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3-Ec20010 e Candidate Nomination Paper

3-Ec20010 e Candidate Nomination Paper

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Published by torontochange

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Published by: torontochange on Dec 09, 2008
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05/09/2014

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NOMINATION PAPER
OF ACANDIDATE ATAFEDERALELECTION OR BY-ELECTION
(As required under section 66 of the
Canada Elections Act 
)
TO BE FILED AFTER THE ISSUE OF THE NOTICE OF ELECTIONPURSUANTTO SUBSECTION 67(1) OF THE
CANADAELECTIONS ACT 
Please read the instructions on pages 3 and 4 carefully before completing this document.
EC 20010(10/07)
PROTECTED WHEN COMPLETED
 
CONTENTS
PageInstructions for completion of this Nomination Paper3-4Part 1 Candidate, Official Agent and Auditor1Part 2 Candidates Consent to Nomination and Designation of Official Agent and Auditor5Part 3 Declaration of Official Agent6Part 4 Oath of Witness to Consent of Candidate7Part 5 Receipt for Nomination Paper and for Deposit9Part 6 Notice of Confirmation or Refusal of Nomination11Part 7 Electors Consenting to Candidacy13-28
The Nomination Paper of a confirmedcandidate may only be disclosed in accordance with the
Canada Elections Act 
. The personal information providedis otherwise protected under the
Canada Elections Act 
and the
Privacy Act 
. The information is retained in Personal Information Bank CEO PPU 005.The Nomination Paper of a confirmed candidate must remain in the office of the returning officer at all times during the election period and maybe examined by any person during that period of time.
 
PART 1 – CANDIDATE, OFFICIALAGENT AND AUDITORPLEASE PRINT CLEARLY. The information below will be used to prepare the ballot paper and for all future correspondence.
CANDIDATE* – NAME AS IT SHOULD APPEAR ON BALLOT PAPER
(
*The candidate, the official agent and the auditor must be three different persons.)
OFFICIALAGENT*AUDITOR* (see instruction #5)
NOTE:
Information on this page will be entered into Elections Canada’s electronic databases. Information on the elected candidatemay be sent to the House of Commons. Please indicate if you consent or do not consent to Elections Canada communicating thisinformation to the House of Commons.ConsentELECTORALDISTRICT
1
Do not consentSURNAME (see instruction #2)SURNAMESURNAMEGIVEN NAME(S) (see instruction #2)
Mr.Mrs.Ms.Miss
SEXMFCorrespondenceEng.Fr.GIVEN NAME(S)GIVEN NAME(S)POLITICALAFFILIATION (see instruction #3)PERMANENTRESIDENTIALADDRESS
No.StreetApt.
PROFESSIONALDESIGNATION(e.g. CA, CGA, CMA)PERMANENTRESIDENTIALADDRESS
No.StreetApt.
CityE-MAILADDRESSE-MAILADDRESSTELEPHONE
Business( )Pager( )Residence( )Cellular( )Fax( )
TELEPHONE
Business( )Residence( )Fax( )Cellular or pager( )
INDICATE ONLYONE TELEPHONE NUMBER TO BE POSTED ON THE ELECTIONS CANADAWEB SITE BYCHECKING THE APPROPRIATE BOX (OPTIONAL)
Campaign office( )
Residence( )
Business( )
Cellular( )
E-MAILADDRESSProvincePostal codeCityProvincePostal codeCityProvincePostal codeCAMPAIGN OFFICE ADDRESS
No.StreetUnit
DATE OF BIRTH
(DD/MM/YYYY)
OCCUPATION (see instruction #4)OCCUPATION
Mr.Mrs.Ms.MissMr.Mrs.Ms.Miss
ADDRESS (where cheque is sent)
No.StreetUnit
CityProvincePostal codeMake cheque payable to:GSTRegistration No.TELEPHONE
Business( )Residence( )Fax( )Cellular or pager( )
NAME OF FIRME-MAILADDRESSCorrespondenceEng.Fr.CorrespondenceEng.Fr.FaxDESIGNATIONREGISTRATION NUMBER

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