MUA 2015-‐2019 Quadrennial Election Application form for a replacement ballot paper
NAME: ………………………………………………………………………………………………………………………. NATIONAL UNION NUMBER: ……………………………………………………………………………………. BRANCH: …………………………………………………………………………………………………………………… ADDRESS: ………………………………………………….................................................................. …………………………………………………………………………………………………………………………………... I seek a replacement ballot paper for the 2015-‐2019 election on the grounds that the original ballot paper issued to me has been: (give reason: eg not delivered, lost, spoilt, etc). …………………………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………………………… I undertake to return any “spoilt” paper with this application, and to destroy or return the original ballot paper should it come into my possession in the future. SIGNED: …………………………………………………………………………………………………………………….. DATE: ………………………………………………………………………………………………………………………… Please return to: National Returning Officer C/o Maritime Union of Australia PO Box 20433 World Square Post Office Sydney, NSW 2002 Phone – 02 92679134 Fax – 02 92613481 Email –
[email protected]
TRIM: 15/4/21/2255
