S.L. 464.5 Art. 14Decision of the Commission. of the Appeals Council, or the Pharmacy Nurses and Professions (**) (Register) (**) name appears VOTING FOR (in VOTE FOR Signature of Signature of

The decision of the Commission on the validity of any nomination, the right of a person to cast the vote, the place where the votes are received and the result of the election, are final and conclusive. FIRST SCHEDULE

Nomination Form for Candidates for Election to the Appeals Committee

We, the undersigned, being voters entitled to vote at an election Committee for

(a) a medical practitioner or dentist registered with the Medical

(b) a pharmacist or pharmacy technician registered with Council, or

(c) a nurse or midwife registered with the Council for Midwives, or

(d) a professional registered with the Council for the Complementary to Medicine, do hereby nominate ........................................................................ registered in the ..............................................................(**) and whose address is ...................................................................... as a candidate for the said election. Proposer: Name ............................................................................ (Block Letters)

Signature ............................................. Date ................................ Registered in the ........................................................................... Seconder: Name ...........................................................................

(Block Letters) Signature ............................................. Date ................................ Registered in the ...........................................................................

DECLARATION BY PERSON NOMINATED I, .......................................................................................... whose (full name in block letters) on the ............................................................. accept the above nomination. (Register)

Date ................................................ ............................................ Candidate’s signature

(**) In block letters SECOND SCHEDULE

Ballot Paper FOR USE BY ............................................

ELECTION OF A CANDIDATE TO THE APPEALS COMMITTEE

Names of Candidates Place a cross in this part against the alphabetical order) name of the candidate for whom you wish to vote

...................... CANDIDATE(S) (only)

Election Commissioner ................................................

Election Commissioner ................................................