Form E

Voters’ Roll - Form E

Notice of Revocation of Corporation Appointment

City of Melbourne Act 2001, Section 9G(2)(b)

This form is to revoke a person's appointment as a voting representative of a corporation that owns or occupies a rateable property in the City of Melbourne.

Please note:

All sections must be completed, and the declaration signed for this application to be valid.

How to revoke an appointment:

Complete this form, sign and submit.

For further information or assistance please call 1300 735 427 or email elections@melbourne.vic.gov.au.

Voting in Melbourne City Council elections is compulsory for every enrolled voter.

Section 1 - Corporation details

A valid ACN is required to complete this form.

ABN: *

Lookup

ACN: *

Corporation name: *

Registered address: *

City:

State:

Postcode:

Section 2 - Details of person whose appointment is to be revoked

Surname: *

Given names: *

Position held in corporation: *

DirectorMember of Governing BodyCompany SecretarySecretary

Section 3 - Declaration

I declare I am the person authorised make the notice of revocation on behalf of the corporation in Section 1.

The appointment of the person shown in Section 2 is revoked.

Name: *

Position held in corporation: *

Signature: *

Draw signature|Type signatureClear

Date: *

I have read and understood the Privacy statement: *

Privacy statement : Information provided on this form is collected for the purposes of compiling the voters’ roll and conducting council elections. The voters’ roll will only show the address of the property owned/occupied by the corporation along with the appointed voters’ names and postal addresses. It will not show any other details about the corporation or its appointed voters. Voters’ rolls will not include dates of birth. If provided, email and mobile contact information may be utilised regarding processing this application and for the purpose of delivering notifications and voting reminders for elections. Voters’ rolls are only available for purposes connected with council elections, to enable the council to communicate with voters in regard to council functions or for a public interest purpose approved by the Victorian Information Commissioner. Sections 11F and 11G of the City of Melbourne Act 2001 require that the certified voters’ roll be available for public inspection until one month after elections day. Candidates may use copies of the voters’ roll for elections purposes only.