Veterinary and Para-Veterinary Professions Act, 1982 (Act No. 19 of 1982)

Full names of deponent

Residential address of deponent

Registration number of deponent

I hereby declare that I am the person to whom the enclosed ballot paper was issued, that I am entitled to cast a vote at the election of members of the South African Veterinary Council and that I have not previously submitted any other ballot paper for this election.

Signature of deponent

Date