Nomination Form

A new vision,
vote to secure
your future 2023 National Elections
TRINBARJAM ELECTIONS COMMISSION

Official Nomiation Form
INSTRUCTIONS FOR NOMINATION
The nominees are requested to take precise note of subsequent requirements while providing suitable nomination details
requested by the Trinbarjam Elections Commission.
View the commission’s website at Election Webpage.docx for more details. Nomination code: 01243020
1. This form must be submitted before April 20, 2023. Any submission after this deadline will NOT be accepted.
2. This form contains 4 sections. Only one individual (that is the candidate), contesting in the 2023 National
Elections is permitted to enter his/her personal information on this form. An eligible witness will be necessary
to complete Section D of this form.
3. Include a high-resolution head and shoulders photo of yourself where requested; “Section A- Candidate Biodata.”
4. Acknowledge all pertinent information requested in each section of this application.
5. When necessary, the Trinbarjam Elections Commission is authorized to request identity proof (s).
6. If a candidate has multiple addresses, they must provide only one address in which they commonly reside.
7. Enter appropriate information throughout the application. Failure to do so will place candidate at a great
disadvantage and may lead to their permanent expulsion in the 2023 National Election.
8. Once this application has been filled and submitted, candidate must not change any personal data until after the
elections would have concluded and your position would have been secured. Data requested to not be
changed may include: Candidate name, phone number, email and address.
9. If the candidate wishes to withdraw their application for the national elections 2023, they are permitted to
contact (+592) 219-5002 for further details concerning the cancellation of their candidacy.
10. Once completed, submit form by selecting the “Submit” option provided latter of the application. NOTE that you
will not be able to submit the form if each field required is not provided with the suitable information.
NOMINATION CODE 01243020 Copyright © 2023 Trinbarjam Elections Commission All rights reserved
01243020/NF/TEC 2023
Go on to the next page
149, Pike Street, Kitty, Georgetown

(+592) 219-5002
TrinbarjamECofficial@gmail.com
Trinbarjam Elections Commission
A new vision,
vote to secure
NOMINATION FOR ELECTION BY CANDIDATE
Section A- Candidate BIODATA
Candidate Image
Personal Data
Candidate Name Forename: Candidate forname Surname: Candidate surname
Sex Male Female Date of birth Select correct D.O.B
Country of Birth Guyana Other (Specify: Click here to specify )
Nationality Guyanese Other (Specify: Click here to specify )
Contact Information
No. Lot no. Street Name Enter the name of your street
City
Enter city/general area in which you reside Postcode Enter
Phone number (H) Enter home number (W) Enter workplace number (M) Enter personal number
Email address Enter email address here

*If candidate has more than one email or resides in multiple places, they should only enter one that is suitable for this
form. Note: Your name will be printed on the website and ballot paper as it appears here.
When/If an election is held, I would like the following information about myself to be circulated nation-wide with the
ballot paper (Strictly limited to 50 words minimum and 100 words maximum. Please note any submission over
the maximum limit would be referred back to you and would delay this process). If you do not wish to provide
any information or the submission space is left blank, your name will still go forward for the election without any
further details.

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Enter relevant information about yourself you wish to be circulated.
* This requirement is optional. However, the council strongly advises that candidates provide suitable information in
the space provided.
01243020/NF/TEC 2023
____________________________________________________________________________________________
Section B- Candidate Educational and general BACKGROUND
Institutions/ Boards/ Universities Year Graduated
Academic
1. Enter response here Type year here
achievement(s) 2. Enter response here Type year here
3. Enter response here Type year here
1. Associate Degree (e.g., AA, AS) Graduated with:
2. Bachelor’s Degree (e.g., BA, BS) Pass
Degree(s) Received 3. Master’s Degree (e.g., MA, MS, MEd) Credit

4. Professional Degree (e.g., MD, DDS, DVM) Distinction
I graduated with a GPA
5. Doctorate (e.g., PhD EdD)
score of:
1. Enter response here
Area(s) of Study 2. Enter response here Insert GPA score here
3. Enter response here
Additional information concerning candidate’s background
1. Have you acquired any special achievements, honours, and/or awards? If yes, please state the award and
the reason you would have achieved said awards. No Yes
Special achievement/s awarded:
Achievement one (1) here Achievement two (2) here Achievement three (3) here

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*If candidate has achieved any special honours, they may only list a minimum of 1 and a maximum of 3 awards.
Mention reason here:
State the achievement number, the name and begin your reason.
01243020/NF/TEC 2023
2. List any special contribution(s) you have made in your areas of study or leadership role, character and/or
service to society:
Enter your response here
3. What is the one life skill you have acquired that has been most helpful to you throughout your life and how
has it aided in your personal development?
Enter your response here
4. Have you ever been employed before? If yes, further specify details in the table provided below.
Yes, I have been employed in the past No, I have not been employed in the past

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Organization(s) Dates Job Title

1. Enter response Enter response Enter response
Employment History
Date of hire Date of hire for Job 1 Date of hire for job 2 Date of hire for job 3
Job 1 Job 2 Job 3
Qualifications for
Enter response Enter response Enter response
job(s) mentioned
01243020/NF/TEC 2023
____________________________________________________________________________________________________
Section C- CANDIDATE POLITICAL DATA
[This section entails everything that is required to be known about your specific party affiliation along
with your role in the campaign as well as your position of interests. ALL requirements are compulsory
and failure to allocate a response in the necessary spaces provided will locate you in a difficult
situation/disadvantage in the 2023 National Elections. Where there are boxes allocated to the various
options given, simply mark them appropriately with an “X” to indicate your choice. Example: ‘ ✘ ’. Ensure
all slots are filled accordingly.]
Choose your respective constituency.
North South West East North West South West East Central
Which party are you affiliated with/intend to campaign for? [ ]
Have you ever contested in the past?

Yes, I have
No, I have not

(+592) 219-5002
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Dear candidate, if you were to win the 2023 National Elections, what are 3 strategies that you would implement to
aid in the betterment of your hometown?
Strategy One (1) Strategy Two (2) Strategy Three (3)
In no more than 50 words, insert your In no more than 50 words, insert your In no more than 50 words, insert your
response. response. response.
In no more than 50 words, insert your response.
What is your main aim protesting

for your campaign?
01243020/NF/TEC 2023
__________________________________________________________________________________________________
Section d- DECLARATION
*This section necessitates that you make your declaration in the presence of a subscribing witness. If you do
not complete this, the council will not review your nomination. The witness is only allowed to enter relevant
information where requested. NOTE: Witness must be 18 years of age or older.
Statement One (1)

I, Enter forename and Surname , hereby certify that I willingly consented to provide the information requested of me
in all sections of the nomination form for the National Elections 2023, and I certify that I am eligible to campaign for
office.
DD/ MM/ YYYY
Statement Two (2)

I, Enter forename and Surname , certify that the information provided within sections A, B, C, and D of this form is
true and correct and acknowledge that, if proven otherwise, it could result in the disqualification of my candidacy.
Further, I certify that the information stated below is true.
 I am 18 years old or older
 I am a candidate of my respective constituency

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 I am not a member of the council
 I am eligible enough and a citizen of the Cooperative Republic of Guyana
 I understand that a false declaration will result in severe repercussions
 I have read the Terms and conditions associated with this form on the Commission’s webpage
DD/ MM/ YYYY
Signature of a witness
Full name Witness forename Witness middle name Witness Surname
Signature Date DD/ MM/ YYYY
Witness contact information

Email Enter email address here Mobile no. Enter personal number
01243020/NF/TEC 2023
Signature of candidate
Full name Candidate forename Candidate middle name Candidate Surname
Signature of the Chief Electoral Officer

Full name Forename Middle name Surname
Return:
Instruction Page
Section A- Candidate Biodata
Section B- Candidate Educational and General Background
Section C- Candidate Political Data
Section D- Declaration

(+592) 219-5002
A new vision,
vote to secure
Click the button below to attach your completed form to an email and then click SEND in your email client to send
your form to the Trinbarjam Elections Commission.
Submit
__________________________________________________________________________________________________
01243020/NF/TEC 2023
End of nomination form

(+592) 219-5002

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A new vision,

TRINBARJAM ELECTIONS COMMISSION

149, Pike Street, Kitty, Georgetown

NOMINATION FOR ELECTION BY CANDIDATE

Section A- Candidate BIODATA

Candidate Name Forename: Candidate forname Surname: Candidate surname

Sex Male Female Date of birth Select correct D.O.B

Country of Birth Guyana Other (Specify: Click here to specify )

Nationality Guyanese Other (Specify: Click here to specify )

Email address Enter email address here

149, Pike Street, Kitty, Georgetown

Section B- Candidate Educational and general BACKGROUND

Institutions/ Boards/ Universities Year Graduated

2. Bachelor’s Degree (e.g., BA, BS) Pass

Degree(s) Received 3. Master’s Degree (e.g., MA, MS, MEd) Credit

Additional information concerning candidate’s background

Special achievement/s awarded:

149, Pike Street, Kitty, Georgetown

Mention reason here:

Enter your response here

Enter your response here

149, Pike Street, Kitty, Georgetown

Organization(s) Dates Job Title

Section C- CANDIDATE POLITICAL DATA

Choose your respective constituency.

Which party are you affiliated with/intend to campaign for? [ ]

Have you ever contested in the past?

No, I have not

149, Pike Street, Kitty, Georgetown

In no more than 50 words, insert your response.

What is your main aim protesting

Statement One (1)

Statement Two (2)

149, Pike Street, Kitty, Georgetown

DD/ MM/ YYYY

Signature Date DD/ MM/ YYYY

Witness contact information

Signature Date DD/ MM/ YYYY

Signature of the Chief Electoral Officer

Signature Date DD/ MM/ YYYY

Section A- Candidate Biodata

Section B- Candidate Educational and General Background

Section C- Candidate Political Data

149, Pike Street, Kitty, Georgetown

149, Pike Street, Kitty, Georgetown

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