Schedule 1
(Section 17(2))
I .............................. of ..............................
.............................. (occupation)
claim to have my name inserted in the Register of Voters for the election of members of the local authority for the ..............................
In so doing I hereby declare that I—
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(a) am a British subject;
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(b) have attained the age of 21 years;
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(c) am not a person of unsound mind so found under any law in force in Saint Lucia; and
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(d) possess the following further qualification—
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Dated this .............................. day of ..............................,
(Signature or Mark)