Declaration under oath or solemn affirmation of an electorwishing to vote in the advance poll because he will be absent orunable to vote on polling dayMunicipality of ................................................Polling subdivision No .........................................I, ............................................................. Given name Surname ............................................................... Occupation ............................................................... Addressdeclare that I have reason to believe( ) that I shall be absent from the municipality on polling day OR( ) that I shall be unable to vote on polling day.I, therefore, wish to vote in the advance poll. ........................... ElectorDeclared under oath(or solemnly affirmed)before me,this ................., 19..... ............................ Deputy returning officer