Independent Election Commission (IEC) Presidential Election Candidate Nomination Application Form

Transcription

1 Form CN-01 1 Independent Election Commission (IEC) Presidential Election 2014 Candidate Nomination Application Form Part I Candidate Gender: Male Female Date of Birth: Place of Birth: District Province: Residential Address: House# Street Village Town District: Province: National ID (Tazkira): Number Age Religion Nationality Place of Issuing Voter Registration Card Number The Last Official Post: Wish to run as an Independent Candidate? YES NO Wish to run as a Candidate endorsed by Political Party? YES NO Wish to run as a Candidate endorsed by Coalition? YES NO Name of the Political Party/Coalition: Page 1 of 5

2 Declaration of the person applying to be registered as a Candidate I do solemnly and sincerely declare that: 1. I consent to being a candidate. 2. I am qualified and not subject to any disqualification under the Constitution or the Electoral Law to be elected and to be the President of Afghanistan. 3. I do solemnly and sincerely declare that: c. In was born of Afghan parents e. I am at least 40 years of age f. I have not been convicted of crimes against humanity or a criminal act, g. I have not been deprived of my civil or political rights by a court of competent jurisdiction 4. EITHER a. I hold none of the offices listed in Article 13, paragraph (1) of the Electoral Law OR b. I previously held the position of (one of those positions) and have submitted my resignation from that position on (date submitted) 5. I will uphold the Code of Conduct for Candidates approved by the Independent Electoral Commission. 6. I would submit the following documents along with application form: a. The names, signatures or thumbprints and voter registration card numbers of the persons required by the Electoral Law to support me as a candidate (100,000 persons, two, two percent from 20 provinces) with photocopies of their voter registration cards; b. A bank receipt for the filing deposit required by the Electoral Law for my candidacy; c. My voter registration card; d. The names and declarations of the persons I wish to name as my Vice Presidents; and e. The party or independent candidate symbol I wish to appear on the ballot. 7. The person I name as my liaison officer is: Signature: Date: / / Time: Page 2 of 5

3 Part II 1 st Vice-President: Candidate Gender: M F Date of Birth: Age: Place of Birth: District: Province: Residential Address: House #: Street: Village: Town: District Province: Voter Registration Card Number: 1. I do solemnly and sincerely declare that I am qualified to serve as a Vice President under Article 62 of the Constitution. 2. I do solemnly and sincerely declare that: c. I was born of Afghan parents e. I am 40 years of age or more f. I have not been convicted of a crime against humanity or a criminal act g. I have not been deprived of my civil rights by a court Date: / / Signature: (1 st Vice President) Page 3 of 5

4 2 nd Vice-President: Candidate Gender: M F Date of Birth: Age: Place of Birth: District Province Residential Address: House #: Street Village: Town: District Province Voter Registration Card Number: 1. I do solemnly and sincerely declare that I am qualified to serve as a Vice President under Article 62 of the Constitution. 2. I do solemnly and sincerely declare that: c. I was born of Afghan parents e. I am 40 years of age or more f. I have not been convicted of a crime against humanity or a criminal act g. I have not been deprived of my civil rights by a court Date: / / Signature: (2 nd Vice President) Name and signature of Candidate: Receipt of this Form by IEC Secretariat Official does NOT constitute an acceptance of the Nomination of the Candidate by the IEC. Page 4 of 5

5 For Official Use Only Serial Number of Candidate Nomination Form: Date and Time of Receipt: Name and Signature of the IEC Candidate Nomination Officer Page 5 of 5