AFFIDAVIT of ____________________________ (full name)

I ______________________________ (full name), residing at

__________________________________________________
______________________________________ (full address),
with the occupa�on of ______________________________,
swear that I will be vo�ng for NZ LOYAL poli�cal party, and
vo�ng for candidate ____________________________ in the
___________________________ electorate in the upcoming
New Zealand elec�ons on 14 October 2023.

Signature of the deponent:

Sworn at _______________________ this _________ day of

__________________ 2023

(Note: leave the below space blank. The person taking the affidavit will fill it in.)
Before me: