Councillor Candidate Information Form - Gloucestershire Conservatives

You are being asked to complete this form following successful selection as a Local Government Councillor Candidate. It is vital that we receive this information as soon as possible so we can complete all the necessary administration for electoral law requirements and your campaign.

Section 1

Full Name including any middle names*

Ward/Division you intend to stand in.*

Commonly used first name if applicable

Commonly used surname name if applicable

Date of Birth*

Date of Birth

E-mail*

Telephone Number*

Full address including postcode*

Please list all social media sites and names that you have or intend to use for campaigning

Section 2 Enter your qualifying address, or qualifying addresses (in full) to each of the relevant qualifications below, please complete ALL sections that apply

(a) I am registered as a local government elector for the area of the *county/district/London borough named above

If (a) applies please enter the qualifying address

(b) I have during the whole of the preceding 12 months occupied as owner or tenant land or other premises in the area named above

If (b) applies please enter the qualifying address

(c) my principal or only place of work during the preceding 12 months has been in the *county/district/London borough named above

If (c) applies please enter the qualifying address

(d) I have during the whole of the preceding 12 months resided in the *county/district or London borough named above

If (d) applies please enter the qualifying address

Section 3

Do you have a proposer and seconder? They must live in the ward/division that you intend to stand in.

Yes
No

Proposers Full Name

Proposers E-mail

Proposers telephone number

Proposers full address including postcode

Proposers Electoral Number if known

Seconders full name

Seconders E-mail

Seconders telephone number

Seconders full address including postcode

Seconders Electoral Number if known

Section 4

Please upload a good quality headshot in JPG or PNG File

Please enter any other information that you would like to inform the office of.

Date Completed*

Date Completed

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