REQUEST TO PURCHASE REGISTERS OF ELECTORS

You may take you about 2 minutes to fill in this form. You will need information from your NRIC/passport. Please sign and email to [email protected]. We will process your request and inform you of the payment and collection details via email.

SECTION A: REQUESTOR DETAILS (All fields to be completed)

Name (as in NRIC) NRIC S Email

Contact no. (mobile no. preferred)

SECTION B: REASON FOR PURCHASE (Tick the appropriate box.)

 I will be / am standing as a candidate at a *Parliamentary / Presidential election.

 I am the appointed election agent of ______(Name of Candidate as shown on NRIC) at a *Parliamentary / Presidential election.

 I am the ______(Designation)

of ______(Name of Political Party).

SECTION C: DETAILS OF PURCHASE (See overleaf.)

SECTION D: PAYMENT MODE (Tick the appropriate box.)

 Electronic funds transfer  Cheque  Cash

SECTION E: ACKNOWLEDGEMENT

I have read and understood the conditions stipulated in section 21A of the Parliamentary Elections Act on the use of the Registers of Electors (see overleaf).

Signature of Requestor Date

For request from political party:

Party Stamp OR Name of Party Office Holder Signature (i.e. Chairman, Secretary, Treasurer, Branch Secretary or equivalent)

* Delete whichever is inapplicable.

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Fill in quantity as required.

s/n Electoral division CD-ROM Hard copy (State qty required) (State qty required) Single-Member Constituency 1 2 3 NORTH 4 5 6 MACPHERSON 7 MARYMOUNT 8 MOUNTBATTEN 9 PIONEER 10 11 WEST 12 RADIN MAS 13 14 YUHUA 4-Member Group Representation Constituency 15 BISHAN- 16 CHUA CHU KANG 17 HOLLAND- 18 JALAN BESAR 19 - 20 5-Member Group Representation Constituency 21 22 23 EAST COAST 24 JURONG 25 26 NEE SOON 27 -PUNGGOL 28 29 30 31 WEST COAST

Section 21A of Parliamentary Elections Act - Use of registers of electors 21A.—(1) Any candidate or his election agent who or any political party which, on payment of any fee, acquires from the Registration Officer any copy (whether in printed or electronic form) of any register of electors — (a) shall use any information recorded in the register only for communicating with electors; (b) shall not use any information recorded in the register for commercial purposes; and (c) may disclose any information recorded in the register to others only after obtaining their written acknowledgment that they are bound by the restrictions in this subsection. (2) Subject to subsection (3), no person who obtains any information recorded in any register of electors shall reproduce, store or transmit any part of the information by electronic or any other means for any purpose. (3) Subsection (2) shall not apply to — (a) a candidate or his election agent who or any political party which, on payment of any fee, acquires a copy of a register of electors from the Registration Officer; or (b) a person who obtains information in any register of electors from a candidate, an election agent or a political party after giving a written acknowledgment described in subsection (1)(c). (4) Any person who knowingly contravenes subsection (1) or (2) shall be guilty of an offence and shall be liable on conviction to a fine not exceeding $1,500 or to imprisonment for a term not exceeding 9 months or to both. (5) In this section, “candidate” includes a candidate at any presidential election. Page 2 of 2