Form EC.3

OBJECTION TO NAME IN SUPPLEMENTARY LIST

To the Supervisory/Assistant Registration/Officer

Constituency

20

of

Address

Whose name appears in the Supplementary List for the above Ward hereby give notice:

That I object to the inclusion in such list of the name of

whose address is given as

on the

following grounds

(Here insert the Grounds)

I wish to produce the following witnesses

Signed

Registered Voter