ŠAttestation respecting elector whose name does not appear on theŠlist of a polling stationŠŠ I certify that the name of the person mentioned below:ŠŠ .........................................................Š NameŠŠ .........................................................Š AddressŠŠ .........................................................Š OccupationŠŠis on the revised list used for the current election.ŠŠDate:..........................................................ŠŠ .....................................Š Returning Officer or Election ClerkŠ