Full residential address street numbernamecity8_6
- Postal code8_6
- Elector signature8_6
- Witness initials8_6
- Internal use only8_6
- Printed name of elector9_6
- Full residential address street numbernamecity9_6
- Postal code9_6
- Elector signature9_6
- Witness initials9_6
- Internal use only9_6
- Printed name of elector10_6
- Full residential address street numbernamecity10_6
- Postal code10_6
- Elector signature10_6
- Witness initials10_6
- Internal use only10_6
- Printed name of elector1_7
- Full residential address street numbernamecity1_7
- Postal code1_7
- Elector signature1_7
- Witness initials1_7
- Internal use only1_7
- Printed name of elector2_7
- Full residential address street numbernamecity2_7
- Postal code2_7
- Elector signature2_7
- Witness initials2_7
- Internal use only2_7
- Printed name of elector3_7
- Full residential address street numbernamecity3_7
- Postal code3_7
- Elector signature3_7
- Witness initials3_7
- Internal use only3_7
- Printed name of elector4_7
- Full residential address street numbernamecity4_7
- Postal code4_7
- Elector signature4_7
- Witness initials4_7
- Internal use only4_7
- Printed name of elector5_7
- Full residential address street numbernamecity5_7
- Postal code5_7
- Elector signature5_7
- Witness initials5_7
- Internal use only5_7
- Printed name of elector6_7
- Full residential address street numbernamecity6_7
- Postal code6_7
- Elector signature6_7
- Witness initials6_7
- Internal use only6_7
- Printed name of elector7_7
- Full residential address street numbernamecity7_7
- Postal code7_7
- Elector signature7_7
- Witness initials7_7
- Internal use only7_7
- Printed name of elector8_7
- Full residential address street numbernamecity8_7
- Postal code8_7
- Elector signature8_7
- Witness initials8_7
- Internal use only8_7
- Printed name of elector9_7
- Full residential address street numbernamecity9_7
- Postal code9_7
- Elector signature9_7
- Witness initials9_7
- Internal use only9_7
- Printed name of elector10_7
- Full residential address street numbernamecity10_7
- Postal code10_7
- Elector signature10_7
- Witness initials10_7
- Internal use only10_7
- Printed name of elector1_8
- Full residential address street numbernamecity1_8
- Postal code1_8
- Elector signature1_8
- Witness initials1_8
- Internal use only1_8
- Printed name of elector2_8
- Full residential address street numbernamecity2_8
- Postal code2_8
- Elector signature2_8
- Witness initials2_8
- Internal use only2_8
- Printed name of elector3_8
- Full residential address street numbernamecity3_8
- Postal code3_8
- Elector signature3_8
- Witness initials3_8
- Internal use only3_8
- Printed name of elector4_8
- Full residential address street numbernamecity4_8
- Postal code4_8
- Elector signature4_8
- Witness initials4_8
- Internal use only4_8
- Printed name of elector5_8
- Full residential address street numbernamecity5_8
- Postal code5_8
- Elector signature5_8
- Witness initials5_8
- Internal use only5_8
- Printed name of elector6_8
- Full residential address street numbernamecity6_8
- Postal code6_8
- Elector signature6_8
- Witness initials6_8
- Internal use only6_8
- Printed name of elector7_8
- Full residential address street numbernamecity7_8
- Postal code7_8
- Elector signature7_8
- Witness initials7_8
- Internal use only7_8
- Printed name of elector8_8
- Full residential address street numbernamecity8_8
- Postal code8_8
- Elector signature8_8
- Witness initials8_8
- Internal use only8_8
- Printed name of elector9_8
- Full residential address street numbernamecity9_8
- Postal code9_8
- Elector signature9_8
- Witness initials9_8
- Internal use only9_8
- Printed name of elector10_8
- Full residential address street numbernamecity10_8
- Postal code10_8
- Elector signature10_8
- Witness initials10_8
- Internal use only10_8
- Printed name of elector1_9
- Full residential address street numbernamecity1_9
- Postal code1_9
- Elector signature1_9
- Witness initials1_9
- Internal use only1_9
- Printed name of elector2_9
- Full residential address street numbernamecity2_9
- Postal code2_9
- Elector signature2_9
- Witness initials2_9
- Internal use only2_9
- Printed name of elector3_9
- Full residential address street numbernamecity3_9
- Postal code3_9
- Elector signature3_9
- Witness initials3_9
- Internal use only3_9
- Printed name of elector4_9
- Full residential address street numbernamecity4_9
- Postal code4_9
- Elector signature4_9
- Witness initials4_9
- Internal use only4_9
- Printed name of elector5_9
- Full residential address street numbernamecity5_9
- Postal code5_9
- Elector signature5_9
- Witness initials5_9
- Internal use only5_9
- Printed name of elector6_9
- Full residential address street numbernamecity6_9
- Postal code6_9
- Elector signature6_9
- Witness initials6_9
- Internal use only6_9
- Printed name of elector7_9
- Full residential address street numbernamecity7_9
- Postal code7_9
- Elector signature7_9
- Witness initials7_9
- Internal use only7_9
- Printed name of elector8_9
- Full residential address street numbernamecity8_9
- Postal code8_9
- Elector signature8_9
- Witness initials8_9
- Internal use only8_9
- Printed name of elector9_9
- Full residential address street numbernamecity9_9
- Postal code9_9
- Elector signature9_9
- Witness initials9_9
- Internal use only9_9
- Printed name of elector10_9
- Full residential address street numbernamecity10_9
- Postal code10_9
- Elector signature10_9
- Witness initials10_9
- Internal use only10_9
- Printed name of elector1_10
- Full residential address street numbernamecity1_10
- Postal code1_10
- Elector signature1_10
- Witness initials1_10
- Internal use only1_10
- Printed name of elector2_10
- Full residential address street numbernamecity2_10
- Postal code2_10
- Elector signature2_10
- Witness initials2_10
- Internal use only2_10
- Printed name of elector3_10
- Full residential address street numbernamecity3_10
- Postal code3_10
- Elector signature3_10
- Witness initials3_10
- Internal use only3_10
- Printed name of elector4_10
- Full residential address street numbernamecity4_10
- Postal code4_10
- Elector signature4_10
- Witness initials4_10
- Internal use only4_10
- Printed name of elector5_10
- Full residential address street numbernamecity5_10
- Postal code5_10
- Elector signature5_10
- Witness initials5_10
- Internal use only5_10
- Printed name of elector6_10
- Full residential address street numbernamecity6_10
- Postal code6_10
- Elector signature6_10
- Witness initials6_10
- Internal use only6_10
- Printed name of elector7_10
- Full residential address street numbernamecity7_10
- Postal code7_10
- Elector signature7_10
- Witness initials7_10
- Internal use only7_10
- Printed name of elector8_10
- Full residential address street numbernamecity8_10
- Postal code8_10
- Elector signature8_10
- Witness initials8_10
- Internal use only8_10
- Printed name of elector9_10
- Full residential address street numbernamecity9_10
- Postal code9_10
- Elector signature9_10
- Witness initials9_10
- Internal use only9_10
- Printed name of elector10_10
- Full residential address street numbernamecity10_10
- Postal code10_10
- Elector signature10_10
- Witness initials10_10
- Internal use only10_10
- Printed name of elector1_11
- Full residential address street numbernamecity1_11
- Postal code1_11
- Elector signature1_11
- Witness initials1_11
- Internal use only1_11
- Printed name of elector2_11
- Full residential address street numbernamecity2_11
- Postal code2_11
- Elector signature2_11
- Witness initials2_11
- Internal use only2_11
- Printed name of elector3_11
- Full residential address street numbernamecity3_11
- Postal code3_11
- Elector signature3_11
- Witness initials3_11
- Internal use only3_11
- Printed name of elector4_11
- Full residential address street numbernamecity4_11
- Postal code4_11
- Elector signature4_11
- Witness initials4_11
- Internal use only4_11
- Printed name of elector5_11
- Full residential address street numbernamecity5_11
- Postal code5_11
- Elector signature5_11
- Witness initials5_11
- Internal use only5_11
- Printed name of elector6_11
- Full residential address street numbernamecity6_11
- Postal code6_11
- Elector signature6_11
- Witness initials6_11
- Internal use only6_11
- Printed name of elector7_11
- Full residential address street numbernamecity7_11
- Postal code7_11
- Elector signature7_11
- Witness initials7_11
- Internal use only7_11
- Printed name of elector8_11
- Full residential address street numbernamecity8_11
- Postal code8_11
- Elector signature8_11
- Witness initials8_11
- Internal use only8_11
- Printed name of elector9_11
- Full residential address street numbernamecity9_11
- Postal code9_11
- Elector signature9_11
- Witness initials9_11
- Internal use only9_11
- Printed name of elector10_11
- Full residential address street numbernamecity10_11
- Postal code10_11
- Elector signature10_11
- Witness initials10_11
- Internal use only10_11
- Printed name of elector1_12
- Full residential address street numbernamecity1_12
- Postal code1_12
- Elector signature1_12
- Witness initials1_12
- Internal use only1_12
- Printed name of elector2_12
- Full residential address street numbernamecity2_12
- Postal code2_12
- Elector signature2_12
- Witness initials2_12
- Internal use only2_12
- Printed name of elector3_12
- Full residential address street numbernamecity3_12
- Postal code3_12
- Elector signature3_12
- Witness initials3_12
- Internal use only3_12
- Printed name of elector4_12
- Full residential address street numbernamecity4_12
- Postal code4_12
- Elector signature4_12
- Witness initials4_12
- Internal use only4_12
- Printed name of elector5_12
- Full residential address street numbernamecity5_12
- Postal code5_12
- Elector signature5_12
- Witness initials5_12
- Internal use only5_12
- Printed name of elector6_12
- Full residential address street numbernamecity6_12
- Postal code6_12
- Elector signature6_12
- Witness initials6_12
- Internal use only6_12
- Printed name of elector7_12
- Full residential address street numbernamecity7_12
- Postal code7_12
- Elector signature7_12
- Witness initials7_12
- Internal use only7_12
- Printed name of elector8_12
- Full residential address street numbernamecity8_12
- Postal code8_12
- Elector signature8_12
- Witness initials8_12
- Internal use only8_12
- Printed name of elector9_12
- Full residential address street numbernamecity9_12
- Postal code9_12
- Elector signature9_12
- Witness initials9_12
- Internal use only9_12
- Printed name of elector10_12
- Full residential address street numbernamecity10_12
- Postal code10_12
- Elector signature10_12
- Witness initials10_12
- Internal use only10_12
- Printed name of elector1_13
- Full residential address street numbernamecity1_13
- Postal code1_13
- Elector signature1_13
- Witness initials1_13
- Internal use only1_13
- Printed name of elector2_13
- Full residential address street numbernamecity2_13
- Postal code2_13
- Elector signature2_13
- Witness initials2_13
- Internal use only2_13
- Printed name of elector3_13
- Full residential address street numbernamecity3_13
- Postal code3_13
- Elector signature3_13
- Witness initials3_13
- Internal use only3_13
- Printed name of elector4_13
- Full residential address street numbernamecity4_13
- Postal code4_13
- Elector signature4_13
- Witness initials4_13
- Internal use only4_13
- Printed name of elector5_13
- Full residential address street numbernamecity5_13
- Postal code5_13
- Elector signature5_13
- Witness initials5_13
- Internal use only5_13
- Printed name of elector6_13
- Full residential address street numbernamecity6_13
- Postal code6_13
- Elector signature6_13
- Witness initials6_13
- Internal use only6_13
- Printed name of elector7_13
- Full residential address street numbernamecity7_13
- Postal code7_13
- Elector signature7_13
- Witness initials7_13
- Internal use only7_13
- Printed name of elector8_13
- Full residential address street numbernamecity8_13
- Postal code8_13
- Elector signature8_13
- Witness initials8_13
- Internal use only8_13
- Printed name of elector9_13
- Full residential address street numbernamecity9_13
- Postal code9_13
- Elector signature9_13
- Witness initials9_13
- Internal use only9_13
- Printed name of elector10_13
- Full residential address street numbernamecity10_13
- Postal code10_13
- Elector signature10_13
- Witness initials10_13
- Internal use only10_13
- Printed name of elector1_14
- Full residential address street numbernamecity1_14
- Postal code1_14
- Elector signature1_14
- Witness initials1_14
- Internal use only1_14
- Printed name of elector2_14
- Full residential address street numbernamecity2_14
- Postal code2_14
- Elector signature2_14
- Witness initials2_14
- Internal use only2_14
- Printed name of elector3_14
- Full residential address street numbernamecity3_14
- Postal code3_14
- Elector signature3_14
- Witness initials3_14
- Internal use only3_14
- Printed name of elector4_14
- Full residential address street numbernamecity4_14
- Postal code4_14
- Elector signature4_14
- Witness initials4_14
- Internal use only4_14
- Printed name of elector5_14
- Full residential address street numbernamecity5_14
- Postal code5_14
- Elector signature5_14
- Witness initials5_14
- Internal use only5_14
- Printed name of elector6_14
- Full residential address street numbernamecity6_14
- Postal code6_14
- Elector signature6_14
- Witness initials6_14
- Internal use only6_14
- Printed name of elector7_14
- Full residential address street numbernamecity7_14
- Postal code7_14
- Elector signature7_14
- Witness initials7_14
- Internal use only7_14
- Printed name of elector8_14
- Full residential address street numbernamecity8_14
- Postal code8_14
- Elector signature8_14
- Witness initials8_14
- Internal use only8_14
- Printed name of elector9_14
- Full residential address street numbernamecity9_14
- Postal code9_14
- Elector signature9_14
- Witness initials9_14
- Internal use only9_14
- Printed name of elector10_14
- Full residential address street numbernamecity10_14
- Postal code10_14
- Elector signature10_14
- Witness initials10_14
- Internal use only10_14
- Printed name of elector1_15
- Full residential address street numbernamecity1_15
- Postal code1_15
- Elector signature1_15
- Witness initials1_15
- Internal use only1_15
- Printed name of elector2_15
- Full residential address street numbernamecity2_15
- Postal code2_15
- Elector signature2_15
- Witness initials2_15
- Internal use only2_15
- Printed name of elector3_15
- Full residential address street numbernamecity3_15
- Postal code3_15
- Elector signature3_15
- Witness initials3_15
- Internal use only3_15
- Printed name of elector4_15
- Full residential address street numbernamecity4_15
- Postal code4_15
- Elector signature4_15
- Witness initials4_15
- Internal use only4_15
- Printed name of elector5_15
- Full residential address street numbernamecity5_15
- Postal code5_15
- Elector signature5_15
- Witness initials5_15
- Internal use only5_15
- Printed name of elector6_15
- Full residential address street numbernamecity6_15
- Postal code6_15
- Elector signature6_15
- Witness initials6_15
- Internal use only6_15
- Printed name of elector7_15
- Full residential address street numbernamecity7_15
- Postal code7_15
- Elector signature7_15
- Witness initials7_15
- Internal use only7_15
- Printed name of elector8_15
- Full residential address street numbernamecity8_15
- Postal code8_15
- Elector signature8_15
- Witness initials8_15
- Internal use only8_15
- Printed name of elector9_15
- Full residential address street numbernamecity9_15
- Postal code9_15
- Elector signature9_15
- Witness initials9_15
- Internal use only9_15
- Printed name of elector10_15
- Full residential address street numbernamecity10_15
- Postal code10_15
- Elector signature10_15
- Witness initials10_15
- Internal use only10_15
- Printed name of elector1_16
- Full residential address street numbernamecity1_16
- Postal code1_16
- Elector signature1_16
- Witness initials1_16
- Internal use only1_16
- Printed name of elector2_16
- Full residential address street numbernamecity2_16
- Postal code2_16
- Elector signature2_16
- Witness initials2_16
- Internal use only2_16
- Printed name of elector3_16
- Full residential address street numbernamecity3_16
- Postal code3_16
- Elector signature3_16
- Witness initials3_16
- Internal use only3_16
- Printed name of elector4_16
- Full residential address street numbernamecity4_16
- Postal code4_16
- Elector signature4_16
- Witness initials4_16
- Internal use only4_16
- Printed name of elector5_16
- Full residential address street numbernamecity5_16
- Postal code5_16
- Elector signature5_16
- Witness initials5_16
- Internal use only5_16
- Printed name of elector6_16
- Full residential address street numbernamecity6_16
- Postal code6_16
- Elector signature6_16
- Witness initials6_16
- Internal use only6_16
- Printed name of elector7_16
- Full residential address street numbernamecity7_16
- Postal code7_16
- Elector signature7_16
- Witness initials7_16
- Internal use only7_16
- Printed name of elector8_16
- Full residential address street numbernamecity8_16
- Postal code8_16
- Elector signature8_16
- Witness initials8_16
- Internal use only8_16
- Printed name of elector9_16
- Full residential address street numbernamecity9_16
- Postal code9_16
- Elector signature9_16
- Witness initials9_16
- Internal use only9_16
- Printed name of elector10_16
- Full residential address street numbernamecity10_16
- Postal code10_16
- Elector signature10_16
- Witness initials10_16
- Internal use only10_16
- Have you completed the Nomination Paper EC 20010 Off
- Do you have authorized proof of identify Off
- Are you endorsed by a political party Off
- Have you made a nomination appointment Off
- Last name - Candidate Name
- First name - Candidate Name
- Name of electoral district- Candidate Information
- First name - Candidate Information
- Last name - Candidate Information
- Ballot Name Off
- Ballot First name(s)
- Ballot Last name(s)
- Gender -Candidate information
- Date of birth (YYY-MM-DD) - Gender -Candidate information
- language of correspondence - Candidate information Off
- Email -Contact information
- Primary phone number - Contact information
- Ext - Primary phone number
- Alternate phone number - Contact information
- Ext - Alternate phone number
- Fax number- Alternate phone number
- Unit -Residential address
- Street -Residential address
- Street name -Residential address
- City -Residential address
- ProvinceTerritory -Residential address
- Postal code - -Residential address
- Mailing address - same as residential address Off
- Occupation- Candidate occupation
- Sharing of information with the Conflict of Interest and Ethics Commissioner and the House of Commons including the Library of Parliament Off
- where applicable if the returning officer is unable to verify that I have been endorsed by the political party identified in section A of this Nomination Paper I wish to Off
- Date of Signature (YYYY-MM-DD) - Candidate signature
- Date of Signature (YYYY-MM-DD) -Signature of person receiving the solemn declaration
- Campaign delegate information
- First name - Campaign delegate information
- Last name - Campaign delegate information
- Language of correspondence - Campaign delegate information Off
- Email - Contact information -Campaign Delegate
- Primary phone number - Contact information -Campaign Delegate
- Primary phone number EXT - Contact information -Campaign Delegate
- Alternate phone number - Contact information -Campaign Delegate
- Alternate phone number EXT - Contact information -Campaign Delegate
- Fax nmuber- Contact information -Campaign Delegate
- Street - Residential address -Campaign delegate
- Street name - Residential address -Campaign delegate
- City - Residential address -Campaign delegate
- ProvinceTerritory - Residential address -Campaign delegate
- Postal Code - Residential address -Campaign delegate
- Campaign delegate - Mailing address ndash Same as residential address Off
- Unit - Residential address -Campaign delegate
- Date (YYYY-MM-DD) - Candidate authorization Signature
- Date (YYYY-MM-DD) - Candidate campaign Signature
- First name - Official agent information
- Last name - Official agent information
- Language of correspondence - Official agent information Off
- Email - Official agent information
- Primary phone number - Official agent information
- Primary phone number EXT - Official agent information
- Alternate phone number EXT - Official agent information
- Alternate phone number - Official agent information
- Fax number - Official agent information
- Unit -Residential address - Official Agent
- Street name -Residential address - Official Agent
- City -Residential address - Official Agent
- Street -Residential address - Official Agent
- ProvinceTerritory -Residential address - Official Agent
- Postal code-Residential address - Official Agent
- Mailing address ndash Same as residential address- Official Agent Off
- Date (YYYY-MM-DD) - Official agent signature
- First name - Auditor information
- Last name - Auditor information
- Language of correspondence - Auditor information Off
- Email - Auditor information
- Primary phone number - Auditor information
- Primary phone number EXT- Auditor information
- Alternate phone number - Auditor information
- Alternate phone number EXT- Auditor information
- Fax number - Auditor information
- Name of firm- Auditor organizational information
- Occupation of auditor - Auditor organizational information
- Professional designation - Auditor organizational information Off
- Designation registration number
- Make cheque payable to
- Unit - Address (where cheque is sent)
- Street - Address (where cheque is sent)
- Street name - Address (where cheque is sent)
- City - Address (where cheque is sent)
- ProvinceTerritory - Address (where cheque is sent)
- Postal code - Address (where cheque is sent)
- Date (YYY-MM-DD) - Auditor signature
- Unit - Campaign office address (optional)
- Street - Campaign office address (optional)
- Street name - Campaign office address (optional)
- City - Campaign office address (optional)
- ProvinceTerritory- Campaign office address (optional)
- Postal code - Campaign office address (optional)
- Name of witness
- Full address of witness
- Name of candidate
- Electoral district
- Year
- Name of candidate2
- Electoral district2
- Year2
- Name of witness2
- Full address of witness2
- Name of candidate3
- Electoral district3
- Year3
- Full address of witness3
- Name of witness3
- Name of candidate 4
- Electoral district4
- Year4
- Full address of witness 4
- Name of witness 4
- Name of candidate5
- Electoral district5
- Year5
- Full address of witness5
- Name of witness5
- Name of candidate6
- Electoral district6
- Year6
- Name of witness6
- Full address of witness6
- Name of candidate7
- Electoral district7
- Year7
- Full address of witness7
- Name of witness7
- Name of candidate8
- Electoral district8
- Year8
- Full address of witness8
- Name of witness8
- Name of candidate9
- Electoral district9
- Year9
- Full address of witness 9
- Name of witness 9
- Name of candidate10
- Electoral district10
- Year10
- Full address of witness10
- Name of witness10
- Name of candidate11
- Electoral district11
- Year11
- Full address of witness11
- Name of witness11
- Name of candidate12
- Electoral district12
- Year12
- Full address of witness12
- Name of witness12
- Name of candidate13
- Electoral district13
- Year13
- Full address of witness13
- Name of witness13
- Name of candidate14
- Electoral district14
- Year14
- Name of witness14
- Full address of witness14
- Name of candidate1
- Electoral district1
- Year1
- Name of witness1
- Full address of witness1
- Name of candidate15
- Electoral district15
- Year15
- Name of witness15
- Full address of witness15
- unit -Mailing address
- Street -Mailing address
- Street name -Mailing address
- City -Mailing address
- ProvinceTerritory -Mailing address
- Postal code -Mailing address
- Unit - Mailing address -Campaign delegate
- Street - Mailing address -Campaign delegate
- Street name - Mailing address -Campaign delegate
- City - Mailing address -Campaign delegate
- ProvinceTerritory- Mailing address -Campaign delegate
- Postal code- Mailing address -Campaign delegate
- Unit -Mailing address - Official Agent
- Street -Mailing address - Official Agent
- Street name -Mailing address - Official Agent
- city -Mailing address - Official Agent
- ProvinceTerritory-Mailing address - Official Agent
- Postal code-Mailing address - Official Agent
19BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
27
20BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
28
21BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
29
22BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
30
EC 20010 (022019)
SECTION G ndash 23B Are You Ready to Submit Your Nomination
Have you completed the Nomination Paper (EC 20010)
bull Are all mandatory fields in sections AndashE complete
bull Have you collected the required number of signatures from qualified electors in section F
o For most electoral districts 100 electors must consent to your candidacy
o For electoral districts identified in Schedule 3 only 50 electors are required
o To ensure a smooth nomination process Elections Canada recommends collecting signatures from at least 150 electors
Do you have authorized proof of identify
bull For a list of authorized identification visit the Elections Canada website
bull If a campaign delegate is submitting on your behalf they must bring a copy of your identification documents signed by you
bull If you want an alternative name to appear on the ballot additional documentation is required visit electionsca for details
Are you endorsed by a political party
bull Make sure your party has submitted the required documentation to Elections Canada attesting your designated political affiliation
Have you made a nomination appointment
bull To facilitate the nomination process make an appointment with the returning officer to finalize the filing of the complete nomination package
bull The nomination period closes 21 days before election day at 200 pm local time
31
- Nomination Paperof a Candidate at a Federal General Election or By-election
- Table of Contents
- General Information
- SECTION A ndash Candidate Information (Mandatory)
- SECTION B ndash Campaign Delegate (Optional)
- SECTION C ndash Official Agent (Mandatory)
- SECTION D ndash Auditor (Optional)
- SECTION E ndash Campaign Office (Optional)
- SECTION F ndash Electors Consenting to Candidacy (Mandatory)
-
- Name of electoral district
- Political affiliation
- Telephone number to be posted on electionsca
- Website to be posted on electionsca including prefix http https
- Printed name of elector1
- Full residential address street numbernamecity1
- Postal code1
- Elector signature1
- Witness initials1
- Internal use only1
- Printed name of elector2
- Full residential address street numbernamecity2
- Postal code2
- Elector signature2
- Witness initials2
- Internal use only2
- Printed name of elector3
- Full residential address street numbernamecity3
- Postal code3
- Elector signature3
- Witness initials3
- Internal use only3
- Printed name of elector4
- Full residential address street numbernamecity4
- Postal code4
- Elector signature4
- Witness initials4
- Internal use only4
- Printed name of elector5
- Full residential address street numbernamecity5
- Postal code5
- Elector signature5
- Witness initials5
- Internal use only5
- Printed name of elector6
- Full residential address street numbernamecity6
- Postal code6
- Elector signature6
- Witness initials6
- Internal use only6
- Printed name of elector7
- Full residential address street numbernamecity7
- Postal code7
- Elector signature7
- Witness initials7
- Internal use only7
- Printed name of elector8
- Full residential address street numbernamecity8
- Postal code8
- Elector signature8
- Witness initials8
- Internal use only8
- Printed name of elector9
- Full residential address street numbernamecity9
- Postal code9
- Elector signature9
- Witness initials9
- Internal use only9
- Printed name of elector10
- Full residential address street numbernamecity10
- Postal code10
- Elector signature10
- Witness initials10
- Internal use only10
- Printed name of elector1_2
- Full residential address street numbernamecity1_2
- Postal code1_2
- Elector signature1_2
- Witness initials1_2
- Internal use only1_2
- Printed name of elector2_2
- Full residential address street numbernamecity2_2
- Postal code2_2
- Elector signature2_2
- Witness initials2_2
- Internal use only2_2
- Printed name of elector3_2
- Full residential address street numbernamecity3_2
- Postal code3_2
- Elector signature3_2
- Witness initials3_2
- Internal use only3_2
- Printed name of elector4_2
- Full residential address street numbernamecity4_2
- Postal code4_2
- Elector signature4_2
- Witness initials4_2
- Internal use only4_2
- Printed name of elector5_2
- Full residential address street numbernamecity5_2
- Postal code5_2
- Elector signature5_2
- Witness initials5_2
- Internal use only5_2
- Printed name of elector6_2
- Full residential address street numbernamecity6_2
- Postal code6_2
- Elector signature6_2
- Witness initials6_2
- Internal use only6_2
- Printed name of elector7_2
- Full residential address street numbernamecity7_2
- Postal code7_2
- Elector signature7_2
- Witness initials7_2
- Internal use only7_2
- Printed name of elector8_2
- Full residential address street numbernamecity8_2
- Postal code8_2
- Elector signature8_2
- Witness initials8_2
- Internal use only8_2
- Printed name of elector9_2
- Full residential address street numbernamecity9_2
- Postal code9_2
- Elector signature9_2
- Witness initials9_2
- Internal use only9_2
- Printed name of elector10_2
- Full residential address street numbernamecity10_2
- Postal code10_2
- Elector signature10_2
- Witness initials10_2
- Internal use only10_2
- Printed name of elector1_3
- Full residential address street numbernamecity1_3
- Postal code1_3
- Elector signature1_3
- Witness initials1_3
- Internal use only1_3
- Printed name of elector2_3
- Full residential address street numbernamecity2_3
- Postal code2_3
- Elector signature2_3
- Witness initials2_3
- Internal use only2_3
- Printed name of elector3_3
- Full residential address street numbernamecity3_3
- Postal code3_3
- Elector signature3_3
- Witness initials3_3
- Internal use only3_3
- Printed name of elector4_3
- Full residential address street numbernamecity4_3
- Postal code4_3
- Elector signature4_3
- Witness initials4_3
- Internal use only4_3
- Printed name of elector5_3
- Full residential address street numbernamecity5_3
- Postal code5_3
- Elector signature5_3
- Witness initials5_3
- Internal use only5_3
- Printed name of elector6_3
- Full residential address street numbernamecity6_3
- Postal code6_3
- Elector signature6_3
- Witness initials6_3
- Internal use only6_3
- Printed name of elector7_3
- Full residential address street numbernamecity7_3
- Postal code7_3
- Elector signature7_3
- Witness initials7_3
- Internal use only7_3
- Printed name of elector8_3
- Full residential address street numbernamecity8_3
- Postal code8_3
- Elector signature8_3
- Witness initials8_3
- Internal use only8_3
- Printed name of elector9_3
- Full residential address street numbernamecity9_3
- Postal code9_3
- Elector signature9_3
- Witness initials9_3
- Internal use only9_3
- Printed name of elector10_3
- Full residential address street numbernamecity10_3
- Postal code10_3
- Elector signature10_3
- Witness initials10_3
- Internal use only10_3
- Printed name of elector1_4
- Full residential address street numbernamecity1_4
- Postal code1_4
- Elector signature1_4
- Witness initials1_4
- Internal use only1_4
- Printed name of elector2_4
- Full residential address street numbernamecity2_4
- Postal code2_4
- Elector signature2_4
- Witness initials2_4
- Internal use only2_4
- Printed name of elector3_4
- Full residential address street numbernamecity3_4
- Postal code3_4
- Elector signature3_4
- Witness initials3_4
- Internal use only3_4
- Printed name of elector4_4
- Full residential address street numbernamecity4_4
- Postal code4_4
- Elector signature4_4
- Witness initials4_4
- Internal use only4_4
- Printed name of elector5_4
- Full residential address street numbernamecity5_4
- Postal code5_4
- Elector signature5_4
- Witness initials5_4
- Internal use only5_4
- Printed name of elector6_4
- Full residential address street numbernamecity6_4
- Postal code6_4
- Elector signature6_4
- Witness initials6_4
- Internal use only6_4
- Printed name of elector7_4
- Full residential address street numbernamecity7_4
- Postal code7_4
- Elector signature7_4
- Witness initials7_4
- Internal use only7_4
- Printed name of elector8_4
- Full residential address street numbernamecity8_4
- Postal code8_4
- Elector signature8_4
- Witness initials8_4
- Internal use only8_4
- Printed name of elector9_4
- Full residential address street numbernamecity9_4
- Postal code9_4
- Elector signature9_4
- Witness initials9_4
- Internal use only9_4
- Printed name of elector10_4
- Full residential address street numbernamecity10_4
- Postal code10_4
- Elector signature10_4
- Witness initials10_4
- Internal use only10_4
- Printed name of elector1_5
- Full residential address street numbernamecity1_5
- Postal code1_5
- Elector signature1_5
- Witness initials1_5
- Internal use only1_5
- Printed name of elector2_5
- Full residential address street numbernamecity2_5
- Postal code2_5
- Elector signature2_5
- Witness initials2_5
- Internal use only2_5
- Printed name of elector3_5
- Full residential address street numbernamecity3_5
- Postal code3_5
- Elector signature3_5
- Witness initials3_5
- Internal use only3_5
- Printed name of elector4_5
- Full residential address street numbernamecity4_5
- Postal code4_5
- Elector signature4_5
- Witness initials4_5
- Internal use only4_5
- Printed name of elector5_5
- Full residential address street numbernamecity5_5
- Postal code5_5
- Elector signature5_5
- Witness initials5_5
- Internal use only5_5
- Printed name of elector6_5
- Full residential address street numbernamecity6_5
- Postal code6_5
- Elector signature6_5
- Witness initials6_5
- Internal use only6_5
- Printed name of elector7_5
- Full residential address street numbernamecity7_5
- Postal code7_5
- Elector signature7_5
- Witness initials7_5
- Internal use only7_5
- Printed name of elector8_5
- Full residential address street numbernamecity8_5
- Postal code8_5
- Elector signature8_5
- Witness initials8_5
- Internal use only8_5
- Printed name of elector9_5
- Full residential address street numbernamecity9_5
- Postal code9_5
- Elector signature9_5
- Witness initials9_5
- Internal use only9_5
- Printed name of elector10_5
- Full residential address street numbernamecity10_5
- Postal code10_5
- Elector signature10_5
- Witness initials10_5
- Internal use only10_5
- Printed name of elector1_6
- Full residential address street numbernamecity1_6
- Postal code1_6
- Elector signature1_6
- Witness initials1_6
- Internal use only1_6
- Printed name of elector2_6
- Full residential address street numbernamecity2_6
- Postal code2_6
- Elector signature2_6
- Witness initials2_6
- Internal use only2_6
- Printed name of elector3_6
- Full residential address street numbernamecity3_6
- Postal code3_6
- Elector signature3_6
- Witness initials3_6
- Internal use only3_6
- Printed name of elector4_6
- Full residential address street numbernamecity4_6
- Postal code4_6
- Elector signature4_6
- Witness initials4_6
- Internal use only4_6
- Printed name of elector5_6
- Full residential address street numbernamecity5_6
- Postal code5_6
- Elector signature5_6
- Witness initials5_6
- Internal use only5_6
- Printed name of elector6_6
- Full residential address street numbernamecity6_6
- Postal code6_6
- Elector signature6_6
- Witness initials6_6
- Internal use only6_6
- Printed name of elector7_6
- Full residential address street numbernamecity7_6
- Postal code7_6
- Elector signature7_6
- Witness initials7_6
- Internal use only7_6
- Printed name of elector8_6
- Full residential address street numbernamecity8_6
- Postal code8_6
- Elector signature8_6
- Witness initials8_6
- Internal use only8_6
- Printed name of elector9_6
- Full residential address street numbernamecity9_6
- Postal code9_6
- Elector signature9_6
- Witness initials9_6
- Internal use only9_6
- Printed name of elector10_6
- Full residential address street numbernamecity10_6
- Postal code10_6
- Elector signature10_6
- Witness initials10_6
- Internal use only10_6
- Printed name of elector1_7
- Full residential address street numbernamecity1_7
- Postal code1_7
- Elector signature1_7
- Witness initials1_7
- Internal use only1_7
- Printed name of elector2_7
- Full residential address street numbernamecity2_7
- Postal code2_7
- Elector signature2_7
- Witness initials2_7
- Internal use only2_7
- Printed name of elector3_7
- Full residential address street numbernamecity3_7
- Postal code3_7
- Elector signature3_7
- Witness initials3_7
- Internal use only3_7
- Printed name of elector4_7
- Full residential address street numbernamecity4_7
- Postal code4_7
- Elector signature4_7
- Witness initials4_7
- Internal use only4_7
- Printed name of elector5_7
- Full residential address street numbernamecity5_7
- Postal code5_7
- Elector signature5_7
- Witness initials5_7
- Internal use only5_7
- Printed name of elector6_7
- Full residential address street numbernamecity6_7
- Postal code6_7
- Elector signature6_7
- Witness initials6_7
- Internal use only6_7
- Printed name of elector7_7
- Full residential address street numbernamecity7_7
- Postal code7_7
- Elector signature7_7
- Witness initials7_7
- Internal use only7_7
- Printed name of elector8_7
- Full residential address street numbernamecity8_7
- Postal code8_7
- Elector signature8_7
- Witness initials8_7
- Internal use only8_7
- Printed name of elector9_7
- Full residential address street numbernamecity9_7
- Postal code9_7
- Elector signature9_7
- Witness initials9_7
- Internal use only9_7
- Printed name of elector10_7
- Full residential address street numbernamecity10_7
- Postal code10_7
- Elector signature10_7
- Witness initials10_7
- Internal use only10_7
- Printed name of elector1_8
- Full residential address street numbernamecity1_8
- Postal code1_8
- Elector signature1_8
- Witness initials1_8
- Internal use only1_8
- Printed name of elector2_8
- Full residential address street numbernamecity2_8
- Postal code2_8
- Elector signature2_8
- Witness initials2_8
- Internal use only2_8
- Printed name of elector3_8
- Full residential address street numbernamecity3_8
- Postal code3_8
- Elector signature3_8
- Witness initials3_8
- Internal use only3_8
- Printed name of elector4_8
- Full residential address street numbernamecity4_8
- Postal code4_8
- Elector signature4_8
- Witness initials4_8
- Internal use only4_8
- Printed name of elector5_8
- Full residential address street numbernamecity5_8
- Postal code5_8
- Elector signature5_8
- Witness initials5_8
- Internal use only5_8
- Printed name of elector6_8
- Full residential address street numbernamecity6_8
- Postal code6_8
- Elector signature6_8
- Witness initials6_8
- Internal use only6_8
- Printed name of elector7_8
- Full residential address street numbernamecity7_8
- Postal code7_8
- Elector signature7_8
- Witness initials7_8
- Internal use only7_8
- Printed name of elector8_8
- Full residential address street numbernamecity8_8
- Postal code8_8
- Elector signature8_8
- Witness initials8_8
- Internal use only8_8
- Printed name of elector9_8
- Full residential address street numbernamecity9_8
- Postal code9_8
- Elector signature9_8
- Witness initials9_8
- Internal use only9_8
- Printed name of elector10_8
- Full residential address street numbernamecity10_8
- Postal code10_8
- Elector signature10_8
- Witness initials10_8
- Internal use only10_8
- Printed name of elector1_9
- Full residential address street numbernamecity1_9
- Postal code1_9
- Elector signature1_9
- Witness initials1_9
- Internal use only1_9
- Printed name of elector2_9
- Full residential address street numbernamecity2_9
- Postal code2_9
- Elector signature2_9
- Witness initials2_9
- Internal use only2_9
- Printed name of elector3_9
- Full residential address street numbernamecity3_9
- Postal code3_9
- Elector signature3_9
- Witness initials3_9
- Internal use only3_9
- Printed name of elector4_9
- Full residential address street numbernamecity4_9
- Postal code4_9
- Elector signature4_9
- Witness initials4_9
- Internal use only4_9
- Printed name of elector5_9
- Full residential address street numbernamecity5_9
- Postal code5_9
- Elector signature5_9
- Witness initials5_9
- Internal use only5_9
- Printed name of elector6_9
- Full residential address street numbernamecity6_9
- Postal code6_9
- Elector signature6_9
- Witness initials6_9
- Internal use only6_9
- Printed name of elector7_9
- Full residential address street numbernamecity7_9
- Postal code7_9
- Elector signature7_9
- Witness initials7_9
- Internal use only7_9
- Printed name of elector8_9
- Full residential address street numbernamecity8_9
- Postal code8_9
- Elector signature8_9
- Witness initials8_9
- Internal use only8_9
- Printed name of elector9_9
- Full residential address street numbernamecity9_9
- Postal code9_9
- Elector signature9_9
- Witness initials9_9
- Internal use only9_9
- Printed name of elector10_9
- Full residential address street numbernamecity10_9
- Postal code10_9
- Elector signature10_9
- Witness initials10_9
- Internal use only10_9
- Printed name of elector1_10
- Full residential address street numbernamecity1_10
- Postal code1_10
- Elector signature1_10
- Witness initials1_10
- Internal use only1_10
- Printed name of elector2_10
- Full residential address street numbernamecity2_10
- Postal code2_10
- Elector signature2_10
- Witness initials2_10
- Internal use only2_10
- Printed name of elector3_10
- Full residential address street numbernamecity3_10
- Postal code3_10
- Elector signature3_10
- Witness initials3_10
- Internal use only3_10
- Printed name of elector4_10
- Full residential address street numbernamecity4_10
- Postal code4_10
- Elector signature4_10
- Witness initials4_10
- Internal use only4_10
- Printed name of elector5_10
- Full residential address street numbernamecity5_10
- Postal code5_10
- Elector signature5_10
- Witness initials5_10
- Internal use only5_10
- Printed name of elector6_10
- Full residential address street numbernamecity6_10
- Postal code6_10
- Elector signature6_10
- Witness initials6_10
- Internal use only6_10
- Printed name of elector7_10
- Full residential address street numbernamecity7_10
- Postal code7_10
- Elector signature7_10
- Witness initials7_10
- Internal use only7_10
- Printed name of elector8_10
- Full residential address street numbernamecity8_10
- Postal code8_10
- Elector signature8_10
- Witness initials8_10
- Internal use only8_10
- Printed name of elector9_10
- Full residential address street numbernamecity9_10
- Postal code9_10
- Elector signature9_10
- Witness initials9_10
- Internal use only9_10
- Printed name of elector10_10
- Full residential address street numbernamecity10_10
- Postal code10_10
- Elector signature10_10
- Witness initials10_10
- Internal use only10_10
- Printed name of elector1_11
- Full residential address street numbernamecity1_11
- Postal code1_11
- Elector signature1_11
- Witness initials1_11
- Internal use only1_11
- Printed name of elector2_11
- Full residential address street numbernamecity2_11
- Postal code2_11
- Elector signature2_11
- Witness initials2_11
- Internal use only2_11
- Printed name of elector3_11
- Full residential address street numbernamecity3_11
- Postal code3_11
- Elector signature3_11
- Witness initials3_11
- Internal use only3_11
- Printed name of elector4_11
- Full residential address street numbernamecity4_11
- Postal code4_11
- Elector signature4_11
- Witness initials4_11
- Internal use only4_11
- Printed name of elector5_11
- Full residential address street numbernamecity5_11
- Postal code5_11
- Elector signature5_11
- Witness initials5_11
- Internal use only5_11
- Printed name of elector6_11
- Full residential address street numbernamecity6_11
- Postal code6_11
- Elector signature6_11
- Witness initials6_11
- Internal use only6_11
- Printed name of elector7_11
- Full residential address street numbernamecity7_11
- Postal code7_11
- Elector signature7_11
- Witness initials7_11
- Internal use only7_11
- Printed name of elector8_11
- Full residential address street numbernamecity8_11
- Postal code8_11
- Elector signature8_11
- Witness initials8_11
- Internal use only8_11
- Printed name of elector9_11
- Full residential address street numbernamecity9_11
- Postal code9_11
- Elector signature9_11
- Witness initials9_11
- Internal use only9_11
- Printed name of elector10_11
- Full residential address street numbernamecity10_11
- Postal code10_11
- Elector signature10_11
- Witness initials10_11
- Internal use only10_11
- Printed name of elector1_12
- Full residential address street numbernamecity1_12
- Postal code1_12
- Elector signature1_12
- Witness initials1_12
- Internal use only1_12
- Printed name of elector2_12
- Full residential address street numbernamecity2_12
- Postal code2_12
- Elector signature2_12
- Witness initials2_12
- Internal use only2_12
- Printed name of elector3_12
- Full residential address street numbernamecity3_12
- Postal code3_12
- Elector signature3_12
- Witness initials3_12
- Internal use only3_12
- Printed name of elector4_12
- Full residential address street numbernamecity4_12
- Postal code4_12
- Elector signature4_12
- Witness initials4_12
- Internal use only4_12
- Printed name of elector5_12
- Full residential address street numbernamecity5_12
- Postal code5_12
- Elector signature5_12
- Witness initials5_12
- Internal use only5_12
- Printed name of elector6_12
- Full residential address street numbernamecity6_12
- Postal code6_12
- Elector signature6_12
- Witness initials6_12
- Internal use only6_12
- Printed name of elector7_12
- Full residential address street numbernamecity7_12
- Postal code7_12
- Elector signature7_12
- Witness initials7_12
- Internal use only7_12
- Printed name of elector8_12
- Full residential address street numbernamecity8_12
- Postal code8_12
- Elector signature8_12
- Witness initials8_12
- Internal use only8_12
- Printed name of elector9_12
- Full residential address street numbernamecity9_12
- Postal code9_12
- Elector signature9_12
- Witness initials9_12
- Internal use only9_12
- Printed name of elector10_12
- Full residential address street numbernamecity10_12
- Postal code10_12
- Elector signature10_12
- Witness initials10_12
- Internal use only10_12
- Printed name of elector1_13
- Full residential address street numbernamecity1_13
- Postal code1_13
- Elector signature1_13
- Witness initials1_13
- Internal use only1_13
- Printed name of elector2_13
- Full residential address street numbernamecity2_13
- Postal code2_13
- Elector signature2_13
- Witness initials2_13
- Internal use only2_13
- Printed name of elector3_13
- Full residential address street numbernamecity3_13
- Postal code3_13
- Elector signature3_13
- Witness initials3_13
- Internal use only3_13
- Printed name of elector4_13
- Full residential address street numbernamecity4_13
- Postal code4_13
- Elector signature4_13
- Witness initials4_13
- Internal use only4_13
- Printed name of elector5_13
- Full residential address street numbernamecity5_13
- Postal code5_13
- Elector signature5_13
- Witness initials5_13
- Internal use only5_13
- Printed name of elector6_13
- Full residential address street numbernamecity6_13
- Postal code6_13
- Elector signature6_13
- Witness initials6_13
- Internal use only6_13
- Printed name of elector7_13
- Full residential address street numbernamecity7_13
- Postal code7_13
- Elector signature7_13
- Witness initials7_13
- Internal use only7_13
- Printed name of elector8_13
- Full residential address street numbernamecity8_13
- Postal code8_13
- Elector signature8_13
- Witness initials8_13
- Internal use only8_13
- Printed name of elector9_13
- Full residential address street numbernamecity9_13
- Postal code9_13
- Elector signature9_13
- Witness initials9_13
- Internal use only9_13
- Printed name of elector10_13
- Full residential address street numbernamecity10_13
- Postal code10_13
- Elector signature10_13
- Witness initials10_13
- Internal use only10_13
- Printed name of elector1_14
- Full residential address street numbernamecity1_14
- Postal code1_14
- Elector signature1_14
- Witness initials1_14
- Internal use only1_14
- Printed name of elector2_14
- Full residential address street numbernamecity2_14
- Postal code2_14
- Elector signature2_14
- Witness initials2_14
- Internal use only2_14
- Printed name of elector3_14
- Full residential address street numbernamecity3_14
- Postal code3_14
- Elector signature3_14
- Witness initials3_14
- Internal use only3_14
- Printed name of elector4_14
- Full residential address street numbernamecity4_14
- Postal code4_14
- Elector signature4_14
- Witness initials4_14
- Internal use only4_14
- Printed name of elector5_14
- Full residential address street numbernamecity5_14
- Postal code5_14
- Elector signature5_14
- Witness initials5_14
- Internal use only5_14
- Printed name of elector6_14
- Full residential address street numbernamecity6_14
- Postal code6_14
- Elector signature6_14
- Witness initials6_14
- Internal use only6_14
- Printed name of elector7_14
- Full residential address street numbernamecity7_14
- Postal code7_14
- Elector signature7_14
- Witness initials7_14
- Internal use only7_14
- Printed name of elector8_14
- Full residential address street numbernamecity8_14
- Postal code8_14
- Elector signature8_14
- Witness initials8_14
- Internal use only8_14
- Printed name of elector9_14
- Full residential address street numbernamecity9_14
- Postal code9_14
- Elector signature9_14
- Witness initials9_14
- Internal use only9_14
- Printed name of elector10_14
- Full residential address street numbernamecity10_14
- Postal code10_14
- Elector signature10_14
- Witness initials10_14
- Internal use only10_14
- Printed name of elector1_15
- Full residential address street numbernamecity1_15
- Postal code1_15
- Elector signature1_15
- Witness initials1_15
- Internal use only1_15
- Printed name of elector2_15
- Full residential address street numbernamecity2_15
- Postal code2_15
- Elector signature2_15
- Witness initials2_15
- Internal use only2_15
- Printed name of elector3_15
- Full residential address street numbernamecity3_15
- Postal code3_15
- Elector signature3_15
- Witness initials3_15
- Internal use only3_15
- Printed name of elector4_15
- Full residential address street numbernamecity4_15
- Postal code4_15
- Elector signature4_15
- Witness initials4_15
- Internal use only4_15
- Printed name of elector5_15
- Full residential address street numbernamecity5_15
- Postal code5_15
- Elector signature5_15
- Witness initials5_15
- Internal use only5_15
- Printed name of elector6_15
- Full residential address street numbernamecity6_15
- Postal code6_15
- Elector signature6_15
- Witness initials6_15
- Internal use only6_15
- Printed name of elector7_15
- Full residential address street numbernamecity7_15
- Postal code7_15
- Elector signature7_15
- Witness initials7_15
- Internal use only7_15
- Printed name of elector8_15
- Full residential address street numbernamecity8_15
- Postal code8_15
- Elector signature8_15
- Witness initials8_15
- Internal use only8_15
- Printed name of elector9_15
- Full residential address street numbernamecity9_15
- Postal code9_15
- Elector signature9_15
- Witness initials9_15
- Internal use only9_15
- Printed name of elector10_15
- Full residential address street numbernamecity10_15
- Postal code10_15
- Elector signature10_15
- Witness initials10_15
- Internal use only10_15
- Printed name of elector1_16
- Full residential address street numbernamecity1_16
- Postal code1_16
- Elector signature1_16
- Witness initials1_16
- Internal use only1_16
- Printed name of elector2_16
- Full residential address street numbernamecity2_16
- Postal code2_16
- Elector signature2_16
- Witness initials2_16
- Internal use only2_16
- Printed name of elector3_16
- Full residential address street numbernamecity3_16
- Postal code3_16
- Elector signature3_16
- Witness initials3_16
- Internal use only3_16
- Printed name of elector4_16
- Full residential address street numbernamecity4_16
- Postal code4_16
- Elector signature4_16
- Witness initials4_16
- Internal use only4_16
- Printed name of elector5_16
- Full residential address street numbernamecity5_16
- Postal code5_16
- Elector signature5_16
- Witness initials5_16
- Internal use only5_16
- Printed name of elector6_16
- Full residential address street numbernamecity6_16
- Postal code6_16
- Elector signature6_16
- Witness initials6_16
- Internal use only6_16
- Printed name of elector7_16
- Full residential address street numbernamecity7_16
- Postal code7_16
- Elector signature7_16
- Witness initials7_16
- Internal use only7_16
- Printed name of elector8_16
- Full residential address street numbernamecity8_16
- Postal code8_16
- Elector signature8_16
- Witness initials8_16
- Internal use only8_16
- Printed name of elector9_16
- Full residential address street numbernamecity9_16
- Postal code9_16
- Elector signature9_16
- Witness initials9_16
- Internal use only9_16
- Printed name of elector10_16
- Full residential address street numbernamecity10_16
- Postal code10_16
- Elector signature10_16
- Witness initials10_16
- Internal use only10_16
- Have you completed the Nomination Paper EC 20010 Off
- Do you have authorized proof of identify Off
- Are you endorsed by a political party Off
- Have you made a nomination appointment Off
- Last name - Candidate Name
- First name - Candidate Name
- Name of electoral district- Candidate Information
- First name - Candidate Information
- Last name - Candidate Information
- Ballot Name Off
- Ballot First name(s)
- Ballot Last name(s)
- Gender -Candidate information
- Date of birth (YYY-MM-DD) - Gender -Candidate information
- language of correspondence - Candidate information Off
- Email -Contact information
- Primary phone number - Contact information
- Ext - Primary phone number
- Alternate phone number - Contact information
- Ext - Alternate phone number
- Fax number- Alternate phone number
- Unit -Residential address
- Street -Residential address
- Street name -Residential address
- City -Residential address
- ProvinceTerritory -Residential address
- Postal code - -Residential address
- Mailing address - same as residential address Off
- Occupation- Candidate occupation
- Sharing of information with the Conflict of Interest and Ethics Commissioner and the House of Commons including the Library of Parliament Off
- where applicable if the returning officer is unable to verify that I have been endorsed by the political party identified in section A of this Nomination Paper I wish to Off
- Date of Signature (YYYY-MM-DD) - Candidate signature
- Date of Signature (YYYY-MM-DD) -Signature of person receiving the solemn declaration
- Campaign delegate information
- First name - Campaign delegate information
- Last name - Campaign delegate information
- Language of correspondence - Campaign delegate information Off
- Email - Contact information -Campaign Delegate
- Primary phone number - Contact information -Campaign Delegate
- Primary phone number EXT - Contact information -Campaign Delegate
- Alternate phone number - Contact information -Campaign Delegate
- Alternate phone number EXT - Contact information -Campaign Delegate
- Fax nmuber- Contact information -Campaign Delegate
- Street - Residential address -Campaign delegate
- Street name - Residential address -Campaign delegate
- City - Residential address -Campaign delegate
- ProvinceTerritory - Residential address -Campaign delegate
- Postal Code - Residential address -Campaign delegate
- Campaign delegate - Mailing address ndash Same as residential address Off
- Unit - Residential address -Campaign delegate
- Date (YYYY-MM-DD) - Candidate authorization Signature
- Date (YYYY-MM-DD) - Candidate campaign Signature
- First name - Official agent information
- Last name - Official agent information
- Language of correspondence - Official agent information Off
- Email - Official agent information
- Primary phone number - Official agent information
- Primary phone number EXT - Official agent information
- Alternate phone number EXT - Official agent information
- Alternate phone number - Official agent information
- Fax number - Official agent information
- Unit -Residential address - Official Agent
- Street name -Residential address - Official Agent
- City -Residential address - Official Agent
- Street -Residential address - Official Agent
- ProvinceTerritory -Residential address - Official Agent
- Postal code-Residential address - Official Agent
- Mailing address ndash Same as residential address- Official Agent Off
- Date (YYYY-MM-DD) - Official agent signature
- First name - Auditor information
- Last name - Auditor information
- Language of correspondence - Auditor information Off
- Email - Auditor information
- Primary phone number - Auditor information
- Primary phone number EXT- Auditor information
- Alternate phone number - Auditor information
- Alternate phone number EXT- Auditor information
- Fax number - Auditor information
- Name of firm- Auditor organizational information
- Occupation of auditor - Auditor organizational information
- Professional designation - Auditor organizational information Off
- Designation registration number
- Make cheque payable to
- Unit - Address (where cheque is sent)
- Street - Address (where cheque is sent)
- Street name - Address (where cheque is sent)
- City - Address (where cheque is sent)
- ProvinceTerritory - Address (where cheque is sent)
- Postal code - Address (where cheque is sent)
- Date (YYY-MM-DD) - Auditor signature
- Unit - Campaign office address (optional)
- Street - Campaign office address (optional)
- Street name - Campaign office address (optional)
- City - Campaign office address (optional)
- ProvinceTerritory- Campaign office address (optional)
- Postal code - Campaign office address (optional)
- Name of witness
- Full address of witness
- Name of candidate
- Electoral district
- Year
- Name of candidate2
- Electoral district2
- Year2
- Name of witness2
- Full address of witness2
- Name of candidate3
- Electoral district3
- Year3
- Full address of witness3
- Name of witness3
- Name of candidate 4
- Electoral district4
- Year4
- Full address of witness 4
- Name of witness 4
- Name of candidate5
- Electoral district5
- Year5
- Full address of witness5
- Name of witness5
- Name of candidate6
- Electoral district6
- Year6
- Name of witness6
- Full address of witness6
- Name of candidate7
- Electoral district7
- Year7
- Full address of witness7
- Name of witness7
- Name of candidate8
- Electoral district8
- Year8
- Full address of witness8
- Name of witness8
- Name of candidate9
- Electoral district9
- Year9
- Full address of witness 9
- Name of witness 9
- Name of candidate10
- Electoral district10
- Year10
- Full address of witness10
- Name of witness10
- Name of candidate11
- Electoral district11
- Year11
- Full address of witness11
- Name of witness11
- Name of candidate12
- Electoral district12
- Year12
- Full address of witness12
- Name of witness12
- Name of candidate13
- Electoral district13
- Year13
- Full address of witness13
- Name of witness13
- Name of candidate14
- Electoral district14
- Year14
- Name of witness14
- Full address of witness14
- Name of candidate1
- Electoral district1
- Year1
- Name of witness1
- Full address of witness1
- Name of candidate15
- Electoral district15
- Year15
- Name of witness15
- Full address of witness15
- unit -Mailing address
- Street -Mailing address
- Street name -Mailing address
- City -Mailing address
- ProvinceTerritory -Mailing address
- Postal code -Mailing address
- Unit - Mailing address -Campaign delegate
- Street - Mailing address -Campaign delegate
- Street name - Mailing address -Campaign delegate
- City - Mailing address -Campaign delegate
- ProvinceTerritory- Mailing address -Campaign delegate
- Postal code- Mailing address -Campaign delegate
- Unit -Mailing address - Official Agent
- Street -Mailing address - Official Agent
- Street name -Mailing address - Official Agent
- city -Mailing address - Official Agent
- ProvinceTerritory-Mailing address - Official Agent
- Postal code-Mailing address - Official Agent
20BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
28
21BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
29
22BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
30
EC 20010 (022019)
SECTION G ndash 23B Are You Ready to Submit Your Nomination
Have you completed the Nomination Paper (EC 20010)
bull Are all mandatory fields in sections AndashE complete
bull Have you collected the required number of signatures from qualified electors in section F
o For most electoral districts 100 electors must consent to your candidacy
o For electoral districts identified in Schedule 3 only 50 electors are required
o To ensure a smooth nomination process Elections Canada recommends collecting signatures from at least 150 electors
Do you have authorized proof of identify
bull For a list of authorized identification visit the Elections Canada website
bull If a campaign delegate is submitting on your behalf they must bring a copy of your identification documents signed by you
bull If you want an alternative name to appear on the ballot additional documentation is required visit electionsca for details
Are you endorsed by a political party
bull Make sure your party has submitted the required documentation to Elections Canada attesting your designated political affiliation
Have you made a nomination appointment
bull To facilitate the nomination process make an appointment with the returning officer to finalize the filing of the complete nomination package
bull The nomination period closes 21 days before election day at 200 pm local time
31
- Nomination Paperof a Candidate at a Federal General Election or By-election
- Table of Contents
- General Information
- SECTION A ndash Candidate Information (Mandatory)
- SECTION B ndash Campaign Delegate (Optional)
- SECTION C ndash Official Agent (Mandatory)
- SECTION D ndash Auditor (Optional)
- SECTION E ndash Campaign Office (Optional)
- SECTION F ndash Electors Consenting to Candidacy (Mandatory)
-
- Name of electoral district
- Political affiliation
- Telephone number to be posted on electionsca
- Website to be posted on electionsca including prefix http https
- Printed name of elector1
- Full residential address street numbernamecity1
- Postal code1
- Elector signature1
- Witness initials1
- Internal use only1
- Printed name of elector2
- Full residential address street numbernamecity2
- Postal code2
- Elector signature2
- Witness initials2
- Internal use only2
- Printed name of elector3
- Full residential address street numbernamecity3
- Postal code3
- Elector signature3
- Witness initials3
- Internal use only3
- Printed name of elector4
- Full residential address street numbernamecity4
- Postal code4
- Elector signature4
- Witness initials4
- Internal use only4
- Printed name of elector5
- Full residential address street numbernamecity5
- Postal code5
- Elector signature5
- Witness initials5
- Internal use only5
- Printed name of elector6
- Full residential address street numbernamecity6
- Postal code6
- Elector signature6
- Witness initials6
- Internal use only6
- Printed name of elector7
- Full residential address street numbernamecity7
- Postal code7
- Elector signature7
- Witness initials7
- Internal use only7
- Printed name of elector8
- Full residential address street numbernamecity8
- Postal code8
- Elector signature8
- Witness initials8
- Internal use only8
- Printed name of elector9
- Full residential address street numbernamecity9
- Postal code9
- Elector signature9
- Witness initials9
- Internal use only9
- Printed name of elector10
- Full residential address street numbernamecity10
- Postal code10
- Elector signature10
- Witness initials10
- Internal use only10
- Printed name of elector1_2
- Full residential address street numbernamecity1_2
- Postal code1_2
- Elector signature1_2
- Witness initials1_2
- Internal use only1_2
- Printed name of elector2_2
- Full residential address street numbernamecity2_2
- Postal code2_2
- Elector signature2_2
- Witness initials2_2
- Internal use only2_2
- Printed name of elector3_2
- Full residential address street numbernamecity3_2
- Postal code3_2
- Elector signature3_2
- Witness initials3_2
- Internal use only3_2
- Printed name of elector4_2
- Full residential address street numbernamecity4_2
- Postal code4_2
- Elector signature4_2
- Witness initials4_2
- Internal use only4_2
- Printed name of elector5_2
- Full residential address street numbernamecity5_2
- Postal code5_2
- Elector signature5_2
- Witness initials5_2
- Internal use only5_2
- Printed name of elector6_2
- Full residential address street numbernamecity6_2
- Postal code6_2
- Elector signature6_2
- Witness initials6_2
- Internal use only6_2
- Printed name of elector7_2
- Full residential address street numbernamecity7_2
- Postal code7_2
- Elector signature7_2
- Witness initials7_2
- Internal use only7_2
- Printed name of elector8_2
- Full residential address street numbernamecity8_2
- Postal code8_2
- Elector signature8_2
- Witness initials8_2
- Internal use only8_2
- Printed name of elector9_2
- Full residential address street numbernamecity9_2
- Postal code9_2
- Elector signature9_2
- Witness initials9_2
- Internal use only9_2
- Printed name of elector10_2
- Full residential address street numbernamecity10_2
- Postal code10_2
- Elector signature10_2
- Witness initials10_2
- Internal use only10_2
- Printed name of elector1_3
- Full residential address street numbernamecity1_3
- Postal code1_3
- Elector signature1_3
- Witness initials1_3
- Internal use only1_3
- Printed name of elector2_3
- Full residential address street numbernamecity2_3
- Postal code2_3
- Elector signature2_3
- Witness initials2_3
- Internal use only2_3
- Printed name of elector3_3
- Full residential address street numbernamecity3_3
- Postal code3_3
- Elector signature3_3
- Witness initials3_3
- Internal use only3_3
- Printed name of elector4_3
- Full residential address street numbernamecity4_3
- Postal code4_3
- Elector signature4_3
- Witness initials4_3
- Internal use only4_3
- Printed name of elector5_3
- Full residential address street numbernamecity5_3
- Postal code5_3
- Elector signature5_3
- Witness initials5_3
- Internal use only5_3
- Printed name of elector6_3
- Full residential address street numbernamecity6_3
- Postal code6_3
- Elector signature6_3
- Witness initials6_3
- Internal use only6_3
- Printed name of elector7_3
- Full residential address street numbernamecity7_3
- Postal code7_3
- Elector signature7_3
- Witness initials7_3
- Internal use only7_3
- Printed name of elector8_3
- Full residential address street numbernamecity8_3
- Postal code8_3
- Elector signature8_3
- Witness initials8_3
- Internal use only8_3
- Printed name of elector9_3
- Full residential address street numbernamecity9_3
- Postal code9_3
- Elector signature9_3
- Witness initials9_3
- Internal use only9_3
- Printed name of elector10_3
- Full residential address street numbernamecity10_3
- Postal code10_3
- Elector signature10_3
- Witness initials10_3
- Internal use only10_3
- Printed name of elector1_4
- Full residential address street numbernamecity1_4
- Postal code1_4
- Elector signature1_4
- Witness initials1_4
- Internal use only1_4
- Printed name of elector2_4
- Full residential address street numbernamecity2_4
- Postal code2_4
- Elector signature2_4
- Witness initials2_4
- Internal use only2_4
- Printed name of elector3_4
- Full residential address street numbernamecity3_4
- Postal code3_4
- Elector signature3_4
- Witness initials3_4
- Internal use only3_4
- Printed name of elector4_4
- Full residential address street numbernamecity4_4
- Postal code4_4
- Elector signature4_4
- Witness initials4_4
- Internal use only4_4
- Printed name of elector5_4
- Full residential address street numbernamecity5_4
- Postal code5_4
- Elector signature5_4
- Witness initials5_4
- Internal use only5_4
- Printed name of elector6_4
- Full residential address street numbernamecity6_4
- Postal code6_4
- Elector signature6_4
- Witness initials6_4
- Internal use only6_4
- Printed name of elector7_4
- Full residential address street numbernamecity7_4
- Postal code7_4
- Elector signature7_4
- Witness initials7_4
- Internal use only7_4
- Printed name of elector8_4
- Full residential address street numbernamecity8_4
- Postal code8_4
- Elector signature8_4
- Witness initials8_4
- Internal use only8_4
- Printed name of elector9_4
- Full residential address street numbernamecity9_4
- Postal code9_4
- Elector signature9_4
- Witness initials9_4
- Internal use only9_4
- Printed name of elector10_4
- Full residential address street numbernamecity10_4
- Postal code10_4
- Elector signature10_4
- Witness initials10_4
- Internal use only10_4
- Printed name of elector1_5
- Full residential address street numbernamecity1_5
- Postal code1_5
- Elector signature1_5
- Witness initials1_5
- Internal use only1_5
- Printed name of elector2_5
- Full residential address street numbernamecity2_5
- Postal code2_5
- Elector signature2_5
- Witness initials2_5
- Internal use only2_5
- Printed name of elector3_5
- Full residential address street numbernamecity3_5
- Postal code3_5
- Elector signature3_5
- Witness initials3_5
- Internal use only3_5
- Printed name of elector4_5
- Full residential address street numbernamecity4_5
- Postal code4_5
- Elector signature4_5
- Witness initials4_5
- Internal use only4_5
- Printed name of elector5_5
- Full residential address street numbernamecity5_5
- Postal code5_5
- Elector signature5_5
- Witness initials5_5
- Internal use only5_5
- Printed name of elector6_5
- Full residential address street numbernamecity6_5
- Postal code6_5
- Elector signature6_5
- Witness initials6_5
- Internal use only6_5
- Printed name of elector7_5
- Full residential address street numbernamecity7_5
- Postal code7_5
- Elector signature7_5
- Witness initials7_5
- Internal use only7_5
- Printed name of elector8_5
- Full residential address street numbernamecity8_5
- Postal code8_5
- Elector signature8_5
- Witness initials8_5
- Internal use only8_5
- Printed name of elector9_5
- Full residential address street numbernamecity9_5
- Postal code9_5
- Elector signature9_5
- Witness initials9_5
- Internal use only9_5
- Printed name of elector10_5
- Full residential address street numbernamecity10_5
- Postal code10_5
- Elector signature10_5
- Witness initials10_5
- Internal use only10_5
- Printed name of elector1_6
- Full residential address street numbernamecity1_6
- Postal code1_6
- Elector signature1_6
- Witness initials1_6
- Internal use only1_6
- Printed name of elector2_6
- Full residential address street numbernamecity2_6
- Postal code2_6
- Elector signature2_6
- Witness initials2_6
- Internal use only2_6
- Printed name of elector3_6
- Full residential address street numbernamecity3_6
- Postal code3_6
- Elector signature3_6
- Witness initials3_6
- Internal use only3_6
- Printed name of elector4_6
- Full residential address street numbernamecity4_6
- Postal code4_6
- Elector signature4_6
- Witness initials4_6
- Internal use only4_6
- Printed name of elector5_6
- Full residential address street numbernamecity5_6
- Postal code5_6
- Elector signature5_6
- Witness initials5_6
- Internal use only5_6
- Printed name of elector6_6
- Full residential address street numbernamecity6_6
- Postal code6_6
- Elector signature6_6
- Witness initials6_6
- Internal use only6_6
- Printed name of elector7_6
- Full residential address street numbernamecity7_6
- Postal code7_6
- Elector signature7_6
- Witness initials7_6
- Internal use only7_6
- Printed name of elector8_6
- Full residential address street numbernamecity8_6
- Postal code8_6
- Elector signature8_6
- Witness initials8_6
- Internal use only8_6
- Printed name of elector9_6
- Full residential address street numbernamecity9_6
- Postal code9_6
- Elector signature9_6
- Witness initials9_6
- Internal use only9_6
- Printed name of elector10_6
- Full residential address street numbernamecity10_6
- Postal code10_6
- Elector signature10_6
- Witness initials10_6
- Internal use only10_6
- Printed name of elector1_7
- Full residential address street numbernamecity1_7
- Postal code1_7
- Elector signature1_7
- Witness initials1_7
- Internal use only1_7
- Printed name of elector2_7
- Full residential address street numbernamecity2_7
- Postal code2_7
- Elector signature2_7
- Witness initials2_7
- Internal use only2_7
- Printed name of elector3_7
- Full residential address street numbernamecity3_7
- Postal code3_7
- Elector signature3_7
- Witness initials3_7
- Internal use only3_7
- Printed name of elector4_7
- Full residential address street numbernamecity4_7
- Postal code4_7
- Elector signature4_7
- Witness initials4_7
- Internal use only4_7
- Printed name of elector5_7
- Full residential address street numbernamecity5_7
- Postal code5_7
- Elector signature5_7
- Witness initials5_7
- Internal use only5_7
- Printed name of elector6_7
- Full residential address street numbernamecity6_7
- Postal code6_7
- Elector signature6_7
- Witness initials6_7
- Internal use only6_7
- Printed name of elector7_7
- Full residential address street numbernamecity7_7
- Postal code7_7
- Elector signature7_7
- Witness initials7_7
- Internal use only7_7
- Printed name of elector8_7
- Full residential address street numbernamecity8_7
- Postal code8_7
- Elector signature8_7
- Witness initials8_7
- Internal use only8_7
- Printed name of elector9_7
- Full residential address street numbernamecity9_7
- Postal code9_7
- Elector signature9_7
- Witness initials9_7
- Internal use only9_7
- Printed name of elector10_7
- Full residential address street numbernamecity10_7
- Postal code10_7
- Elector signature10_7
- Witness initials10_7
- Internal use only10_7
- Printed name of elector1_8
- Full residential address street numbernamecity1_8
- Postal code1_8
- Elector signature1_8
- Witness initials1_8
- Internal use only1_8
- Printed name of elector2_8
- Full residential address street numbernamecity2_8
- Postal code2_8
- Elector signature2_8
- Witness initials2_8
- Internal use only2_8
- Printed name of elector3_8
- Full residential address street numbernamecity3_8
- Postal code3_8
- Elector signature3_8
- Witness initials3_8
- Internal use only3_8
- Printed name of elector4_8
- Full residential address street numbernamecity4_8
- Postal code4_8
- Elector signature4_8
- Witness initials4_8
- Internal use only4_8
- Printed name of elector5_8
- Full residential address street numbernamecity5_8
- Postal code5_8
- Elector signature5_8
- Witness initials5_8
- Internal use only5_8
- Printed name of elector6_8
- Full residential address street numbernamecity6_8
- Postal code6_8
- Elector signature6_8
- Witness initials6_8
- Internal use only6_8
- Printed name of elector7_8
- Full residential address street numbernamecity7_8
- Postal code7_8
- Elector signature7_8
- Witness initials7_8
- Internal use only7_8
- Printed name of elector8_8
- Full residential address street numbernamecity8_8
- Postal code8_8
- Elector signature8_8
- Witness initials8_8
- Internal use only8_8
- Printed name of elector9_8
- Full residential address street numbernamecity9_8
- Postal code9_8
- Elector signature9_8
- Witness initials9_8
- Internal use only9_8
- Printed name of elector10_8
- Full residential address street numbernamecity10_8
- Postal code10_8
- Elector signature10_8
- Witness initials10_8
- Internal use only10_8
- Printed name of elector1_9
- Full residential address street numbernamecity1_9
- Postal code1_9
- Elector signature1_9
- Witness initials1_9
- Internal use only1_9
- Printed name of elector2_9
- Full residential address street numbernamecity2_9
- Postal code2_9
- Elector signature2_9
- Witness initials2_9
- Internal use only2_9
- Printed name of elector3_9
- Full residential address street numbernamecity3_9
- Postal code3_9
- Elector signature3_9
- Witness initials3_9
- Internal use only3_9
- Printed name of elector4_9
- Full residential address street numbernamecity4_9
- Postal code4_9
- Elector signature4_9
- Witness initials4_9
- Internal use only4_9
- Printed name of elector5_9
- Full residential address street numbernamecity5_9
- Postal code5_9
- Elector signature5_9
- Witness initials5_9
- Internal use only5_9
- Printed name of elector6_9
- Full residential address street numbernamecity6_9
- Postal code6_9
- Elector signature6_9
- Witness initials6_9
- Internal use only6_9
- Printed name of elector7_9
- Full residential address street numbernamecity7_9
- Postal code7_9
- Elector signature7_9
- Witness initials7_9
- Internal use only7_9
- Printed name of elector8_9
- Full residential address street numbernamecity8_9
- Postal code8_9
- Elector signature8_9
- Witness initials8_9
- Internal use only8_9
- Printed name of elector9_9
- Full residential address street numbernamecity9_9
- Postal code9_9
- Elector signature9_9
- Witness initials9_9
- Internal use only9_9
- Printed name of elector10_9
- Full residential address street numbernamecity10_9
- Postal code10_9
- Elector signature10_9
- Witness initials10_9
- Internal use only10_9
- Printed name of elector1_10
- Full residential address street numbernamecity1_10
- Postal code1_10
- Elector signature1_10
- Witness initials1_10
- Internal use only1_10
- Printed name of elector2_10
- Full residential address street numbernamecity2_10
- Postal code2_10
- Elector signature2_10
- Witness initials2_10
- Internal use only2_10
- Printed name of elector3_10
- Full residential address street numbernamecity3_10
- Postal code3_10
- Elector signature3_10
- Witness initials3_10
- Internal use only3_10
- Printed name of elector4_10
- Full residential address street numbernamecity4_10
- Postal code4_10
- Elector signature4_10
- Witness initials4_10
- Internal use only4_10
- Printed name of elector5_10
- Full residential address street numbernamecity5_10
- Postal code5_10
- Elector signature5_10
- Witness initials5_10
- Internal use only5_10
- Printed name of elector6_10
- Full residential address street numbernamecity6_10
- Postal code6_10
- Elector signature6_10
- Witness initials6_10
- Internal use only6_10
- Printed name of elector7_10
- Full residential address street numbernamecity7_10
- Postal code7_10
- Elector signature7_10
- Witness initials7_10
- Internal use only7_10
- Printed name of elector8_10
- Full residential address street numbernamecity8_10
- Postal code8_10
- Elector signature8_10
- Witness initials8_10
- Internal use only8_10
- Printed name of elector9_10
- Full residential address street numbernamecity9_10
- Postal code9_10
- Elector signature9_10
- Witness initials9_10
- Internal use only9_10
- Printed name of elector10_10
- Full residential address street numbernamecity10_10
- Postal code10_10
- Elector signature10_10
- Witness initials10_10
- Internal use only10_10
- Printed name of elector1_11
- Full residential address street numbernamecity1_11
- Postal code1_11
- Elector signature1_11
- Witness initials1_11
- Internal use only1_11
- Printed name of elector2_11
- Full residential address street numbernamecity2_11
- Postal code2_11
- Elector signature2_11
- Witness initials2_11
- Internal use only2_11
- Printed name of elector3_11
- Full residential address street numbernamecity3_11
- Postal code3_11
- Elector signature3_11
- Witness initials3_11
- Internal use only3_11
- Printed name of elector4_11
- Full residential address street numbernamecity4_11
- Postal code4_11
- Elector signature4_11
- Witness initials4_11
- Internal use only4_11
- Printed name of elector5_11
- Full residential address street numbernamecity5_11
- Postal code5_11
- Elector signature5_11
- Witness initials5_11
- Internal use only5_11
- Printed name of elector6_11
- Full residential address street numbernamecity6_11
- Postal code6_11
- Elector signature6_11
- Witness initials6_11
- Internal use only6_11
- Printed name of elector7_11
- Full residential address street numbernamecity7_11
- Postal code7_11
- Elector signature7_11
- Witness initials7_11
- Internal use only7_11
- Printed name of elector8_11
- Full residential address street numbernamecity8_11
- Postal code8_11
- Elector signature8_11
- Witness initials8_11
- Internal use only8_11
- Printed name of elector9_11
- Full residential address street numbernamecity9_11
- Postal code9_11
- Elector signature9_11
- Witness initials9_11
- Internal use only9_11
- Printed name of elector10_11
- Full residential address street numbernamecity10_11
- Postal code10_11
- Elector signature10_11
- Witness initials10_11
- Internal use only10_11
- Printed name of elector1_12
- Full residential address street numbernamecity1_12
- Postal code1_12
- Elector signature1_12
- Witness initials1_12
- Internal use only1_12
- Printed name of elector2_12
- Full residential address street numbernamecity2_12
- Postal code2_12
- Elector signature2_12
- Witness initials2_12
- Internal use only2_12
- Printed name of elector3_12
- Full residential address street numbernamecity3_12
- Postal code3_12
- Elector signature3_12
- Witness initials3_12
- Internal use only3_12
- Printed name of elector4_12
- Full residential address street numbernamecity4_12
- Postal code4_12
- Elector signature4_12
- Witness initials4_12
- Internal use only4_12
- Printed name of elector5_12
- Full residential address street numbernamecity5_12
- Postal code5_12
- Elector signature5_12
- Witness initials5_12
- Internal use only5_12
- Printed name of elector6_12
- Full residential address street numbernamecity6_12
- Postal code6_12
- Elector signature6_12
- Witness initials6_12
- Internal use only6_12
- Printed name of elector7_12
- Full residential address street numbernamecity7_12
- Postal code7_12
- Elector signature7_12
- Witness initials7_12
- Internal use only7_12
- Printed name of elector8_12
- Full residential address street numbernamecity8_12
- Postal code8_12
- Elector signature8_12
- Witness initials8_12
- Internal use only8_12
- Printed name of elector9_12
- Full residential address street numbernamecity9_12
- Postal code9_12
- Elector signature9_12
- Witness initials9_12
- Internal use only9_12
- Printed name of elector10_12
- Full residential address street numbernamecity10_12
- Postal code10_12
- Elector signature10_12
- Witness initials10_12
- Internal use only10_12
- Printed name of elector1_13
- Full residential address street numbernamecity1_13
- Postal code1_13
- Elector signature1_13
- Witness initials1_13
- Internal use only1_13
- Printed name of elector2_13
- Full residential address street numbernamecity2_13
- Postal code2_13
- Elector signature2_13
- Witness initials2_13
- Internal use only2_13
- Printed name of elector3_13
- Full residential address street numbernamecity3_13
- Postal code3_13
- Elector signature3_13
- Witness initials3_13
- Internal use only3_13
- Printed name of elector4_13
- Full residential address street numbernamecity4_13
- Postal code4_13
- Elector signature4_13
- Witness initials4_13
- Internal use only4_13
- Printed name of elector5_13
- Full residential address street numbernamecity5_13
- Postal code5_13
- Elector signature5_13
- Witness initials5_13
- Internal use only5_13
- Printed name of elector6_13
- Full residential address street numbernamecity6_13
- Postal code6_13
- Elector signature6_13
- Witness initials6_13
- Internal use only6_13
- Printed name of elector7_13
- Full residential address street numbernamecity7_13
- Postal code7_13
- Elector signature7_13
- Witness initials7_13
- Internal use only7_13
- Printed name of elector8_13
- Full residential address street numbernamecity8_13
- Postal code8_13
- Elector signature8_13
- Witness initials8_13
- Internal use only8_13
- Printed name of elector9_13
- Full residential address street numbernamecity9_13
- Postal code9_13
- Elector signature9_13
- Witness initials9_13
- Internal use only9_13
- Printed name of elector10_13
- Full residential address street numbernamecity10_13
- Postal code10_13
- Elector signature10_13
- Witness initials10_13
- Internal use only10_13
- Printed name of elector1_14
- Full residential address street numbernamecity1_14
- Postal code1_14
- Elector signature1_14
- Witness initials1_14
- Internal use only1_14
- Printed name of elector2_14
- Full residential address street numbernamecity2_14
- Postal code2_14
- Elector signature2_14
- Witness initials2_14
- Internal use only2_14
- Printed name of elector3_14
- Full residential address street numbernamecity3_14
- Postal code3_14
- Elector signature3_14
- Witness initials3_14
- Internal use only3_14
- Printed name of elector4_14
- Full residential address street numbernamecity4_14
- Postal code4_14
- Elector signature4_14
- Witness initials4_14
- Internal use only4_14
- Printed name of elector5_14
- Full residential address street numbernamecity5_14
- Postal code5_14
- Elector signature5_14
- Witness initials5_14
- Internal use only5_14
- Printed name of elector6_14
- Full residential address street numbernamecity6_14
- Postal code6_14
- Elector signature6_14
- Witness initials6_14
- Internal use only6_14
- Printed name of elector7_14
- Full residential address street numbernamecity7_14
- Postal code7_14
- Elector signature7_14
- Witness initials7_14
- Internal use only7_14
- Printed name of elector8_14
- Full residential address street numbernamecity8_14
- Postal code8_14
- Elector signature8_14
- Witness initials8_14
- Internal use only8_14
- Printed name of elector9_14
- Full residential address street numbernamecity9_14
- Postal code9_14
- Elector signature9_14
- Witness initials9_14
- Internal use only9_14
- Printed name of elector10_14
- Full residential address street numbernamecity10_14
- Postal code10_14
- Elector signature10_14
- Witness initials10_14
- Internal use only10_14
- Printed name of elector1_15
- Full residential address street numbernamecity1_15
- Postal code1_15
- Elector signature1_15
- Witness initials1_15
- Internal use only1_15
- Printed name of elector2_15
- Full residential address street numbernamecity2_15
- Postal code2_15
- Elector signature2_15
- Witness initials2_15
- Internal use only2_15
- Printed name of elector3_15
- Full residential address street numbernamecity3_15
- Postal code3_15
- Elector signature3_15
- Witness initials3_15
- Internal use only3_15
- Printed name of elector4_15
- Full residential address street numbernamecity4_15
- Postal code4_15
- Elector signature4_15
- Witness initials4_15
- Internal use only4_15
- Printed name of elector5_15
- Full residential address street numbernamecity5_15
- Postal code5_15
- Elector signature5_15
- Witness initials5_15
- Internal use only5_15
- Printed name of elector6_15
- Full residential address street numbernamecity6_15
- Postal code6_15
- Elector signature6_15
- Witness initials6_15
- Internal use only6_15
- Printed name of elector7_15
- Full residential address street numbernamecity7_15
- Postal code7_15
- Elector signature7_15
- Witness initials7_15
- Internal use only7_15
- Printed name of elector8_15
- Full residential address street numbernamecity8_15
- Postal code8_15
- Elector signature8_15
- Witness initials8_15
- Internal use only8_15
- Printed name of elector9_15
- Full residential address street numbernamecity9_15
- Postal code9_15
- Elector signature9_15
- Witness initials9_15
- Internal use only9_15
- Printed name of elector10_15
- Full residential address street numbernamecity10_15
- Postal code10_15
- Elector signature10_15
- Witness initials10_15
- Internal use only10_15
- Printed name of elector1_16
- Full residential address street numbernamecity1_16
- Postal code1_16
- Elector signature1_16
- Witness initials1_16
- Internal use only1_16
- Printed name of elector2_16
- Full residential address street numbernamecity2_16
- Postal code2_16
- Elector signature2_16
- Witness initials2_16
- Internal use only2_16
- Printed name of elector3_16
- Full residential address street numbernamecity3_16
- Postal code3_16
- Elector signature3_16
- Witness initials3_16
- Internal use only3_16
- Printed name of elector4_16
- Full residential address street numbernamecity4_16
- Postal code4_16
- Elector signature4_16
- Witness initials4_16
- Internal use only4_16
- Printed name of elector5_16
- Full residential address street numbernamecity5_16
- Postal code5_16
- Elector signature5_16
- Witness initials5_16
- Internal use only5_16
- Printed name of elector6_16
- Full residential address street numbernamecity6_16
- Postal code6_16
- Elector signature6_16
- Witness initials6_16
- Internal use only6_16
- Printed name of elector7_16
- Full residential address street numbernamecity7_16
- Postal code7_16
- Elector signature7_16
- Witness initials7_16
- Internal use only7_16
- Printed name of elector8_16
- Full residential address street numbernamecity8_16
- Postal code8_16
- Elector signature8_16
- Witness initials8_16
- Internal use only8_16
- Printed name of elector9_16
- Full residential address street numbernamecity9_16
- Postal code9_16
- Elector signature9_16
- Witness initials9_16
- Internal use only9_16
- Printed name of elector10_16
- Full residential address street numbernamecity10_16
- Postal code10_16
- Elector signature10_16
- Witness initials10_16
- Internal use only10_16
- Have you completed the Nomination Paper EC 20010 Off
- Do you have authorized proof of identify Off
- Are you endorsed by a political party Off
- Have you made a nomination appointment Off
- Last name - Candidate Name
- First name - Candidate Name
- Name of electoral district- Candidate Information
- First name - Candidate Information
- Last name - Candidate Information
- Ballot Name Off
- Ballot First name(s)
- Ballot Last name(s)
- Gender -Candidate information
- Date of birth (YYY-MM-DD) - Gender -Candidate information
- language of correspondence - Candidate information Off
- Email -Contact information
- Primary phone number - Contact information
- Ext - Primary phone number
- Alternate phone number - Contact information
- Ext - Alternate phone number
- Fax number- Alternate phone number
- Unit -Residential address
- Street -Residential address
- Street name -Residential address
- City -Residential address
- ProvinceTerritory -Residential address
- Postal code - -Residential address
- Mailing address - same as residential address Off
- Occupation- Candidate occupation
- Sharing of information with the Conflict of Interest and Ethics Commissioner and the House of Commons including the Library of Parliament Off
- where applicable if the returning officer is unable to verify that I have been endorsed by the political party identified in section A of this Nomination Paper I wish to Off
- Date of Signature (YYYY-MM-DD) - Candidate signature
- Date of Signature (YYYY-MM-DD) -Signature of person receiving the solemn declaration
- Campaign delegate information
- First name - Campaign delegate information
- Last name - Campaign delegate information
- Language of correspondence - Campaign delegate information Off
- Email - Contact information -Campaign Delegate
- Primary phone number - Contact information -Campaign Delegate
- Primary phone number EXT - Contact information -Campaign Delegate
- Alternate phone number - Contact information -Campaign Delegate
- Alternate phone number EXT - Contact information -Campaign Delegate
- Fax nmuber- Contact information -Campaign Delegate
- Street - Residential address -Campaign delegate
- Street name - Residential address -Campaign delegate
- City - Residential address -Campaign delegate
- ProvinceTerritory - Residential address -Campaign delegate
- Postal Code - Residential address -Campaign delegate
- Campaign delegate - Mailing address ndash Same as residential address Off
- Unit - Residential address -Campaign delegate
- Date (YYYY-MM-DD) - Candidate authorization Signature
- Date (YYYY-MM-DD) - Candidate campaign Signature
- First name - Official agent information
- Last name - Official agent information
- Language of correspondence - Official agent information Off
- Email - Official agent information
- Primary phone number - Official agent information
- Primary phone number EXT - Official agent information
- Alternate phone number EXT - Official agent information
- Alternate phone number - Official agent information
- Fax number - Official agent information
- Unit -Residential address - Official Agent
- Street name -Residential address - Official Agent
- City -Residential address - Official Agent
- Street -Residential address - Official Agent
- ProvinceTerritory -Residential address - Official Agent
- Postal code-Residential address - Official Agent
- Mailing address ndash Same as residential address- Official Agent Off
- Date (YYYY-MM-DD) - Official agent signature
- First name - Auditor information
- Last name - Auditor information
- Language of correspondence - Auditor information Off
- Email - Auditor information
- Primary phone number - Auditor information
- Primary phone number EXT- Auditor information
- Alternate phone number - Auditor information
- Alternate phone number EXT- Auditor information
- Fax number - Auditor information
- Name of firm- Auditor organizational information
- Occupation of auditor - Auditor organizational information
- Professional designation - Auditor organizational information Off
- Designation registration number
- Make cheque payable to
- Unit - Address (where cheque is sent)
- Street - Address (where cheque is sent)
- Street name - Address (where cheque is sent)
- City - Address (where cheque is sent)
- ProvinceTerritory - Address (where cheque is sent)
- Postal code - Address (where cheque is sent)
- Date (YYY-MM-DD) - Auditor signature
- Unit - Campaign office address (optional)
- Street - Campaign office address (optional)
- Street name - Campaign office address (optional)
- City - Campaign office address (optional)
- ProvinceTerritory- Campaign office address (optional)
- Postal code - Campaign office address (optional)
- Name of witness
- Full address of witness
- Name of candidate
- Electoral district
- Year
- Name of candidate2
- Electoral district2
- Year2
- Name of witness2
- Full address of witness2
- Name of candidate3
- Electoral district3
- Year3
- Full address of witness3
- Name of witness3
- Name of candidate 4
- Electoral district4
- Year4
- Full address of witness 4
- Name of witness 4
- Name of candidate5
- Electoral district5
- Year5
- Full address of witness5
- Name of witness5
- Name of candidate6
- Electoral district6
- Year6
- Name of witness6
- Full address of witness6
- Name of candidate7
- Electoral district7
- Year7
- Full address of witness7
- Name of witness7
- Name of candidate8
- Electoral district8
- Year8
- Full address of witness8
- Name of witness8
- Name of candidate9
- Electoral district9
- Year9
- Full address of witness 9
- Name of witness 9
- Name of candidate10
- Electoral district10
- Year10
- Full address of witness10
- Name of witness10
- Name of candidate11
- Electoral district11
- Year11
- Full address of witness11
- Name of witness11
- Name of candidate12
- Electoral district12
- Year12
- Full address of witness12
- Name of witness12
- Name of candidate13
- Electoral district13
- Year13
- Full address of witness13
- Name of witness13
- Name of candidate14
- Electoral district14
- Year14
- Name of witness14
- Full address of witness14
- Name of candidate1
- Electoral district1
- Year1
- Name of witness1
- Full address of witness1
- Name of candidate15
- Electoral district15
- Year15
- Name of witness15
- Full address of witness15
- unit -Mailing address
- Street -Mailing address
- Street name -Mailing address
- City -Mailing address
- ProvinceTerritory -Mailing address
- Postal code -Mailing address
- Unit - Mailing address -Campaign delegate
- Street - Mailing address -Campaign delegate
- Street name - Mailing address -Campaign delegate
- City - Mailing address -Campaign delegate
- ProvinceTerritory- Mailing address -Campaign delegate
- Postal code- Mailing address -Campaign delegate
- Unit -Mailing address - Official Agent
- Street -Mailing address - Official Agent
- Street name -Mailing address - Official Agent
- city -Mailing address - Official Agent
- ProvinceTerritory-Mailing address - Official Agent
- Postal code-Mailing address - Official Agent
21BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
29
22BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
30
EC 20010 (022019)
SECTION G ndash 23B Are You Ready to Submit Your Nomination
Have you completed the Nomination Paper (EC 20010)
bull Are all mandatory fields in sections AndashE complete
bull Have you collected the required number of signatures from qualified electors in section F
o For most electoral districts 100 electors must consent to your candidacy
o For electoral districts identified in Schedule 3 only 50 electors are required
o To ensure a smooth nomination process Elections Canada recommends collecting signatures from at least 150 electors
Do you have authorized proof of identify
bull For a list of authorized identification visit the Elections Canada website
bull If a campaign delegate is submitting on your behalf they must bring a copy of your identification documents signed by you
bull If you want an alternative name to appear on the ballot additional documentation is required visit electionsca for details
Are you endorsed by a political party
bull Make sure your party has submitted the required documentation to Elections Canada attesting your designated political affiliation
Have you made a nomination appointment
bull To facilitate the nomination process make an appointment with the returning officer to finalize the filing of the complete nomination package
bull The nomination period closes 21 days before election day at 200 pm local time
31
- Nomination Paperof a Candidate at a Federal General Election or By-election
- Table of Contents
- General Information
- SECTION A ndash Candidate Information (Mandatory)
- SECTION B ndash Campaign Delegate (Optional)
- SECTION C ndash Official Agent (Mandatory)
- SECTION D ndash Auditor (Optional)
- SECTION E ndash Campaign Office (Optional)
- SECTION F ndash Electors Consenting to Candidacy (Mandatory)
-
- Name of electoral district
- Political affiliation
- Telephone number to be posted on electionsca
- Website to be posted on electionsca including prefix http https
- Printed name of elector1
- Full residential address street numbernamecity1
- Postal code1
- Elector signature1
- Witness initials1
- Internal use only1
- Printed name of elector2
- Full residential address street numbernamecity2
- Postal code2
- Elector signature2
- Witness initials2
- Internal use only2
- Printed name of elector3
- Full residential address street numbernamecity3
- Postal code3
- Elector signature3
- Witness initials3
- Internal use only3
- Printed name of elector4
- Full residential address street numbernamecity4
- Postal code4
- Elector signature4
- Witness initials4
- Internal use only4
- Printed name of elector5
- Full residential address street numbernamecity5
- Postal code5
- Elector signature5
- Witness initials5
- Internal use only5
- Printed name of elector6
- Full residential address street numbernamecity6
- Postal code6
- Elector signature6
- Witness initials6
- Internal use only6
- Printed name of elector7
- Full residential address street numbernamecity7
- Postal code7
- Elector signature7
- Witness initials7
- Internal use only7
- Printed name of elector8
- Full residential address street numbernamecity8
- Postal code8
- Elector signature8
- Witness initials8
- Internal use only8
- Printed name of elector9
- Full residential address street numbernamecity9
- Postal code9
- Elector signature9
- Witness initials9
- Internal use only9
- Printed name of elector10
- Full residential address street numbernamecity10
- Postal code10
- Elector signature10
- Witness initials10
- Internal use only10
- Printed name of elector1_2
- Full residential address street numbernamecity1_2
- Postal code1_2
- Elector signature1_2
- Witness initials1_2
- Internal use only1_2
- Printed name of elector2_2
- Full residential address street numbernamecity2_2
- Postal code2_2
- Elector signature2_2
- Witness initials2_2
- Internal use only2_2
- Printed name of elector3_2
- Full residential address street numbernamecity3_2
- Postal code3_2
- Elector signature3_2
- Witness initials3_2
- Internal use only3_2
- Printed name of elector4_2
- Full residential address street numbernamecity4_2
- Postal code4_2
- Elector signature4_2
- Witness initials4_2
- Internal use only4_2
- Printed name of elector5_2
- Full residential address street numbernamecity5_2
- Postal code5_2
- Elector signature5_2
- Witness initials5_2
- Internal use only5_2
- Printed name of elector6_2
- Full residential address street numbernamecity6_2
- Postal code6_2
- Elector signature6_2
- Witness initials6_2
- Internal use only6_2
- Printed name of elector7_2
- Full residential address street numbernamecity7_2
- Postal code7_2
- Elector signature7_2
- Witness initials7_2
- Internal use only7_2
- Printed name of elector8_2
- Full residential address street numbernamecity8_2
- Postal code8_2
- Elector signature8_2
- Witness initials8_2
- Internal use only8_2
- Printed name of elector9_2
- Full residential address street numbernamecity9_2
- Postal code9_2
- Elector signature9_2
- Witness initials9_2
- Internal use only9_2
- Printed name of elector10_2
- Full residential address street numbernamecity10_2
- Postal code10_2
- Elector signature10_2
- Witness initials10_2
- Internal use only10_2
- Printed name of elector1_3
- Full residential address street numbernamecity1_3
- Postal code1_3
- Elector signature1_3
- Witness initials1_3
- Internal use only1_3
- Printed name of elector2_3
- Full residential address street numbernamecity2_3
- Postal code2_3
- Elector signature2_3
- Witness initials2_3
- Internal use only2_3
- Printed name of elector3_3
- Full residential address street numbernamecity3_3
- Postal code3_3
- Elector signature3_3
- Witness initials3_3
- Internal use only3_3
- Printed name of elector4_3
- Full residential address street numbernamecity4_3
- Postal code4_3
- Elector signature4_3
- Witness initials4_3
- Internal use only4_3
- Printed name of elector5_3
- Full residential address street numbernamecity5_3
- Postal code5_3
- Elector signature5_3
- Witness initials5_3
- Internal use only5_3
- Printed name of elector6_3
- Full residential address street numbernamecity6_3
- Postal code6_3
- Elector signature6_3
- Witness initials6_3
- Internal use only6_3
- Printed name of elector7_3
- Full residential address street numbernamecity7_3
- Postal code7_3
- Elector signature7_3
- Witness initials7_3
- Internal use only7_3
- Printed name of elector8_3
- Full residential address street numbernamecity8_3
- Postal code8_3
- Elector signature8_3
- Witness initials8_3
- Internal use only8_3
- Printed name of elector9_3
- Full residential address street numbernamecity9_3
- Postal code9_3
- Elector signature9_3
- Witness initials9_3
- Internal use only9_3
- Printed name of elector10_3
- Full residential address street numbernamecity10_3
- Postal code10_3
- Elector signature10_3
- Witness initials10_3
- Internal use only10_3
- Printed name of elector1_4
- Full residential address street numbernamecity1_4
- Postal code1_4
- Elector signature1_4
- Witness initials1_4
- Internal use only1_4
- Printed name of elector2_4
- Full residential address street numbernamecity2_4
- Postal code2_4
- Elector signature2_4
- Witness initials2_4
- Internal use only2_4
- Printed name of elector3_4
- Full residential address street numbernamecity3_4
- Postal code3_4
- Elector signature3_4
- Witness initials3_4
- Internal use only3_4
- Printed name of elector4_4
- Full residential address street numbernamecity4_4
- Postal code4_4
- Elector signature4_4
- Witness initials4_4
- Internal use only4_4
- Printed name of elector5_4
- Full residential address street numbernamecity5_4
- Postal code5_4
- Elector signature5_4
- Witness initials5_4
- Internal use only5_4
- Printed name of elector6_4
- Full residential address street numbernamecity6_4
- Postal code6_4
- Elector signature6_4
- Witness initials6_4
- Internal use only6_4
- Printed name of elector7_4
- Full residential address street numbernamecity7_4
- Postal code7_4
- Elector signature7_4
- Witness initials7_4
- Internal use only7_4
- Printed name of elector8_4
- Full residential address street numbernamecity8_4
- Postal code8_4
- Elector signature8_4
- Witness initials8_4
- Internal use only8_4
- Printed name of elector9_4
- Full residential address street numbernamecity9_4
- Postal code9_4
- Elector signature9_4
- Witness initials9_4
- Internal use only9_4
- Printed name of elector10_4
- Full residential address street numbernamecity10_4
- Postal code10_4
- Elector signature10_4
- Witness initials10_4
- Internal use only10_4
- Printed name of elector1_5
- Full residential address street numbernamecity1_5
- Postal code1_5
- Elector signature1_5
- Witness initials1_5
- Internal use only1_5
- Printed name of elector2_5
- Full residential address street numbernamecity2_5
- Postal code2_5
- Elector signature2_5
- Witness initials2_5
- Internal use only2_5
- Printed name of elector3_5
- Full residential address street numbernamecity3_5
- Postal code3_5
- Elector signature3_5
- Witness initials3_5
- Internal use only3_5
- Printed name of elector4_5
- Full residential address street numbernamecity4_5
- Postal code4_5
- Elector signature4_5
- Witness initials4_5
- Internal use only4_5
- Printed name of elector5_5
- Full residential address street numbernamecity5_5
- Postal code5_5
- Elector signature5_5
- Witness initials5_5
- Internal use only5_5
- Printed name of elector6_5
- Full residential address street numbernamecity6_5
- Postal code6_5
- Elector signature6_5
- Witness initials6_5
- Internal use only6_5
- Printed name of elector7_5
- Full residential address street numbernamecity7_5
- Postal code7_5
- Elector signature7_5
- Witness initials7_5
- Internal use only7_5
- Printed name of elector8_5
- Full residential address street numbernamecity8_5
- Postal code8_5
- Elector signature8_5
- Witness initials8_5
- Internal use only8_5
- Printed name of elector9_5
- Full residential address street numbernamecity9_5
- Postal code9_5
- Elector signature9_5
- Witness initials9_5
- Internal use only9_5
- Printed name of elector10_5
- Full residential address street numbernamecity10_5
- Postal code10_5
- Elector signature10_5
- Witness initials10_5
- Internal use only10_5
- Printed name of elector1_6
- Full residential address street numbernamecity1_6
- Postal code1_6
- Elector signature1_6
- Witness initials1_6
- Internal use only1_6
- Printed name of elector2_6
- Full residential address street numbernamecity2_6
- Postal code2_6
- Elector signature2_6
- Witness initials2_6
- Internal use only2_6
- Printed name of elector3_6
- Full residential address street numbernamecity3_6
- Postal code3_6
- Elector signature3_6
- Witness initials3_6
- Internal use only3_6
- Printed name of elector4_6
- Full residential address street numbernamecity4_6
- Postal code4_6
- Elector signature4_6
- Witness initials4_6
- Internal use only4_6
- Printed name of elector5_6
- Full residential address street numbernamecity5_6
- Postal code5_6
- Elector signature5_6
- Witness initials5_6
- Internal use only5_6
- Printed name of elector6_6
- Full residential address street numbernamecity6_6
- Postal code6_6
- Elector signature6_6
- Witness initials6_6
- Internal use only6_6
- Printed name of elector7_6
- Full residential address street numbernamecity7_6
- Postal code7_6
- Elector signature7_6
- Witness initials7_6
- Internal use only7_6
- Printed name of elector8_6
- Full residential address street numbernamecity8_6
- Postal code8_6
- Elector signature8_6
- Witness initials8_6
- Internal use only8_6
- Printed name of elector9_6
- Full residential address street numbernamecity9_6
- Postal code9_6
- Elector signature9_6
- Witness initials9_6
- Internal use only9_6
- Printed name of elector10_6
- Full residential address street numbernamecity10_6
- Postal code10_6
- Elector signature10_6
- Witness initials10_6
- Internal use only10_6
- Printed name of elector1_7
- Full residential address street numbernamecity1_7
- Postal code1_7
- Elector signature1_7
- Witness initials1_7
- Internal use only1_7
- Printed name of elector2_7
- Full residential address street numbernamecity2_7
- Postal code2_7
- Elector signature2_7
- Witness initials2_7
- Internal use only2_7
- Printed name of elector3_7
- Full residential address street numbernamecity3_7
- Postal code3_7
- Elector signature3_7
- Witness initials3_7
- Internal use only3_7
- Printed name of elector4_7
- Full residential address street numbernamecity4_7
- Postal code4_7
- Elector signature4_7
- Witness initials4_7
- Internal use only4_7
- Printed name of elector5_7
- Full residential address street numbernamecity5_7
- Postal code5_7
- Elector signature5_7
- Witness initials5_7
- Internal use only5_7
- Printed name of elector6_7
- Full residential address street numbernamecity6_7
- Postal code6_7
- Elector signature6_7
- Witness initials6_7
- Internal use only6_7
- Printed name of elector7_7
- Full residential address street numbernamecity7_7
- Postal code7_7
- Elector signature7_7
- Witness initials7_7
- Internal use only7_7
- Printed name of elector8_7
- Full residential address street numbernamecity8_7
- Postal code8_7
- Elector signature8_7
- Witness initials8_7
- Internal use only8_7
- Printed name of elector9_7
- Full residential address street numbernamecity9_7
- Postal code9_7
- Elector signature9_7
- Witness initials9_7
- Internal use only9_7
- Printed name of elector10_7
- Full residential address street numbernamecity10_7
- Postal code10_7
- Elector signature10_7
- Witness initials10_7
- Internal use only10_7
- Printed name of elector1_8
- Full residential address street numbernamecity1_8
- Postal code1_8
- Elector signature1_8
- Witness initials1_8
- Internal use only1_8
- Printed name of elector2_8
- Full residential address street numbernamecity2_8
- Postal code2_8
- Elector signature2_8
- Witness initials2_8
- Internal use only2_8
- Printed name of elector3_8
- Full residential address street numbernamecity3_8
- Postal code3_8
- Elector signature3_8
- Witness initials3_8
- Internal use only3_8
- Printed name of elector4_8
- Full residential address street numbernamecity4_8
- Postal code4_8
- Elector signature4_8
- Witness initials4_8
- Internal use only4_8
- Printed name of elector5_8
- Full residential address street numbernamecity5_8
- Postal code5_8
- Elector signature5_8
- Witness initials5_8
- Internal use only5_8
- Printed name of elector6_8
- Full residential address street numbernamecity6_8
- Postal code6_8
- Elector signature6_8
- Witness initials6_8
- Internal use only6_8
- Printed name of elector7_8
- Full residential address street numbernamecity7_8
- Postal code7_8
- Elector signature7_8
- Witness initials7_8
- Internal use only7_8
- Printed name of elector8_8
- Full residential address street numbernamecity8_8
- Postal code8_8
- Elector signature8_8
- Witness initials8_8
- Internal use only8_8
- Printed name of elector9_8
- Full residential address street numbernamecity9_8
- Postal code9_8
- Elector signature9_8
- Witness initials9_8
- Internal use only9_8
- Printed name of elector10_8
- Full residential address street numbernamecity10_8
- Postal code10_8
- Elector signature10_8
- Witness initials10_8
- Internal use only10_8
- Printed name of elector1_9
- Full residential address street numbernamecity1_9
- Postal code1_9
- Elector signature1_9
- Witness initials1_9
- Internal use only1_9
- Printed name of elector2_9
- Full residential address street numbernamecity2_9
- Postal code2_9
- Elector signature2_9
- Witness initials2_9
- Internal use only2_9
- Printed name of elector3_9
- Full residential address street numbernamecity3_9
- Postal code3_9
- Elector signature3_9
- Witness initials3_9
- Internal use only3_9
- Printed name of elector4_9
- Full residential address street numbernamecity4_9
- Postal code4_9
- Elector signature4_9
- Witness initials4_9
- Internal use only4_9
- Printed name of elector5_9
- Full residential address street numbernamecity5_9
- Postal code5_9
- Elector signature5_9
- Witness initials5_9
- Internal use only5_9
- Printed name of elector6_9
- Full residential address street numbernamecity6_9
- Postal code6_9
- Elector signature6_9
- Witness initials6_9
- Internal use only6_9
- Printed name of elector7_9
- Full residential address street numbernamecity7_9
- Postal code7_9
- Elector signature7_9
- Witness initials7_9
- Internal use only7_9
- Printed name of elector8_9
- Full residential address street numbernamecity8_9
- Postal code8_9
- Elector signature8_9
- Witness initials8_9
- Internal use only8_9
- Printed name of elector9_9
- Full residential address street numbernamecity9_9
- Postal code9_9
- Elector signature9_9
- Witness initials9_9
- Internal use only9_9
- Printed name of elector10_9
- Full residential address street numbernamecity10_9
- Postal code10_9
- Elector signature10_9
- Witness initials10_9
- Internal use only10_9
- Printed name of elector1_10
- Full residential address street numbernamecity1_10
- Postal code1_10
- Elector signature1_10
- Witness initials1_10
- Internal use only1_10
- Printed name of elector2_10
- Full residential address street numbernamecity2_10
- Postal code2_10
- Elector signature2_10
- Witness initials2_10
- Internal use only2_10
- Printed name of elector3_10
- Full residential address street numbernamecity3_10
- Postal code3_10
- Elector signature3_10
- Witness initials3_10
- Internal use only3_10
- Printed name of elector4_10
- Full residential address street numbernamecity4_10
- Postal code4_10
- Elector signature4_10
- Witness initials4_10
- Internal use only4_10
- Printed name of elector5_10
- Full residential address street numbernamecity5_10
- Postal code5_10
- Elector signature5_10
- Witness initials5_10
- Internal use only5_10
- Printed name of elector6_10
- Full residential address street numbernamecity6_10
- Postal code6_10
- Elector signature6_10
- Witness initials6_10
- Internal use only6_10
- Printed name of elector7_10
- Full residential address street numbernamecity7_10
- Postal code7_10
- Elector signature7_10
- Witness initials7_10
- Internal use only7_10
- Printed name of elector8_10
- Full residential address street numbernamecity8_10
- Postal code8_10
- Elector signature8_10
- Witness initials8_10
- Internal use only8_10
- Printed name of elector9_10
- Full residential address street numbernamecity9_10
- Postal code9_10
- Elector signature9_10
- Witness initials9_10
- Internal use only9_10
- Printed name of elector10_10
- Full residential address street numbernamecity10_10
- Postal code10_10
- Elector signature10_10
- Witness initials10_10
- Internal use only10_10
- Printed name of elector1_11
- Full residential address street numbernamecity1_11
- Postal code1_11
- Elector signature1_11
- Witness initials1_11
- Internal use only1_11
- Printed name of elector2_11
- Full residential address street numbernamecity2_11
- Postal code2_11
- Elector signature2_11
- Witness initials2_11
- Internal use only2_11
- Printed name of elector3_11
- Full residential address street numbernamecity3_11
- Postal code3_11
- Elector signature3_11
- Witness initials3_11
- Internal use only3_11
- Printed name of elector4_11
- Full residential address street numbernamecity4_11
- Postal code4_11
- Elector signature4_11
- Witness initials4_11
- Internal use only4_11
- Printed name of elector5_11
- Full residential address street numbernamecity5_11
- Postal code5_11
- Elector signature5_11
- Witness initials5_11
- Internal use only5_11
- Printed name of elector6_11
- Full residential address street numbernamecity6_11
- Postal code6_11
- Elector signature6_11
- Witness initials6_11
- Internal use only6_11
- Printed name of elector7_11
- Full residential address street numbernamecity7_11
- Postal code7_11
- Elector signature7_11
- Witness initials7_11
- Internal use only7_11
- Printed name of elector8_11
- Full residential address street numbernamecity8_11
- Postal code8_11
- Elector signature8_11
- Witness initials8_11
- Internal use only8_11
- Printed name of elector9_11
- Full residential address street numbernamecity9_11
- Postal code9_11
- Elector signature9_11
- Witness initials9_11
- Internal use only9_11
- Printed name of elector10_11
- Full residential address street numbernamecity10_11
- Postal code10_11
- Elector signature10_11
- Witness initials10_11
- Internal use only10_11
- Printed name of elector1_12
- Full residential address street numbernamecity1_12
- Postal code1_12
- Elector signature1_12
- Witness initials1_12
- Internal use only1_12
- Printed name of elector2_12
- Full residential address street numbernamecity2_12
- Postal code2_12
- Elector signature2_12
- Witness initials2_12
- Internal use only2_12
- Printed name of elector3_12
- Full residential address street numbernamecity3_12
- Postal code3_12
- Elector signature3_12
- Witness initials3_12
- Internal use only3_12
- Printed name of elector4_12
- Full residential address street numbernamecity4_12
- Postal code4_12
- Elector signature4_12
- Witness initials4_12
- Internal use only4_12
- Printed name of elector5_12
- Full residential address street numbernamecity5_12
- Postal code5_12
- Elector signature5_12
- Witness initials5_12
- Internal use only5_12
- Printed name of elector6_12
- Full residential address street numbernamecity6_12
- Postal code6_12
- Elector signature6_12
- Witness initials6_12
- Internal use only6_12
- Printed name of elector7_12
- Full residential address street numbernamecity7_12
- Postal code7_12
- Elector signature7_12
- Witness initials7_12
- Internal use only7_12
- Printed name of elector8_12
- Full residential address street numbernamecity8_12
- Postal code8_12
- Elector signature8_12
- Witness initials8_12
- Internal use only8_12
- Printed name of elector9_12
- Full residential address street numbernamecity9_12
- Postal code9_12
- Elector signature9_12
- Witness initials9_12
- Internal use only9_12
- Printed name of elector10_12
- Full residential address street numbernamecity10_12
- Postal code10_12
- Elector signature10_12
- Witness initials10_12
- Internal use only10_12
- Printed name of elector1_13
- Full residential address street numbernamecity1_13
- Postal code1_13
- Elector signature1_13
- Witness initials1_13
- Internal use only1_13
- Printed name of elector2_13
- Full residential address street numbernamecity2_13
- Postal code2_13
- Elector signature2_13
- Witness initials2_13
- Internal use only2_13
- Printed name of elector3_13
- Full residential address street numbernamecity3_13
- Postal code3_13
- Elector signature3_13
- Witness initials3_13
- Internal use only3_13
- Printed name of elector4_13
- Full residential address street numbernamecity4_13
- Postal code4_13
- Elector signature4_13
- Witness initials4_13
- Internal use only4_13
- Printed name of elector5_13
- Full residential address street numbernamecity5_13
- Postal code5_13
- Elector signature5_13
- Witness initials5_13
- Internal use only5_13
- Printed name of elector6_13
- Full residential address street numbernamecity6_13
- Postal code6_13
- Elector signature6_13
- Witness initials6_13
- Internal use only6_13
- Printed name of elector7_13
- Full residential address street numbernamecity7_13
- Postal code7_13
- Elector signature7_13
- Witness initials7_13
- Internal use only7_13
- Printed name of elector8_13
- Full residential address street numbernamecity8_13
- Postal code8_13
- Elector signature8_13
- Witness initials8_13
- Internal use only8_13
- Printed name of elector9_13
- Full residential address street numbernamecity9_13
- Postal code9_13
- Elector signature9_13
- Witness initials9_13
- Internal use only9_13
- Printed name of elector10_13
- Full residential address street numbernamecity10_13
- Postal code10_13
- Elector signature10_13
- Witness initials10_13
- Internal use only10_13
- Printed name of elector1_14
- Full residential address street numbernamecity1_14
- Postal code1_14
- Elector signature1_14
- Witness initials1_14
- Internal use only1_14
- Printed name of elector2_14
- Full residential address street numbernamecity2_14
- Postal code2_14
- Elector signature2_14
- Witness initials2_14
- Internal use only2_14
- Printed name of elector3_14
- Full residential address street numbernamecity3_14
- Postal code3_14
- Elector signature3_14
- Witness initials3_14
- Internal use only3_14
- Printed name of elector4_14
- Full residential address street numbernamecity4_14
- Postal code4_14
- Elector signature4_14
- Witness initials4_14
- Internal use only4_14
- Printed name of elector5_14
- Full residential address street numbernamecity5_14
- Postal code5_14
- Elector signature5_14
- Witness initials5_14
- Internal use only5_14
- Printed name of elector6_14
- Full residential address street numbernamecity6_14
- Postal code6_14
- Elector signature6_14
- Witness initials6_14
- Internal use only6_14
- Printed name of elector7_14
- Full residential address street numbernamecity7_14
- Postal code7_14
- Elector signature7_14
- Witness initials7_14
- Internal use only7_14
- Printed name of elector8_14
- Full residential address street numbernamecity8_14
- Postal code8_14
- Elector signature8_14
- Witness initials8_14
- Internal use only8_14
- Printed name of elector9_14
- Full residential address street numbernamecity9_14
- Postal code9_14
- Elector signature9_14
- Witness initials9_14
- Internal use only9_14
- Printed name of elector10_14
- Full residential address street numbernamecity10_14
- Postal code10_14
- Elector signature10_14
- Witness initials10_14
- Internal use only10_14
- Printed name of elector1_15
- Full residential address street numbernamecity1_15
- Postal code1_15
- Elector signature1_15
- Witness initials1_15
- Internal use only1_15
- Printed name of elector2_15
- Full residential address street numbernamecity2_15
- Postal code2_15
- Elector signature2_15
- Witness initials2_15
- Internal use only2_15
- Printed name of elector3_15
- Full residential address street numbernamecity3_15
- Postal code3_15
- Elector signature3_15
- Witness initials3_15
- Internal use only3_15
- Printed name of elector4_15
- Full residential address street numbernamecity4_15
- Postal code4_15
- Elector signature4_15
- Witness initials4_15
- Internal use only4_15
- Printed name of elector5_15
- Full residential address street numbernamecity5_15
- Postal code5_15
- Elector signature5_15
- Witness initials5_15
- Internal use only5_15
- Printed name of elector6_15
- Full residential address street numbernamecity6_15
- Postal code6_15
- Elector signature6_15
- Witness initials6_15
- Internal use only6_15
- Printed name of elector7_15
- Full residential address street numbernamecity7_15
- Postal code7_15
- Elector signature7_15
- Witness initials7_15
- Internal use only7_15
- Printed name of elector8_15
- Full residential address street numbernamecity8_15
- Postal code8_15
- Elector signature8_15
- Witness initials8_15
- Internal use only8_15
- Printed name of elector9_15
- Full residential address street numbernamecity9_15
- Postal code9_15
- Elector signature9_15
- Witness initials9_15
- Internal use only9_15
- Printed name of elector10_15
- Full residential address street numbernamecity10_15
- Postal code10_15
- Elector signature10_15
- Witness initials10_15
- Internal use only10_15
- Printed name of elector1_16
- Full residential address street numbernamecity1_16
- Postal code1_16
- Elector signature1_16
- Witness initials1_16
- Internal use only1_16
- Printed name of elector2_16
- Full residential address street numbernamecity2_16
- Postal code2_16
- Elector signature2_16
- Witness initials2_16
- Internal use only2_16
- Printed name of elector3_16
- Full residential address street numbernamecity3_16
- Postal code3_16
- Elector signature3_16
- Witness initials3_16
- Internal use only3_16
- Printed name of elector4_16
- Full residential address street numbernamecity4_16
- Postal code4_16
- Elector signature4_16
- Witness initials4_16
- Internal use only4_16
- Printed name of elector5_16
- Full residential address street numbernamecity5_16
- Postal code5_16
- Elector signature5_16
- Witness initials5_16
- Internal use only5_16
- Printed name of elector6_16
- Full residential address street numbernamecity6_16
- Postal code6_16
- Elector signature6_16
- Witness initials6_16
- Internal use only6_16
- Printed name of elector7_16
- Full residential address street numbernamecity7_16
- Postal code7_16
- Elector signature7_16
- Witness initials7_16
- Internal use only7_16
- Printed name of elector8_16
- Full residential address street numbernamecity8_16
- Postal code8_16
- Elector signature8_16
- Witness initials8_16
- Internal use only8_16
- Printed name of elector9_16
- Full residential address street numbernamecity9_16
- Postal code9_16
- Elector signature9_16
- Witness initials9_16
- Internal use only9_16
- Printed name of elector10_16
- Full residential address street numbernamecity10_16
- Postal code10_16
- Elector signature10_16
- Witness initials10_16
- Internal use only10_16
- Have you completed the Nomination Paper EC 20010 Off
- Do you have authorized proof of identify Off
- Are you endorsed by a political party Off
- Have you made a nomination appointment Off
- Last name - Candidate Name
- First name - Candidate Name
- Name of electoral district- Candidate Information
- First name - Candidate Information
- Last name - Candidate Information
- Ballot Name Off
- Ballot First name(s)
- Ballot Last name(s)
- Gender -Candidate information
- Date of birth (YYY-MM-DD) - Gender -Candidate information
- language of correspondence - Candidate information Off
- Email -Contact information
- Primary phone number - Contact information
- Ext - Primary phone number
- Alternate phone number - Contact information
- Ext - Alternate phone number
- Fax number- Alternate phone number
- Unit -Residential address
- Street -Residential address
- Street name -Residential address
- City -Residential address
- ProvinceTerritory -Residential address
- Postal code - -Residential address
- Mailing address - same as residential address Off
- Occupation- Candidate occupation
- Sharing of information with the Conflict of Interest and Ethics Commissioner and the House of Commons including the Library of Parliament Off
- where applicable if the returning officer is unable to verify that I have been endorsed by the political party identified in section A of this Nomination Paper I wish to Off
- Date of Signature (YYYY-MM-DD) - Candidate signature
- Date of Signature (YYYY-MM-DD) -Signature of person receiving the solemn declaration
- Campaign delegate information
- First name - Campaign delegate information
- Last name - Campaign delegate information
- Language of correspondence - Campaign delegate information Off
- Email - Contact information -Campaign Delegate
- Primary phone number - Contact information -Campaign Delegate
- Primary phone number EXT - Contact information -Campaign Delegate
- Alternate phone number - Contact information -Campaign Delegate
- Alternate phone number EXT - Contact information -Campaign Delegate
- Fax nmuber- Contact information -Campaign Delegate
- Street - Residential address -Campaign delegate
- Street name - Residential address -Campaign delegate
- City - Residential address -Campaign delegate
- ProvinceTerritory - Residential address -Campaign delegate
- Postal Code - Residential address -Campaign delegate
- Campaign delegate - Mailing address ndash Same as residential address Off
- Unit - Residential address -Campaign delegate
- Date (YYYY-MM-DD) - Candidate authorization Signature
- Date (YYYY-MM-DD) - Candidate campaign Signature
- First name - Official agent information
- Last name - Official agent information
- Language of correspondence - Official agent information Off
- Email - Official agent information
- Primary phone number - Official agent information
- Primary phone number EXT - Official agent information
- Alternate phone number EXT - Official agent information
- Alternate phone number - Official agent information
- Fax number - Official agent information
- Unit -Residential address - Official Agent
- Street name -Residential address - Official Agent
- City -Residential address - Official Agent
- Street -Residential address - Official Agent
- ProvinceTerritory -Residential address - Official Agent
- Postal code-Residential address - Official Agent
- Mailing address ndash Same as residential address- Official Agent Off
- Date (YYYY-MM-DD) - Official agent signature
- First name - Auditor information
- Last name - Auditor information
- Language of correspondence - Auditor information Off
- Email - Auditor information
- Primary phone number - Auditor information
- Primary phone number EXT- Auditor information
- Alternate phone number - Auditor information
- Alternate phone number EXT- Auditor information
- Fax number - Auditor information
- Name of firm- Auditor organizational information
- Occupation of auditor - Auditor organizational information
- Professional designation - Auditor organizational information Off
- Designation registration number
- Make cheque payable to
- Unit - Address (where cheque is sent)
- Street - Address (where cheque is sent)
- Street name - Address (where cheque is sent)
- City - Address (where cheque is sent)
- ProvinceTerritory - Address (where cheque is sent)
- Postal code - Address (where cheque is sent)
- Date (YYY-MM-DD) - Auditor signature
- Unit - Campaign office address (optional)
- Street - Campaign office address (optional)
- Street name - Campaign office address (optional)
- City - Campaign office address (optional)
- ProvinceTerritory- Campaign office address (optional)
- Postal code - Campaign office address (optional)
- Name of witness
- Full address of witness
- Name of candidate
- Electoral district
- Year
- Name of candidate2
- Electoral district2
- Year2
- Name of witness2
- Full address of witness2
- Name of candidate3
- Electoral district3
- Year3
- Full address of witness3
- Name of witness3
- Name of candidate 4
- Electoral district4
- Year4
- Full address of witness 4
- Name of witness 4
- Name of candidate5
- Electoral district5
- Year5
- Full address of witness5
- Name of witness5
- Name of candidate6
- Electoral district6
- Year6
- Name of witness6
- Full address of witness6
- Name of candidate7
- Electoral district7
- Year7
- Full address of witness7
- Name of witness7
- Name of candidate8
- Electoral district8
- Year8
- Full address of witness8
- Name of witness8
- Name of candidate9
- Electoral district9
- Year9
- Full address of witness 9
- Name of witness 9
- Name of candidate10
- Electoral district10
- Year10
- Full address of witness10
- Name of witness10
- Name of candidate11
- Electoral district11
- Year11
- Full address of witness11
- Name of witness11
- Name of candidate12
- Electoral district12
- Year12
- Full address of witness12
- Name of witness12
- Name of candidate13
- Electoral district13
- Year13
- Full address of witness13
- Name of witness13
- Name of candidate14
- Electoral district14
- Year14
- Name of witness14
- Full address of witness14
- Name of candidate1
- Electoral district1
- Year1
- Name of witness1
- Full address of witness1
- Name of candidate15
- Electoral district15
- Year15
- Name of witness15
- Full address of witness15
- unit -Mailing address
- Street -Mailing address
- Street name -Mailing address
- City -Mailing address
- ProvinceTerritory -Mailing address
- Postal code -Mailing address
- Unit - Mailing address -Campaign delegate
- Street - Mailing address -Campaign delegate
- Street name - Mailing address -Campaign delegate
- City - Mailing address -Campaign delegate
- ProvinceTerritory- Mailing address -Campaign delegate
- Postal code- Mailing address -Campaign delegate
- Unit -Mailing address - Official Agent
- Street -Mailing address - Official Agent
- Street name -Mailing address - Official Agent
- city -Mailing address - Official Agent
- ProvinceTerritory-Mailing address - Official Agent
- Postal code-Mailing address - Official Agent
22BSection F - Electors Consenting to Candidacy (Mandatory)
Name of candidate Electoral district Year
Declaration of electors I the undersigned consent to the candidacy of the person listed above I am a qualified elector and reside in the electoral district listed above A qualified elector is a Canadian citizen who will be 18 or older on election day
Printed name of elector Full residential address (street numbernamecity) Postal code Elector signature Witness
initials Internal use only
1
2
3
4
5
6
7
8
9
10
Witness to signature
Note Under subsection 66(4) of the Canada Elections Act the witness shall use due diligence to ensure that the electors consenting to the candidacy reside within the electoral district The witness to the signature supporting a candidate is not required to be a qualified elector in any electoral district The signatures on this page must all be witnessed by the same person
Name of witness Full address of witness Signature of witness
Personal information in this Nomination Paper and all associated supporting documents are collected to determine a candidatersquos eligibility to seek election and be declared elected to the House of Commons pursuant to the Canada Elections Act (CEA)
The completed Nomination Paper may be accessed by the public at the local returning office during the election period After the election period the Nomination Paper is submitted to the Chief Electoral Officer and becomes a protected election document Information in the Nomination Paper and all associated supporting documents may be shared with the Commissioner of Canada Elections to ensure that the CEA is complied with and enforced It may also be shared within Elections Canada to administer federal election voting procedures and the political financing provisions of the CEA
You have the right to access correct and protect your personal information under the Privacy Act You also have the right to file a complaint with the Privacy Commissioner of Canada regarding the handling of your personal information Your personal information is retained under the Personal Information Bank (PIB) Candidates and Members Elected Elections PPU 005 A description of the PIB can be found at electionsca
30
EC 20010 (022019)
SECTION G ndash 23B Are You Ready to Submit Your Nomination
Have you completed the Nomination Paper (EC 20010)
bull Are all mandatory fields in sections AndashE complete
bull Have you collected the required number of signatures from qualified electors in section F
o For most electoral districts 100 electors must consent to your candidacy
o For electoral districts identified in Schedule 3 only 50 electors are required
o To ensure a smooth nomination process Elections Canada recommends collecting signatures from at least 150 electors
Do you have authorized proof of identify
bull For a list of authorized identification visit the Elections Canada website
bull If a campaign delegate is submitting on your behalf they must bring a copy of your identification documents signed by you
bull If you want an alternative name to appear on the ballot additional documentation is required visit electionsca for details
Are you endorsed by a political party
bull Make sure your party has submitted the required documentation to Elections Canada attesting your designated political affiliation
Have you made a nomination appointment
bull To facilitate the nomination process make an appointment with the returning officer to finalize the filing of the complete nomination package
bull The nomination period closes 21 days before election day at 200 pm local time
31
- Nomination Paperof a Candidate at a Federal General Election or By-election
- Table of Contents
- General Information
- SECTION A ndash Candidate Information (Mandatory)
- SECTION B ndash Campaign Delegate (Optional)
- SECTION C ndash Official Agent (Mandatory)
- SECTION D ndash Auditor (Optional)
- SECTION E ndash Campaign Office (Optional)
- SECTION F ndash Electors Consenting to Candidacy (Mandatory)
-
- Name of electoral district
- Political affiliation
- Telephone number to be posted on electionsca
- Website to be posted on electionsca including prefix http https
- Printed name of elector1
- Full residential address street numbernamecity1
- Postal code1
- Elector signature1
- Witness initials1
- Internal use only1
- Printed name of elector2
- Full residential address street numbernamecity2
- Postal code2
- Elector signature2
- Witness initials2
- Internal use only2
- Printed name of elector3
- Full residential address street numbernamecity3
- Postal code3
- Elector signature3
- Witness initials3
- Internal use only3
- Printed name of elector4
- Full residential address street numbernamecity4
- Postal code4
- Elector signature4
- Witness initials4
- Internal use only4
- Printed name of elector5
- Full residential address street numbernamecity5
- Postal code5
- Elector signature5
- Witness initials5
- Internal use only5
- Printed name of elector6
- Full residential address street numbernamecity6
- Postal code6
- Elector signature6
- Witness initials6
- Internal use only6
- Printed name of elector7
- Full residential address street numbernamecity7
- Postal code7
- Elector signature7
- Witness initials7
- Internal use only7
- Printed name of elector8
- Full residential address street numbernamecity8
- Postal code8
- Elector signature8
- Witness initials8
- Internal use only8
- Printed name of elector9
- Full residential address street numbernamecity9
- Postal code9
- Elector signature9
- Witness initials9
- Internal use only9
- Printed name of elector10
- Full residential address street numbernamecity10
- Postal code10
- Elector signature10
- Witness initials10
- Internal use only10
- Printed name of elector1_2
- Full residential address street numbernamecity1_2
- Postal code1_2
- Elector signature1_2
- Witness initials1_2
- Internal use only1_2
- Printed name of elector2_2
- Full residential address street numbernamecity2_2
- Postal code2_2
- Elector signature2_2
- Witness initials2_2
- Internal use only2_2
- Printed name of elector3_2
- Full residential address street numbernamecity3_2
- Postal code3_2
- Elector signature3_2
- Witness initials3_2
- Internal use only3_2
- Printed name of elector4_2
- Full residential address street numbernamecity4_2
- Postal code4_2
- Elector signature4_2
- Witness initials4_2
- Internal use only4_2
- Printed name of elector5_2
- Full residential address street numbernamecity5_2
- Postal code5_2
- Elector signature5_2
- Witness initials5_2
- Internal use only5_2
- Printed name of elector6_2
- Full residential address street numbernamecity6_2
- Postal code6_2
- Elector signature6_2
- Witness initials6_2
- Internal use only6_2
- Printed name of elector7_2
- Full residential address street numbernamecity7_2
- Postal code7_2
- Elector signature7_2
- Witness initials7_2
- Internal use only7_2
- Printed name of elector8_2
- Full residential address street numbernamecity8_2
- Postal code8_2
- Elector signature8_2
- Witness initials8_2
- Internal use only8_2
- Printed name of elector9_2
- Full residential address street numbernamecity9_2
- Postal code9_2
- Elector signature9_2
- Witness initials9_2
- Internal use only9_2
- Printed name of elector10_2
- Full residential address street numbernamecity10_2
- Postal code10_2
- Elector signature10_2
- Witness initials10_2
- Internal use only10_2
- Printed name of elector1_3
- Full residential address street numbernamecity1_3
- Postal code1_3
- Elector signature1_3
- Witness initials1_3
- Internal use only1_3
- Printed name of elector2_3
- Full residential address street numbernamecity2_3
- Postal code2_3
- Elector signature2_3
- Witness initials2_3
- Internal use only2_3
- Printed name of elector3_3
- Full residential address street numbernamecity3_3
- Postal code3_3
- Elector signature3_3
- Witness initials3_3
- Internal use only3_3
- Printed name of elector4_3
- Full residential address street numbernamecity4_3
- Postal code4_3
- Elector signature4_3
- Witness initials4_3
- Internal use only4_3
- Printed name of elector5_3
- Full residential address street numbernamecity5_3
- Postal code5_3
- Elector signature5_3
- Witness initials5_3
- Internal use only5_3
- Printed name of elector6_3
- Full residential address street numbernamecity6_3
- Postal code6_3
- Elector signature6_3
- Witness initials6_3
- Internal use only6_3
- Printed name of elector7_3
- Full residential address street numbernamecity7_3
- Postal code7_3
- Elector signature7_3
- Witness initials7_3
- Internal use only7_3
- Printed name of elector8_3
- Full residential address street numbernamecity8_3
- Postal code8_3
- Elector signature8_3
- Witness initials8_3
- Internal use only8_3
- Printed name of elector9_3
- Full residential address street numbernamecity9_3
- Postal code9_3
- Elector signature9_3
- Witness initials9_3
- Internal use only9_3
- Printed name of elector10_3
- Full residential address street numbernamecity10_3
- Postal code10_3
- Elector signature10_3
- Witness initials10_3
- Internal use only10_3
- Printed name of elector1_4
- Full residential address street numbernamecity1_4
- Postal code1_4
- Elector signature1_4
- Witness initials1_4
- Internal use only1_4
- Printed name of elector2_4
- Full residential address street numbernamecity2_4
- Postal code2_4
- Elector signature2_4
- Witness initials2_4
- Internal use only2_4
- Printed name of elector3_4
- Full residential address street numbernamecity3_4
- Postal code3_4
- Elector signature3_4
- Witness initials3_4
- Internal use only3_4
- Printed name of elector4_4
- Full residential address street numbernamecity4_4
- Postal code4_4
- Elector signature4_4
- Witness initials4_4
- Internal use only4_4
- Printed name of elector5_4
- Full residential address street numbernamecity5_4
- Postal code5_4
- Elector signature5_4
- Witness initials5_4
- Internal use only5_4
- Printed name of elector6_4
- Full residential address street numbernamecity6_4
- Postal code6_4
- Elector signature6_4
- Witness initials6_4
- Internal use only6_4
- Printed name of elector7_4
- Full residential address street numbernamecity7_4
- Postal code7_4
- Elector signature7_4
- Witness initials7_4
- Internal use only7_4
- Printed name of elector8_4
- Full residential address street numbernamecity8_4
- Postal code8_4
- Elector signature8_4
- Witness initials8_4
- Internal use only8_4
- Printed name of elector9_4
- Full residential address street numbernamecity9_4
- Postal code9_4
- Elector signature9_4
- Witness initials9_4
- Internal use only9_4
- Printed name of elector10_4
- Full residential address street numbernamecity10_4
- Postal code10_4
- Elector signature10_4
- Witness initials10_4
- Internal use only10_4
- Printed name of elector1_5
- Full residential address street numbernamecity1_5
- Postal code1_5
- Elector signature1_5
- Witness initials1_5
- Internal use only1_5
- Printed name of elector2_5
- Full residential address street numbernamecity2_5
- Postal code2_5
- Elector signature2_5
- Witness initials2_5
- Internal use only2_5
- Printed name of elector3_5
- Full residential address street numbernamecity3_5
- Postal code3_5
- Elector signature3_5
- Witness initials3_5
- Internal use only3_5
- Printed name of elector4_5
- Full residential address street numbernamecity4_5
- Postal code4_5
- Elector signature4_5
- Witness initials4_5
- Internal use only4_5
- Printed name of elector5_5
- Full residential address street numbernamecity5_5
- Postal code5_5
- Elector signature5_5
- Witness initials5_5
- Internal use only5_5
- Printed name of elector6_5
- Full residential address street numbernamecity6_5
- Postal code6_5
- Elector signature6_5
- Witness initials6_5
- Internal use only6_5
- Printed name of elector7_5
- Full residential address street numbernamecity7_5
- Postal code7_5
- Elector signature7_5
- Witness initials7_5
- Internal use only7_5
- Printed name of elector8_5
- Full residential address street numbernamecity8_5
- Postal code8_5
- Elector signature8_5
- Witness initials8_5
- Internal use only8_5
- Printed name of elector9_5
- Full residential address street numbernamecity9_5
- Postal code9_5
- Elector signature9_5
- Witness initials9_5
- Internal use only9_5
- Printed name of elector10_5
- Full residential address street numbernamecity10_5
- Postal code10_5
- Elector signature10_5
- Witness initials10_5
- Internal use only10_5
- Printed name of elector1_6
- Full residential address street numbernamecity1_6
- Postal code1_6
- Elector signature1_6
- Witness initials1_6
- Internal use only1_6
- Printed name of elector2_6
- Full residential address street numbernamecity2_6
- Postal code2_6
- Elector signature2_6
- Witness initials2_6
- Internal use only2_6
- Printed name of elector3_6
- Full residential address street numbernamecity3_6
- Postal code3_6
- Elector signature3_6
- Witness initials3_6
- Internal use only3_6
- Printed name of elector4_6
- Full residential address street numbernamecity4_6
- Postal code4_6
- Elector signature4_6
- Witness initials4_6
- Internal use only4_6
- Printed name of elector5_6
- Full residential address street numbernamecity5_6
- Postal code5_6
- Elector signature5_6
- Witness initials5_6
- Internal use only5_6
- Printed name of elector6_6
- Full residential address street numbernamecity6_6
- Postal code6_6
- Elector signature6_6
- Witness initials6_6
- Internal use only6_6
- Printed name of elector7_6
- Full residential address street numbernamecity7_6
- Postal code7_6
- Elector signature7_6
- Witness initials7_6
- Internal use only7_6
- Printed name of elector8_6
- Full residential address street numbernamecity8_6
- Postal code8_6
- Elector signature8_6
- Witness initials8_6
- Internal use only8_6
- Printed name of elector9_6
- Full residential address street numbernamecity9_6
- Postal code9_6
- Elector signature9_6
- Witness initials9_6
- Internal use only9_6
- Printed name of elector10_6
- Full residential address street numbernamecity10_6
- Postal code10_6
- Elector signature10_6
- Witness initials10_6
- Internal use only10_6
- Printed name of elector1_7
- Full residential address street numbernamecity1_7
- Postal code1_7
- Elector signature1_7
- Witness initials1_7
- Internal use only1_7
- Printed name of elector2_7
- Full residential address street numbernamecity2_7
- Postal code2_7
- Elector signature2_7
- Witness initials2_7
- Internal use only2_7
- Printed name of elector3_7
- Full residential address street numbernamecity3_7
- Postal code3_7
- Elector signature3_7
- Witness initials3_7
- Internal use only3_7
- Printed name of elector4_7
- Full residential address street numbernamecity4_7
- Postal code4_7
- Elector signature4_7
- Witness initials4_7
- Internal use only4_7
- Printed name of elector5_7
- Full residential address street numbernamecity5_7
- Postal code5_7
- Elector signature5_7
- Witness initials5_7
- Internal use only5_7
- Printed name of elector6_7
- Full residential address street numbernamecity6_7
- Postal code6_7
- Elector signature6_7
- Witness initials6_7
- Internal use only6_7
- Printed name of elector7_7
- Full residential address street numbernamecity7_7
- Postal code7_7
- Elector signature7_7
- Witness initials7_7
- Internal use only7_7
- Printed name of elector8_7
- Full residential address street numbernamecity8_7
- Postal code8_7
- Elector signature8_7
- Witness initials8_7
- Internal use only8_7
- Printed name of elector9_7
- Full residential address street numbernamecity9_7
- Postal code9_7
- Elector signature9_7
- Witness initials9_7
- Internal use only9_7
- Printed name of elector10_7
- Full residential address street numbernamecity10_7
- Postal code10_7
- Elector signature10_7
- Witness initials10_7
- Internal use only10_7
- Printed name of elector1_8
- Full residential address street numbernamecity1_8
- Postal code1_8
- Elector signature1_8
- Witness initials1_8
- Internal use only1_8
- Printed name of elector2_8
- Full residential address street numbernamecity2_8
- Postal code2_8
- Elector signature2_8
- Witness initials2_8
- Internal use only2_8
- Printed name of elector3_8
- Full residential address street numbernamecity3_8
- Postal code3_8
- Elector signature3_8
- Witness initials3_8
- Internal use only3_8
- Printed name of elector4_8
- Full residential address street numbernamecity4_8
- Postal code4_8
- Elector signature4_8
- Witness initials4_8
- Internal use only4_8
- Printed name of elector5_8
- Full residential address street numbernamecity5_8
- Postal code5_8
- Elector signature5_8
- Witness initials5_8
- Internal use only5_8
- Printed name of elector6_8
- Full residential address street numbernamecity6_8
- Postal code6_8
- Elector signature6_8
- Witness initials6_8
- Internal use only6_8
- Printed name of elector7_8
- Full residential address street numbernamecity7_8
- Postal code7_8
- Elector signature7_8
- Witness initials7_8
- Internal use only7_8
- Printed name of elector8_8
- Full residential address street numbernamecity8_8
- Postal code8_8
- Elector signature8_8
- Witness initials8_8
- Internal use only8_8
- Printed name of elector9_8
- Full residential address street numbernamecity9_8
- Postal code9_8
- Elector signature9_8
- Witness initials9_8
- Internal use only9_8
- Printed name of elector10_8
- Full residential address street numbernamecity10_8
- Postal code10_8
- Elector signature10_8
- Witness initials10_8
- Internal use only10_8
- Printed name of elector1_9
- Full residential address street numbernamecity1_9
- Postal code1_9
- Elector signature1_9
- Witness initials1_9
- Internal use only1_9
- Printed name of elector2_9
- Full residential address street numbernamecity2_9
- Postal code2_9
- Elector signature2_9
- Witness initials2_9
- Internal use only2_9
- Printed name of elector3_9
- Full residential address street numbernamecity3_9
- Postal code3_9
- Elector signature3_9
- Witness initials3_9
- Internal use only3_9
- Printed name of elector4_9
- Full residential address street numbernamecity4_9
- Postal code4_9
- Elector signature4_9
- Witness initials4_9
- Internal use only4_9
- Printed name of elector5_9
- Full residential address street numbernamecity5_9
- Postal code5_9
- Elector signature5_9
- Witness initials5_9
- Internal use only5_9
- Printed name of elector6_9
- Full residential address street numbernamecity6_9
- Postal code6_9
- Elector signature6_9
- Witness initials6_9
- Internal use only6_9
- Printed name of elector7_9
- Full residential address street numbernamecity7_9
- Postal code7_9
- Elector signature7_9
- Witness initials7_9
- Internal use only7_9
- Printed name of elector8_9
- Full residential address street numbernamecity8_9
- Postal code8_9
- Elector signature8_9
- Witness initials8_9
- Internal use only8_9
- Printed name of elector9_9
- Full residential address street numbernamecity9_9
- Postal code9_9
- Elector signature9_9
- Witness initials9_9
- Internal use only9_9
- Printed name of elector10_9
- Full residential address street numbernamecity10_9
- Postal code10_9
- Elector signature10_9
- Witness initials10_9
- Internal use only10_9
- Printed name of elector1_10
- Full residential address street numbernamecity1_10
- Postal code1_10
- Elector signature1_10
- Witness initials1_10
- Internal use only1_10
- Printed name of elector2_10
- Full residential address street numbernamecity2_10
- Postal code2_10
- Elector signature2_10
- Witness initials2_10
- Internal use only2_10
- Printed name of elector3_10
- Full residential address street numbernamecity3_10
- Postal code3_10
- Elector signature3_10
- Witness initials3_10
- Internal use only3_10
- Printed name of elector4_10
- Full residential address street numbernamecity4_10
- Postal code4_10
- Elector signature4_10
- Witness initials4_10
- Internal use only4_10
- Printed name of elector5_10
- Full residential address street numbernamecity5_10
- Postal code5_10
- Elector signature5_10
- Witness initials5_10
- Internal use only5_10
- Printed name of elector6_10
- Full residential address street numbernamecity6_10
- Postal code6_10
- Elector signature6_10
- Witness initials6_10
- Internal use only6_10
- Printed name of elector7_10
- Full residential address street numbernamecity7_10
- Postal code7_10
- Elector signature7_10
- Witness initials7_10
- Internal use only7_10
- Printed name of elector8_10
- Full residential address street numbernamecity8_10
- Postal code8_10
- Elector signature8_10
- Witness initials8_10
- Internal use only8_10
- Printed name of elector9_10
- Full residential address street numbernamecity9_10
- Postal code9_10
- Elector signature9_10
- Witness initials9_10
- Internal use only9_10
- Printed name of elector10_10
- Full residential address street numbernamecity10_10
- Postal code10_10
- Elector signature10_10
- Witness initials10_10
- Internal use only10_10
- Printed name of elector1_11
- Full residential address street numbernamecity1_11
- Postal code1_11
- Elector signature1_11
- Witness initials1_11
- Internal use only1_11
- Printed name of elector2_11
- Full residential address street numbernamecity2_11
- Postal code2_11
- Elector signature2_11
- Witness initials2_11
- Internal use only2_11
- Printed name of elector3_11
- Full residential address street numbernamecity3_11
- Postal code3_11
- Elector signature3_11
- Witness initials3_11
- Internal use only3_11
- Printed name of elector4_11
- Full residential address street numbernamecity4_11
- Postal code4_11
- Elector signature4_11
- Witness initials4_11
- Internal use only4_11
- Printed name of elector5_11
- Full residential address street numbernamecity5_11
- Postal code5_11
- Elector signature5_11
- Witness initials5_11
- Internal use only5_11
- Printed name of elector6_11
- Full residential address street numbernamecity6_11
- Postal code6_11
- Elector signature6_11
- Witness initials6_11
- Internal use only6_11
- Printed name of elector7_11
- Full residential address street numbernamecity7_11
- Postal code7_11
- Elector signature7_11
- Witness initials7_11
- Internal use only7_11
- Printed name of elector8_11
- Full residential address street numbernamecity8_11
- Postal code8_11
- Elector signature8_11
- Witness initials8_11
- Internal use only8_11
- Printed name of elector9_11
- Full residential address street numbernamecity9_11
- Postal code9_11
- Elector signature9_11
- Witness initials9_11
- Internal use only9_11
- Printed name of elector10_11
- Full residential address street numbernamecity10_11
- Postal code10_11
- Elector signature10_11
- Witness initials10_11
- Internal use only10_11
- Printed name of elector1_12
- Full residential address street numbernamecity1_12
- Postal code1_12
- Elector signature1_12
- Witness initials1_12
- Internal use only1_12
- Printed name of elector2_12
- Full residential address street numbernamecity2_12
- Postal code2_12
- Elector signature2_12
- Witness initials2_12
- Internal use only2_12
- Printed name of elector3_12
- Full residential address street numbernamecity3_12
- Postal code3_12
- Elector signature3_12
- Witness initials3_12
- Internal use only3_12
- Printed name of elector4_12
- Full residential address street numbernamecity4_12
- Postal code4_12
- Elector signature4_12
- Witness initials4_12
- Internal use only4_12
- Printed name of elector5_12
- Full residential address street numbernamecity5_12
- Postal code5_12
- Elector signature5_12
- Witness initials5_12
- Internal use only5_12
- Printed name of elector6_12
- Full residential address street numbernamecity6_12
- Postal code6_12
- Elector signature6_12
- Witness initials6_12
- Internal use only6_12
- Printed name of elector7_12
- Full residential address street numbernamecity7_12
- Postal code7_12
- Elector signature7_12
- Witness initials7_12
- Internal use only7_12
- Printed name of elector8_12
- Full residential address street numbernamecity8_12
- Postal code8_12
- Elector signature8_12
- Witness initials8_12
- Internal use only8_12
- Printed name of elector9_12
- Full residential address street numbernamecity9_12
- Postal code9_12
- Elector signature9_12
- Witness initials9_12
- Internal use only9_12
- Printed name of elector10_12
- Full residential address street numbernamecity10_12
- Postal code10_12
- Elector signature10_12
- Witness initials10_12
- Internal use only10_12
- Printed name of elector1_13
- Full residential address street numbernamecity1_13
- Postal code1_13
- Elector signature1_13
- Witness initials1_13
- Internal use only1_13
- Printed name of elector2_13
- Full residential address street numbernamecity2_13
- Postal code2_13
- Elector signature2_13
- Witness initials2_13
- Internal use only2_13
- Printed name of elector3_13
- Full residential address street numbernamecity3_13
- Postal code3_13
- Elector signature3_13
- Witness initials3_13
- Internal use only3_13
- Printed name of elector4_13
- Full residential address street numbernamecity4_13
- Postal code4_13
- Elector signature4_13
- Witness initials4_13
- Internal use only4_13
- Printed name of elector5_13
- Full residential address street numbernamecity5_13
- Postal code5_13
- Elector signature5_13
- Witness initials5_13
- Internal use only5_13
- Printed name of elector6_13
- Full residential address street numbernamecity6_13
- Postal code6_13
- Elector signature6_13
- Witness initials6_13
- Internal use only6_13
- Printed name of elector7_13
- Full residential address street numbernamecity7_13
- Postal code7_13
- Elector signature7_13
- Witness initials7_13
- Internal use only7_13
- Printed name of elector8_13
- Full residential address street numbernamecity8_13
- Postal code8_13
- Elector signature8_13
- Witness initials8_13
- Internal use only8_13
- Printed name of elector9_13
- Full residential address street numbernamecity9_13
- Postal code9_13
- Elector signature9_13
- Witness initials9_13
- Internal use only9_13
- Printed name of elector10_13
- Full residential address street numbernamecity10_13
- Postal code10_13
- Elector signature10_13
- Witness initials10_13
- Internal use only10_13
- Printed name of elector1_14
- Full residential address street numbernamecity1_14
- Postal code1_14
- Elector signature1_14
- Witness initials1_14
- Internal use only1_14
- Printed name of elector2_14
- Full residential address street numbernamecity2_14
- Postal code2_14
- Elector signature2_14
- Witness initials2_14
- Internal use only2_14
- Printed name of elector3_14
- Full residential address street numbernamecity3_14
- Postal code3_14
- Elector signature3_14
- Witness initials3_14
- Internal use only3_14
- Printed name of elector4_14
- Full residential address street numbernamecity4_14
- Postal code4_14
- Elector signature4_14
- Witness initials4_14
- Internal use only4_14
- Printed name of elector5_14
- Full residential address street numbernamecity5_14
- Postal code5_14
- Elector signature5_14
- Witness initials5_14
- Internal use only5_14
- Printed name of elector6_14
- Full residential address street numbernamecity6_14
- Postal code6_14
- Elector signature6_14
- Witness initials6_14
- Internal use only6_14
- Printed name of elector7_14
- Full residential address street numbernamecity7_14
- Postal code7_14
- Elector signature7_14
- Witness initials7_14
- Internal use only7_14
- Printed name of elector8_14
- Full residential address street numbernamecity8_14
- Postal code8_14
- Elector signature8_14
- Witness initials8_14
- Internal use only8_14
- Printed name of elector9_14
- Full residential address street numbernamecity9_14
- Postal code9_14
- Elector signature9_14
- Witness initials9_14
- Internal use only9_14
- Printed name of elector10_14
- Full residential address street numbernamecity10_14
- Postal code10_14
- Elector signature10_14
- Witness initials10_14
- Internal use only10_14
- Printed name of elector1_15
- Full residential address street numbernamecity1_15
- Postal code1_15
- Elector signature1_15
- Witness initials1_15
- Internal use only1_15
- Printed name of elector2_15
- Full residential address street numbernamecity2_15
- Postal code2_15
- Elector signature2_15
- Witness initials2_15
- Internal use only2_15
- Printed name of elector3_15
- Full residential address street numbernamecity3_15
- Postal code3_15
- Elector signature3_15
- Witness initials3_15
- Internal use only3_15
- Printed name of elector4_15
- Full residential address street numbernamecity4_15
- Postal code4_15
- Elector signature4_15
- Witness initials4_15
- Internal use only4_15
- Printed name of elector5_15
- Full residential address street numbernamecity5_15
- Postal code5_15
- Elector signature5_15
- Witness initials5_15
- Internal use only5_15
- Printed name of elector6_15
- Full residential address street numbernamecity6_15
- Postal code6_15
- Elector signature6_15
- Witness initials6_15
- Internal use only6_15
- Printed name of elector7_15
- Full residential address street numbernamecity7_15
- Postal code7_15
- Elector signature7_15
- Witness initials7_15
- Internal use only7_15
- Printed name of elector8_15
- Full residential address street numbernamecity8_15
- Postal code8_15
- Elector signature8_15
- Witness initials8_15
- Internal use only8_15
- Printed name of elector9_15
- Full residential address street numbernamecity9_15
- Postal code9_15
- Elector signature9_15
- Witness initials9_15
- Internal use only9_15
- Printed name of elector10_15
- Full residential address street numbernamecity10_15
- Postal code10_15
- Elector signature10_15
- Witness initials10_15
- Internal use only10_15
- Printed name of elector1_16
- Full residential address street numbernamecity1_16
- Postal code1_16
- Elector signature1_16
- Witness initials1_16
- Internal use only1_16
- Printed name of elector2_16
- Full residential address street numbernamecity2_16
- Postal code2_16
- Elector signature2_16
- Witness initials2_16
- Internal use only2_16
- Printed name of elector3_16
- Full residential address street numbernamecity3_16
- Postal code3_16
- Elector signature3_16
- Witness initials3_16
- Internal use only3_16
- Printed name of elector4_16
- Full residential address street numbernamecity4_16
- Postal code4_16
- Elector signature4_16
- Witness initials4_16
- Internal use only4_16
- Printed name of elector5_16
- Full residential address street numbernamecity5_16
- Postal code5_16
- Elector signature5_16
- Witness initials5_16
- Internal use only5_16
- Printed name of elector6_16
- Full residential address street numbernamecity6_16
- Postal code6_16
- Elector signature6_16
- Witness initials6_16
- Internal use only6_16
- Printed name of elector7_16
- Full residential address street numbernamecity7_16
- Postal code7_16
- Elector signature7_16
- Witness initials7_16
- Internal use only7_16
- Printed name of elector8_16
- Full residential address street numbernamecity8_16
- Postal code8_16
- Elector signature8_16
- Witness initials8_16
- Internal use only8_16
- Printed name of elector9_16
- Full residential address street numbernamecity9_16
- Postal code9_16
- Elector signature9_16
- Witness initials9_16
- Internal use only9_16
- Printed name of elector10_16
- Full residential address street numbernamecity10_16
- Postal code10_16
- Elector signature10_16
- Witness initials10_16
- Internal use only10_16
- Have you completed the Nomination Paper EC 20010 Off
- Do you have authorized proof of identify Off
- Are you endorsed by a political party Off
- Have you made a nomination appointment Off
- Last name - Candidate Name
- First name - Candidate Name
- Name of electoral district- Candidate Information
- First name - Candidate Information
- Last name - Candidate Information
- Ballot Name Off
- Ballot First name(s)
- Ballot Last name(s)
- Gender -Candidate information
- Date of birth (YYY-MM-DD) - Gender -Candidate information
- language of correspondence - Candidate information Off
- Email -Contact information
- Primary phone number - Contact information
- Ext - Primary phone number
- Alternate phone number - Contact information
- Ext - Alternate phone number
- Fax number- Alternate phone number
- Unit -Residential address
- Street -Residential address
- Street name -Residential address
- City -Residential address
- ProvinceTerritory -Residential address
- Postal code - -Residential address
- Mailing address - same as residential address Off
- Occupation- Candidate occupation
- Sharing of information with the Conflict of Interest and Ethics Commissioner and the House of Commons including the Library of Parliament Off
- where applicable if the returning officer is unable to verify that I have been endorsed by the political party identified in section A of this Nomination Paper I wish to Off
- Date of Signature (YYYY-MM-DD) - Candidate signature
- Date of Signature (YYYY-MM-DD) -Signature of person receiving the solemn declaration
- Campaign delegate information
- First name - Campaign delegate information
- Last name - Campaign delegate information
- Language of correspondence - Campaign delegate information Off
- Email - Contact information -Campaign Delegate
- Primary phone number - Contact information -Campaign Delegate
- Primary phone number EXT - Contact information -Campaign Delegate
- Alternate phone number - Contact information -Campaign Delegate
- Alternate phone number EXT - Contact information -Campaign Delegate
- Fax nmuber- Contact information -Campaign Delegate
- Street - Residential address -Campaign delegate
- Street name - Residential address -Campaign delegate
- City - Residential address -Campaign delegate
- ProvinceTerritory - Residential address -Campaign delegate
- Postal Code - Residential address -Campaign delegate
- Campaign delegate - Mailing address ndash Same as residential address Off
- Unit - Residential address -Campaign delegate
- Date (YYYY-MM-DD) - Candidate authorization Signature
- Date (YYYY-MM-DD) - Candidate campaign Signature
- First name - Official agent information
- Last name - Official agent information
- Language of correspondence - Official agent information Off
- Email - Official agent information
- Primary phone number - Official agent information
- Primary phone number EXT - Official agent information
- Alternate phone number EXT - Official agent information
- Alternate phone number - Official agent information
- Fax number - Official agent information
- Unit -Residential address - Official Agent
- Street name -Residential address - Official Agent
- City -Residential address - Official Agent
- Street -Residential address - Official Agent
- ProvinceTerritory -Residential address - Official Agent
- Postal code-Residential address - Official Agent
- Mailing address ndash Same as residential address- Official Agent Off
- Date (YYYY-MM-DD) - Official agent signature
- First name - Auditor information
- Last name - Auditor information
- Language of correspondence - Auditor information Off
- Email - Auditor information
- Primary phone number - Auditor information
- Primary phone number EXT- Auditor information
- Alternate phone number - Auditor information
- Alternate phone number EXT- Auditor information
- Fax number - Auditor information
- Name of firm- Auditor organizational information
- Occupation of auditor - Auditor organizational information
- Professional designation - Auditor organizational information Off
- Designation registration number
- Make cheque payable to
- Unit - Address (where cheque is sent)
- Street - Address (where cheque is sent)
- Street name - Address (where cheque is sent)
- City - Address (where cheque is sent)
- ProvinceTerritory - Address (where cheque is sent)
- Postal code - Address (where cheque is sent)
- Date (YYY-MM-DD) - Auditor signature
- Unit - Campaign office address (optional)
- Street - Campaign office address (optional)
- Street name - Campaign office address (optional)
- City - Campaign office address (optional)
- ProvinceTerritory- Campaign office address (optional)
- Postal code - Campaign office address (optional)
- Name of witness
- Full address of witness
- Name of candidate
- Electoral district
- Year
- Name of candidate2
- Electoral district2
- Year2
- Name of witness2
- Full address of witness2
- Name of candidate3
- Electoral district3
- Year3
- Full address of witness3
- Name of witness3
- Name of candidate 4
- Electoral district4
- Year4
- Full address of witness 4
- Name of witness 4
- Name of candidate5
- Electoral district5
- Year5
- Full address of witness5
- Name of witness5
- Name of candidate6
- Electoral district6
- Year6
- Name of witness6
- Full address of witness6
- Name of candidate7
- Electoral district7
- Year7
- Full address of witness7
- Name of witness7
- Name of candidate8
- Electoral district8
- Year8
- Full address of witness8
- Name of witness8
- Name of candidate9
- Electoral district9
- Year9
- Full address of witness 9
- Name of witness 9
- Name of candidate10
- Electoral district10
- Year10
- Full address of witness10
- Name of witness10
- Name of candidate11
- Electoral district11
- Year11
- Full address of witness11
- Name of witness11
- Name of candidate12
- Electoral district12
- Year12
- Full address of witness12
- Name of witness12
- Name of candidate13
- Electoral district13
- Year13
- Full address of witness13
- Name of witness13
- Name of candidate14
- Electoral district14
- Year14
- Name of witness14
- Full address of witness14
- Name of candidate1
- Electoral district1
- Year1
- Name of witness1
- Full address of witness1
- Name of candidate15
- Electoral district15
- Year15
- Name of witness15
- Full address of witness15
- unit -Mailing address
- Street -Mailing address
- Street name -Mailing address
- City -Mailing address
- ProvinceTerritory -Mailing address
- Postal code -Mailing address
- Unit - Mailing address -Campaign delegate
- Street - Mailing address -Campaign delegate
- Street name - Mailing address -Campaign delegate
- City - Mailing address -Campaign delegate
- ProvinceTerritory- Mailing address -Campaign delegate
- Postal code- Mailing address -Campaign delegate
- Unit -Mailing address - Official Agent
- Street -Mailing address - Official Agent
- Street name -Mailing address - Official Agent
- city -Mailing address - Official Agent
- ProvinceTerritory-Mailing address - Official Agent
- Postal code-Mailing address - Official Agent
EC 20010 (022019)
SECTION G ndash 23B Are You Ready to Submit Your Nomination
Have you completed the Nomination Paper (EC 20010)
bull Are all mandatory fields in sections AndashE complete
bull Have you collected the required number of signatures from qualified electors in section F
o For most electoral districts 100 electors must consent to your candidacy
o For electoral districts identified in Schedule 3 only 50 electors are required
o To ensure a smooth nomination process Elections Canada recommends collecting signatures from at least 150 electors
Do you have authorized proof of identify
bull For a list of authorized identification visit the Elections Canada website
bull If a campaign delegate is submitting on your behalf they must bring a copy of your identification documents signed by you
bull If you want an alternative name to appear on the ballot additional documentation is required visit electionsca for details
Are you endorsed by a political party
bull Make sure your party has submitted the required documentation to Elections Canada attesting your designated political affiliation
Have you made a nomination appointment
bull To facilitate the nomination process make an appointment with the returning officer to finalize the filing of the complete nomination package
bull The nomination period closes 21 days before election day at 200 pm local time
31
- Nomination Paperof a Candidate at a Federal General Election or By-election
- Table of Contents
- General Information
- SECTION A ndash Candidate Information (Mandatory)
- SECTION B ndash Campaign Delegate (Optional)
- SECTION C ndash Official Agent (Mandatory)
- SECTION D ndash Auditor (Optional)
- SECTION E ndash Campaign Office (Optional)
- SECTION F ndash Electors Consenting to Candidacy (Mandatory)
-
- Name of electoral district
- Political affiliation
- Telephone number to be posted on electionsca
- Website to be posted on electionsca including prefix http https
- Printed name of elector1
- Full residential address street numbernamecity1
- Postal code1
- Elector signature1
- Witness initials1
- Internal use only1
- Printed name of elector2
- Full residential address street numbernamecity2
- Postal code2
- Elector signature2
- Witness initials2
- Internal use only2
- Printed name of elector3
- Full residential address street numbernamecity3
- Postal code3
- Elector signature3
- Witness initials3
- Internal use only3
- Printed name of elector4
- Full residential address street numbernamecity4
- Postal code4
- Elector signature4
- Witness initials4
- Internal use only4
- Printed name of elector5
- Full residential address street numbernamecity5
- Postal code5
- Elector signature5
- Witness initials5
- Internal use only5
- Printed name of elector6
- Full residential address street numbernamecity6
- Postal code6
- Elector signature6
- Witness initials6
- Internal use only6
- Printed name of elector7
- Full residential address street numbernamecity7
- Postal code7
- Elector signature7
- Witness initials7
- Internal use only7
- Printed name of elector8
- Full residential address street numbernamecity8
- Postal code8
- Elector signature8
- Witness initials8
- Internal use only8
- Printed name of elector9
- Full residential address street numbernamecity9
- Postal code9
- Elector signature9
- Witness initials9
- Internal use only9
- Printed name of elector10
- Full residential address street numbernamecity10
- Postal code10
- Elector signature10
- Witness initials10
- Internal use only10
- Printed name of elector1_2
- Full residential address street numbernamecity1_2
- Postal code1_2
- Elector signature1_2
- Witness initials1_2
- Internal use only1_2
- Printed name of elector2_2
- Full residential address street numbernamecity2_2
- Postal code2_2
- Elector signature2_2
- Witness initials2_2
- Internal use only2_2
- Printed name of elector3_2
- Full residential address street numbernamecity3_2
- Postal code3_2
- Elector signature3_2
- Witness initials3_2
- Internal use only3_2
- Printed name of elector4_2
- Full residential address street numbernamecity4_2
- Postal code4_2
- Elector signature4_2
- Witness initials4_2
- Internal use only4_2
- Printed name of elector5_2
- Full residential address street numbernamecity5_2
- Postal code5_2
- Elector signature5_2
- Witness initials5_2
- Internal use only5_2
- Printed name of elector6_2
- Full residential address street numbernamecity6_2
- Postal code6_2
- Elector signature6_2
- Witness initials6_2
- Internal use only6_2
- Printed name of elector7_2
- Full residential address street numbernamecity7_2
- Postal code7_2
- Elector signature7_2
- Witness initials7_2
- Internal use only7_2
- Printed name of elector8_2
- Full residential address street numbernamecity8_2
- Postal code8_2
- Elector signature8_2
- Witness initials8_2
- Internal use only8_2
- Printed name of elector9_2
- Full residential address street numbernamecity9_2
- Postal code9_2
- Elector signature9_2
- Witness initials9_2
- Internal use only9_2
- Printed name of elector10_2
- Full residential address street numbernamecity10_2
- Postal code10_2
- Elector signature10_2
- Witness initials10_2
- Internal use only10_2
- Printed name of elector1_3
- Full residential address street numbernamecity1_3
- Postal code1_3
- Elector signature1_3
- Witness initials1_3
- Internal use only1_3
- Printed name of elector2_3
- Full residential address street numbernamecity2_3
- Postal code2_3
- Elector signature2_3
- Witness initials2_3
- Internal use only2_3
- Printed name of elector3_3
- Full residential address street numbernamecity3_3
- Postal code3_3
- Elector signature3_3
- Witness initials3_3
- Internal use only3_3
- Printed name of elector4_3
- Full residential address street numbernamecity4_3
- Postal code4_3
- Elector signature4_3
- Witness initials4_3
- Internal use only4_3
- Printed name of elector5_3
- Full residential address street numbernamecity5_3
- Postal code5_3
- Elector signature5_3
- Witness initials5_3
- Internal use only5_3
- Printed name of elector6_3
- Full residential address street numbernamecity6_3
- Postal code6_3
- Elector signature6_3
- Witness initials6_3
- Internal use only6_3
- Printed name of elector7_3
- Full residential address street numbernamecity7_3
- Postal code7_3
- Elector signature7_3
- Witness initials7_3
- Internal use only7_3
- Printed name of elector8_3
- Full residential address street numbernamecity8_3
- Postal code8_3
- Elector signature8_3
- Witness initials8_3
- Internal use only8_3
- Printed name of elector9_3
- Full residential address street numbernamecity9_3
- Postal code9_3
- Elector signature9_3
- Witness initials9_3
- Internal use only9_3
- Printed name of elector10_3
- Full residential address street numbernamecity10_3
- Postal code10_3
- Elector signature10_3
- Witness initials10_3
- Internal use only10_3
- Printed name of elector1_4
- Full residential address street numbernamecity1_4
- Postal code1_4
- Elector signature1_4
- Witness initials1_4
- Internal use only1_4
- Printed name of elector2_4
- Full residential address street numbernamecity2_4
- Postal code2_4
- Elector signature2_4
- Witness initials2_4
- Internal use only2_4
- Printed name of elector3_4
- Full residential address street numbernamecity3_4
- Postal code3_4
- Elector signature3_4
- Witness initials3_4
- Internal use only3_4
- Printed name of elector4_4
- Full residential address street numbernamecity4_4
- Postal code4_4
- Elector signature4_4
- Witness initials4_4
- Internal use only4_4
- Printed name of elector5_4
- Full residential address street numbernamecity5_4
- Postal code5_4
- Elector signature5_4
- Witness initials5_4
- Internal use only5_4
- Printed name of elector6_4
- Full residential address street numbernamecity6_4
- Postal code6_4
- Elector signature6_4
- Witness initials6_4
- Internal use only6_4
- Printed name of elector7_4
- Full residential address street numbernamecity7_4
- Postal code7_4
- Elector signature7_4
- Witness initials7_4
- Internal use only7_4
- Printed name of elector8_4
- Full residential address street numbernamecity8_4
- Postal code8_4
- Elector signature8_4
- Witness initials8_4
- Internal use only8_4
- Printed name of elector9_4
- Full residential address street numbernamecity9_4
- Postal code9_4
- Elector signature9_4
- Witness initials9_4
- Internal use only9_4
- Printed name of elector10_4
- Full residential address street numbernamecity10_4
- Postal code10_4
- Elector signature10_4
- Witness initials10_4
- Internal use only10_4
- Printed name of elector1_5
- Full residential address street numbernamecity1_5
- Postal code1_5
- Elector signature1_5
- Witness initials1_5
- Internal use only1_5
- Printed name of elector2_5
- Full residential address street numbernamecity2_5
- Postal code2_5
- Elector signature2_5
- Witness initials2_5
- Internal use only2_5
- Printed name of elector3_5
- Full residential address street numbernamecity3_5
- Postal code3_5
- Elector signature3_5
- Witness initials3_5
- Internal use only3_5
- Printed name of elector4_5
- Full residential address street numbernamecity4_5
- Postal code4_5
- Elector signature4_5
- Witness initials4_5
- Internal use only4_5
- Printed name of elector5_5
- Full residential address street numbernamecity5_5
- Postal code5_5
- Elector signature5_5
- Witness initials5_5
- Internal use only5_5
- Printed name of elector6_5
- Full residential address street numbernamecity6_5
- Postal code6_5
- Elector signature6_5
- Witness initials6_5
- Internal use only6_5
- Printed name of elector7_5
- Full residential address street numbernamecity7_5
- Postal code7_5
- Elector signature7_5
- Witness initials7_5
- Internal use only7_5
- Printed name of elector8_5
- Full residential address street numbernamecity8_5
- Postal code8_5
- Elector signature8_5
- Witness initials8_5
- Internal use only8_5
- Printed name of elector9_5
- Full residential address street numbernamecity9_5
- Postal code9_5
- Elector signature9_5
- Witness initials9_5
- Internal use only9_5
- Printed name of elector10_5
- Full residential address street numbernamecity10_5
- Postal code10_5
- Elector signature10_5
- Witness initials10_5
- Internal use only10_5
- Printed name of elector1_6
- Full residential address street numbernamecity1_6
- Postal code1_6
- Elector signature1_6
- Witness initials1_6
- Internal use only1_6
- Printed name of elector2_6
- Full residential address street numbernamecity2_6
- Postal code2_6
- Elector signature2_6
- Witness initials2_6
- Internal use only2_6
- Printed name of elector3_6
- Full residential address street numbernamecity3_6
- Postal code3_6
- Elector signature3_6
- Witness initials3_6
- Internal use only3_6
- Printed name of elector4_6
- Full residential address street numbernamecity4_6
- Postal code4_6
- Elector signature4_6
- Witness initials4_6
- Internal use only4_6
- Printed name of elector5_6
- Full residential address street numbernamecity5_6
- Postal code5_6
- Elector signature5_6
- Witness initials5_6
- Internal use only5_6
- Printed name of elector6_6
- Full residential address street numbernamecity6_6
- Postal code6_6
- Elector signature6_6
- Witness initials6_6
- Internal use only6_6
- Printed name of elector7_6
- Full residential address street numbernamecity7_6
- Postal code7_6
- Elector signature7_6
- Witness initials7_6
- Internal use only7_6
- Printed name of elector8_6
- Full residential address street numbernamecity8_6
- Postal code8_6
- Elector signature8_6
- Witness initials8_6
- Internal use only8_6
- Printed name of elector9_6
- Full residential address street numbernamecity9_6
- Postal code9_6
- Elector signature9_6
- Witness initials9_6
- Internal use only9_6
- Printed name of elector10_6
- Full residential address street numbernamecity10_6
- Postal code10_6
- Elector signature10_6
- Witness initials10_6
- Internal use only10_6
- Printed name of elector1_7
- Full residential address street numbernamecity1_7
- Postal code1_7
- Elector signature1_7
- Witness initials1_7
- Internal use only1_7
- Printed name of elector2_7
- Full residential address street numbernamecity2_7
- Postal code2_7
- Elector signature2_7
- Witness initials2_7
- Internal use only2_7
- Printed name of elector3_7
- Full residential address street numbernamecity3_7
- Postal code3_7
- Elector signature3_7
- Witness initials3_7
- Internal use only3_7
- Printed name of elector4_7
- Full residential address street numbernamecity4_7
- Postal code4_7
- Elector signature4_7
- Witness initials4_7
- Internal use only4_7
- Printed name of elector5_7
- Full residential address street numbernamecity5_7
- Postal code5_7
- Elector signature5_7
- Witness initials5_7
- Internal use only5_7
- Printed name of elector6_7
- Full residential address street numbernamecity6_7
- Postal code6_7
- Elector signature6_7
- Witness initials6_7
- Internal use only6_7
- Printed name of elector7_7
- Full residential address street numbernamecity7_7
- Postal code7_7
- Elector signature7_7
- Witness initials7_7
- Internal use only7_7
- Printed name of elector8_7
- Full residential address street numbernamecity8_7
- Postal code8_7
- Elector signature8_7
- Witness initials8_7
- Internal use only8_7
- Printed name of elector9_7
- Full residential address street numbernamecity9_7
- Postal code9_7
- Elector signature9_7
- Witness initials9_7
- Internal use only9_7
- Printed name of elector10_7
- Full residential address street numbernamecity10_7
- Postal code10_7
- Elector signature10_7
- Witness initials10_7
- Internal use only10_7
- Printed name of elector1_8
- Full residential address street numbernamecity1_8
- Postal code1_8
- Elector signature1_8
- Witness initials1_8
- Internal use only1_8
- Printed name of elector2_8
- Full residential address street numbernamecity2_8
- Postal code2_8
- Elector signature2_8
- Witness initials2_8
- Internal use only2_8
- Printed name of elector3_8
- Full residential address street numbernamecity3_8
- Postal code3_8
- Elector signature3_8
- Witness initials3_8
- Internal use only3_8
- Printed name of elector4_8
- Full residential address street numbernamecity4_8
- Postal code4_8
- Elector signature4_8
- Witness initials4_8
- Internal use only4_8
- Printed name of elector5_8
- Full residential address street numbernamecity5_8
- Postal code5_8
- Elector signature5_8
- Witness initials5_8
- Internal use only5_8
- Printed name of elector6_8
- Full residential address street numbernamecity6_8
- Postal code6_8
- Elector signature6_8
- Witness initials6_8
- Internal use only6_8
- Printed name of elector7_8
- Full residential address street numbernamecity7_8
- Postal code7_8
- Elector signature7_8
- Witness initials7_8
- Internal use only7_8
- Printed name of elector8_8
- Full residential address street numbernamecity8_8
- Postal code8_8
- Elector signature8_8
- Witness initials8_8
- Internal use only8_8
- Printed name of elector9_8
- Full residential address street numbernamecity9_8
- Postal code9_8
- Elector signature9_8
- Witness initials9_8
- Internal use only9_8
- Printed name of elector10_8
- Full residential address street numbernamecity10_8
- Postal code10_8
- Elector signature10_8
- Witness initials10_8
- Internal use only10_8
- Printed name of elector1_9
- Full residential address street numbernamecity1_9
- Postal code1_9
- Elector signature1_9
- Witness initials1_9
- Internal use only1_9
- Printed name of elector2_9
- Full residential address street numbernamecity2_9
- Postal code2_9
- Elector signature2_9
- Witness initials2_9
- Internal use only2_9
- Printed name of elector3_9
- Full residential address street numbernamecity3_9
- Postal code3_9
- Elector signature3_9
- Witness initials3_9
- Internal use only3_9
- Printed name of elector4_9
- Full residential address street numbernamecity4_9
- Postal code4_9
- Elector signature4_9
- Witness initials4_9
- Internal use only4_9
- Printed name of elector5_9
- Full residential address street numbernamecity5_9
- Postal code5_9
- Elector signature5_9
- Witness initials5_9
- Internal use only5_9
- Printed name of elector6_9
- Full residential address street numbernamecity6_9
- Postal code6_9
- Elector signature6_9
- Witness initials6_9
- Internal use only6_9
- Printed name of elector7_9
- Full residential address street numbernamecity7_9
- Postal code7_9
- Elector signature7_9
- Witness initials7_9
- Internal use only7_9
- Printed name of elector8_9
- Full residential address street numbernamecity8_9
- Postal code8_9
- Elector signature8_9
- Witness initials8_9
- Internal use only8_9
- Printed name of elector9_9
- Full residential address street numbernamecity9_9
- Postal code9_9
- Elector signature9_9
- Witness initials9_9
- Internal use only9_9
- Printed name of elector10_9
- Full residential address street numbernamecity10_9
- Postal code10_9
- Elector signature10_9
- Witness initials10_9
- Internal use only10_9
- Printed name of elector1_10
- Full residential address street numbernamecity1_10
- Postal code1_10
- Elector signature1_10
- Witness initials1_10
- Internal use only1_10
- Printed name of elector2_10
- Full residential address street numbernamecity2_10
- Postal code2_10
- Elector signature2_10
- Witness initials2_10
- Internal use only2_10
- Printed name of elector3_10
- Full residential address street numbernamecity3_10
- Postal code3_10
- Elector signature3_10
- Witness initials3_10
- Internal use only3_10
- Printed name of elector4_10
- Full residential address street numbernamecity4_10
- Postal code4_10
- Elector signature4_10
- Witness initials4_10
- Internal use only4_10
- Printed name of elector5_10
- Full residential address street numbernamecity5_10
- Postal code5_10
- Elector signature5_10
- Witness initials5_10
- Internal use only5_10
- Printed name of elector6_10
- Full residential address street numbernamecity6_10
- Postal code6_10
- Elector signature6_10
- Witness initials6_10
- Internal use only6_10
- Printed name of elector7_10
- Full residential address street numbernamecity7_10
- Postal code7_10
- Elector signature7_10
- Witness initials7_10
- Internal use only7_10
- Printed name of elector8_10
- Full residential address street numbernamecity8_10
- Postal code8_10
- Elector signature8_10
- Witness initials8_10
- Internal use only8_10
- Printed name of elector9_10
- Full residential address street numbernamecity9_10
- Postal code9_10
- Elector signature9_10
- Witness initials9_10
- Internal use only9_10
- Printed name of elector10_10
- Full residential address street numbernamecity10_10
- Postal code10_10
- Elector signature10_10
- Witness initials10_10
- Internal use only10_10
- Printed name of elector1_11
- Full residential address street numbernamecity1_11
- Postal code1_11
- Elector signature1_11
- Witness initials1_11
- Internal use only1_11
- Printed name of elector2_11
- Full residential address street numbernamecity2_11
- Postal code2_11
- Elector signature2_11
- Witness initials2_11
- Internal use only2_11
- Printed name of elector3_11
- Full residential address street numbernamecity3_11
- Postal code3_11
- Elector signature3_11
- Witness initials3_11
- Internal use only3_11
- Printed name of elector4_11
- Full residential address street numbernamecity4_11
- Postal code4_11
- Elector signature4_11
- Witness initials4_11
- Internal use only4_11
- Printed name of elector5_11
- Full residential address street numbernamecity5_11
- Postal code5_11
- Elector signature5_11
- Witness initials5_11
- Internal use only5_11
- Printed name of elector6_11
- Full residential address street numbernamecity6_11
- Postal code6_11
- Elector signature6_11
- Witness initials6_11
- Internal use only6_11
- Printed name of elector7_11
- Full residential address street numbernamecity7_11
- Postal code7_11
- Elector signature7_11
- Witness initials7_11
- Internal use only7_11
- Printed name of elector8_11
- Full residential address street numbernamecity8_11
- Postal code8_11
- Elector signature8_11
- Witness initials8_11
- Internal use only8_11
- Printed name of elector9_11
- Full residential address street numbernamecity9_11
- Postal code9_11
- Elector signature9_11
- Witness initials9_11
- Internal use only9_11
- Printed name of elector10_11
- Full residential address street numbernamecity10_11
- Postal code10_11
- Elector signature10_11
- Witness initials10_11
- Internal use only10_11
- Printed name of elector1_12
- Full residential address street numbernamecity1_12
- Postal code1_12
- Elector signature1_12
- Witness initials1_12
- Internal use only1_12
- Printed name of elector2_12
- Full residential address street numbernamecity2_12
- Postal code2_12
- Elector signature2_12
- Witness initials2_12
- Internal use only2_12
- Printed name of elector3_12
- Full residential address street numbernamecity3_12
- Postal code3_12
- Elector signature3_12
- Witness initials3_12
- Internal use only3_12
- Printed name of elector4_12
- Full residential address street numbernamecity4_12
- Postal code4_12
- Elector signature4_12
- Witness initials4_12
- Internal use only4_12
- Printed name of elector5_12
- Full residential address street numbernamecity5_12
- Postal code5_12
- Elector signature5_12
- Witness initials5_12
- Internal use only5_12
- Printed name of elector6_12
- Full residential address street numbernamecity6_12
- Postal code6_12
- Elector signature6_12
- Witness initials6_12
- Internal use only6_12
- Printed name of elector7_12
- Full residential address street numbernamecity7_12
- Postal code7_12
- Elector signature7_12
- Witness initials7_12
- Internal use only7_12
- Printed name of elector8_12
- Full residential address street numbernamecity8_12
- Postal code8_12
- Elector signature8_12
- Witness initials8_12
- Internal use only8_12
- Printed name of elector9_12
- Full residential address street numbernamecity9_12
- Postal code9_12
- Elector signature9_12
- Witness initials9_12
- Internal use only9_12
- Printed name of elector10_12
- Full residential address street numbernamecity10_12
- Postal code10_12
- Elector signature10_12
- Witness initials10_12
- Internal use only10_12
- Printed name of elector1_13
- Full residential address street numbernamecity1_13
- Postal code1_13
- Elector signature1_13
- Witness initials1_13
- Internal use only1_13
- Printed name of elector2_13
- Full residential address street numbernamecity2_13
- Postal code2_13
- Elector signature2_13
- Witness initials2_13
- Internal use only2_13
- Printed name of elector3_13
- Full residential address street numbernamecity3_13
- Postal code3_13
- Elector signature3_13
- Witness initials3_13
- Internal use only3_13
- Printed name of elector4_13
- Full residential address street numbernamecity4_13
- Postal code4_13
- Elector signature4_13
- Witness initials4_13
- Internal use only4_13
- Printed name of elector5_13
- Full residential address street numbernamecity5_13
- Postal code5_13
- Elector signature5_13
- Witness initials5_13
- Internal use only5_13
- Printed name of elector6_13
- Full residential address street numbernamecity6_13
- Postal code6_13
- Elector signature6_13
- Witness initials6_13
- Internal use only6_13
- Printed name of elector7_13
- Full residential address street numbernamecity7_13
- Postal code7_13
- Elector signature7_13
- Witness initials7_13
- Internal use only7_13
- Printed name of elector8_13
- Full residential address street numbernamecity8_13
- Postal code8_13
- Elector signature8_13
- Witness initials8_13
- Internal use only8_13
- Printed name of elector9_13
- Full residential address street numbernamecity9_13
- Postal code9_13
- Elector signature9_13
- Witness initials9_13
- Internal use only9_13
- Printed name of elector10_13
- Full residential address street numbernamecity10_13
- Postal code10_13
- Elector signature10_13
- Witness initials10_13
- Internal use only10_13
- Printed name of elector1_14
- Full residential address street numbernamecity1_14
- Postal code1_14
- Elector signature1_14
- Witness initials1_14
- Internal use only1_14
- Printed name of elector2_14
- Full residential address street numbernamecity2_14
- Postal code2_14
- Elector signature2_14
- Witness initials2_14
- Internal use only2_14
- Printed name of elector3_14
- Full residential address street numbernamecity3_14
- Postal code3_14
- Elector signature3_14
- Witness initials3_14
- Internal use only3_14
- Printed name of elector4_14
- Full residential address street numbernamecity4_14
- Postal code4_14
- Elector signature4_14
- Witness initials4_14
- Internal use only4_14
- Printed name of elector5_14
- Full residential address street numbernamecity5_14
- Postal code5_14
- Elector signature5_14
- Witness initials5_14
- Internal use only5_14
- Printed name of elector6_14
- Full residential address street numbernamecity6_14
- Postal code6_14
- Elector signature6_14
- Witness initials6_14
- Internal use only6_14
- Printed name of elector7_14
- Full residential address street numbernamecity7_14
- Postal code7_14
- Elector signature7_14
- Witness initials7_14
- Internal use only7_14
- Printed name of elector8_14
- Full residential address street numbernamecity8_14
- Postal code8_14
- Elector signature8_14
- Witness initials8_14
- Internal use only8_14
- Printed name of elector9_14
- Full residential address street numbernamecity9_14
- Postal code9_14
- Elector signature9_14
- Witness initials9_14
- Internal use only9_14
- Printed name of elector10_14
- Full residential address street numbernamecity10_14
- Postal code10_14
- Elector signature10_14
- Witness initials10_14
- Internal use only10_14
- Printed name of elector1_15
- Full residential address street numbernamecity1_15
- Postal code1_15
- Elector signature1_15
- Witness initials1_15
- Internal use only1_15
- Printed name of elector2_15
- Full residential address street numbernamecity2_15
- Postal code2_15
- Elector signature2_15
- Witness initials2_15
- Internal use only2_15
- Printed name of elector3_15
- Full residential address street numbernamecity3_15
- Postal code3_15
- Elector signature3_15
- Witness initials3_15
- Internal use only3_15
- Printed name of elector4_15
- Full residential address street numbernamecity4_15
- Postal code4_15
- Elector signature4_15
- Witness initials4_15
- Internal use only4_15
- Printed name of elector5_15
- Full residential address street numbernamecity5_15
- Postal code5_15
- Elector signature5_15
- Witness initials5_15
- Internal use only5_15
- Printed name of elector6_15
- Full residential address street numbernamecity6_15
- Postal code6_15
- Elector signature6_15
- Witness initials6_15
- Internal use only6_15
- Printed name of elector7_15
- Full residential address street numbernamecity7_15
- Postal code7_15
- Elector signature7_15
- Witness initials7_15
- Internal use only7_15
- Printed name of elector8_15
- Full residential address street numbernamecity8_15
- Postal code8_15
- Elector signature8_15
- Witness initials8_15
- Internal use only8_15
- Printed name of elector9_15
- Full residential address street numbernamecity9_15
- Postal code9_15
- Elector signature9_15
- Witness initials9_15
- Internal use only9_15
- Printed name of elector10_15
- Full residential address street numbernamecity10_15
- Postal code10_15
- Elector signature10_15
- Witness initials10_15
- Internal use only10_15
- Printed name of elector1_16
- Full residential address street numbernamecity1_16
- Postal code1_16
- Elector signature1_16
- Witness initials1_16
- Internal use only1_16
- Printed name of elector2_16
- Full residential address street numbernamecity2_16
- Postal code2_16
- Elector signature2_16
- Witness initials2_16
- Internal use only2_16
- Printed name of elector3_16
- Full residential address street numbernamecity3_16
- Postal code3_16
- Elector signature3_16
- Witness initials3_16
- Internal use only3_16
- Printed name of elector4_16
- Full residential address street numbernamecity4_16
- Postal code4_16
- Elector signature4_16
- Witness initials4_16
- Internal use only4_16
- Printed name of elector5_16
- Full residential address street numbernamecity5_16
- Postal code5_16
- Elector signature5_16
- Witness initials5_16
- Internal use only5_16
- Printed name of elector6_16
- Full residential address street numbernamecity6_16
- Postal code6_16
- Elector signature6_16
- Witness initials6_16
- Internal use only6_16
- Printed name of elector7_16
- Full residential address street numbernamecity7_16
- Postal code7_16
- Elector signature7_16
- Witness initials7_16
- Internal use only7_16
- Printed name of elector8_16
- Full residential address street numbernamecity8_16
- Postal code8_16
- Elector signature8_16
- Witness initials8_16
- Internal use only8_16
- Printed name of elector9_16
- Full residential address street numbernamecity9_16
- Postal code9_16
- Elector signature9_16
- Witness initials9_16
- Internal use only9_16
- Printed name of elector10_16
- Full residential address street numbernamecity10_16
- Postal code10_16
- Elector signature10_16
- Witness initials10_16
- Internal use only10_16
- Have you completed the Nomination Paper EC 20010 Off
- Do you have authorized proof of identify Off
- Are you endorsed by a political party Off
- Have you made a nomination appointment Off
- Last name - Candidate Name
- First name - Candidate Name
- Name of electoral district- Candidate Information
- First name - Candidate Information
- Last name - Candidate Information
- Ballot Name Off
- Ballot First name(s)
- Ballot Last name(s)
- Gender -Candidate information
- Date of birth (YYY-MM-DD) - Gender -Candidate information
- language of correspondence - Candidate information Off
- Email -Contact information
- Primary phone number - Contact information
- Ext - Primary phone number
- Alternate phone number - Contact information
- Ext - Alternate phone number
- Fax number- Alternate phone number
- Unit -Residential address
- Street -Residential address
- Street name -Residential address
- City -Residential address
- ProvinceTerritory -Residential address
- Postal code - -Residential address
- Mailing address - same as residential address Off
- Occupation- Candidate occupation
- Sharing of information with the Conflict of Interest and Ethics Commissioner and the House of Commons including the Library of Parliament Off
- where applicable if the returning officer is unable to verify that I have been endorsed by the political party identified in section A of this Nomination Paper I wish to Off
- Date of Signature (YYYY-MM-DD) - Candidate signature
- Date of Signature (YYYY-MM-DD) -Signature of person receiving the solemn declaration
- Campaign delegate information
- First name - Campaign delegate information
- Last name - Campaign delegate information
- Language of correspondence - Campaign delegate information Off
- Email - Contact information -Campaign Delegate
- Primary phone number - Contact information -Campaign Delegate
- Primary phone number EXT - Contact information -Campaign Delegate
- Alternate phone number - Contact information -Campaign Delegate
- Alternate phone number EXT - Contact information -Campaign Delegate
- Fax nmuber- Contact information -Campaign Delegate
- Street - Residential address -Campaign delegate
- Street name - Residential address -Campaign delegate
- City - Residential address -Campaign delegate
- ProvinceTerritory - Residential address -Campaign delegate
- Postal Code - Residential address -Campaign delegate
- Campaign delegate - Mailing address ndash Same as residential address Off
- Unit - Residential address -Campaign delegate
- Date (YYYY-MM-DD) - Candidate authorization Signature
- Date (YYYY-MM-DD) - Candidate campaign Signature
- First name - Official agent information
- Last name - Official agent information
- Language of correspondence - Official agent information Off
- Email - Official agent information
- Primary phone number - Official agent information
- Primary phone number EXT - Official agent information
- Alternate phone number EXT - Official agent information
- Alternate phone number - Official agent information
- Fax number - Official agent information
- Unit -Residential address - Official Agent
- Street name -Residential address - Official Agent
- City -Residential address - Official Agent
- Street -Residential address - Official Agent
- ProvinceTerritory -Residential address - Official Agent
- Postal code-Residential address - Official Agent
- Mailing address ndash Same as residential address- Official Agent Off
- Date (YYYY-MM-DD) - Official agent signature
- First name - Auditor information
- Last name - Auditor information
- Language of correspondence - Auditor information Off
- Email - Auditor information
- Primary phone number - Auditor information
- Primary phone number EXT- Auditor information
- Alternate phone number - Auditor information
- Alternate phone number EXT- Auditor information
- Fax number - Auditor information
- Name of firm- Auditor organizational information
- Occupation of auditor - Auditor organizational information
- Professional designation - Auditor organizational information Off
- Designation registration number
- Make cheque payable to
- Unit - Address (where cheque is sent)
- Street - Address (where cheque is sent)
- Street name - Address (where cheque is sent)
- City - Address (where cheque is sent)
- ProvinceTerritory - Address (where cheque is sent)
- Postal code - Address (where cheque is sent)
- Date (YYY-MM-DD) - Auditor signature
- Unit - Campaign office address (optional)
- Street - Campaign office address (optional)
- Street name - Campaign office address (optional)
- City - Campaign office address (optional)
- ProvinceTerritory- Campaign office address (optional)
- Postal code - Campaign office address (optional)
- Name of witness
- Full address of witness
- Name of candidate
- Electoral district
- Year
- Name of candidate2
- Electoral district2
- Year2
- Name of witness2
- Full address of witness2
- Name of candidate3
- Electoral district3
- Year3
- Full address of witness3
- Name of witness3
- Name of candidate 4
- Electoral district4
- Year4
- Full address of witness 4
- Name of witness 4
- Name of candidate5
- Electoral district5
- Year5
- Full address of witness5
- Name of witness5
- Name of candidate6
- Electoral district6
- Year6
- Name of witness6
- Full address of witness6
- Name of candidate7
- Electoral district7
- Year7
- Full address of witness7
- Name of witness7
- Name of candidate8
- Electoral district8
- Year8
- Full address of witness8
- Name of witness8
- Name of candidate9
- Electoral district9
- Year9
- Full address of witness 9
- Name of witness 9
- Name of candidate10
- Electoral district10
- Year10
- Full address of witness10
- Name of witness10
- Name of candidate11
- Electoral district11
- Year11
- Full address of witness11
- Name of witness11
- Name of candidate12
- Electoral district12
- Year12
- Full address of witness12
- Name of witness12
- Name of candidate13
- Electoral district13
- Year13
- Full address of witness13
- Name of witness13
- Name of candidate14
- Electoral district14
- Year14
- Name of witness14
- Full address of witness14
- Name of candidate1
- Electoral district1
- Year1
- Name of witness1
- Full address of witness1
- Name of candidate15
- Electoral district15
- Year15
- Name of witness15
- Full address of witness15
- unit -Mailing address
- Street -Mailing address
- Street name -Mailing address
- City -Mailing address
- ProvinceTerritory -Mailing address
- Postal code -Mailing address
- Unit - Mailing address -Campaign delegate
- Street - Mailing address -Campaign delegate
- Street name - Mailing address -Campaign delegate
- City - Mailing address -Campaign delegate
- ProvinceTerritory- Mailing address -Campaign delegate
- Postal code- Mailing address -Campaign delegate
- Unit -Mailing address - Official Agent
- Street -Mailing address - Official Agent
- Street name -Mailing address - Official Agent
- city -Mailing address - Official Agent
- ProvinceTerritory-Mailing address - Official Agent
- Postal code-Mailing address - Official Agent