选举代理人委任通知书NOTICEOFAPPOINTMENT-民政事务总署.PDF

選舉代理人委任通知書 NOTICE OF APPOINTMENT OF ELECTION AGENT 第三十四屆鄉議局選舉 ELECTION OF THE 34th TERM OF THE HEUNG YEE KUK 特別議員選舉 ELECTION OF SPECIAL COUNCILLORS 選舉日期：20 15 年5 月12 日 Date of election: 12 May 2015 ﹝備註： 在填寫此通知書前，請小心參閱夾附的《填寫委任選舉代理人通知書說明》。﹞ [Note: Before completing this notice, please read carefully the accompanying “Notes on Completion of Notice of Appointment of Election Agent”.] 第一部分 委任 （由候選人填寫） PART I APPOINTMENT (to be completed by candidate) 1. 我為上述選舉的候選人，現委任下列人士在上述選舉中擔任本人之選舉代理人－ I, the candidate for the above election, hereby appoint the following person to act as my election agent at the above election － 中文姓名（正楷）： Name in Chinese 英文姓名（大楷）： Name in English (in BLOCK LETTERS) (姓Surname) (名Other name) 香港身分證號碼： Hong Kong Identity Card Number 聯絡電話號碼：