NATIONAL UNIVERSITY OF IRELAND - OLLSCOIL NA hÉIREANN
49 Merrion Square, Dublin 2;
Telephone:+ 353 (1) 439 2424; Fax: + 353 (1) 439 2477; Email: records@nui.ie; Web: www.nui.ie
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CLAIM TO BE REGISTERED AS A UNIVERSITY ELECTOR - SEANAD ELECTORAL (UNIVERSITY MEMBERS) ACTS, 1937-2001
Every person who is a citizen of Ireland and has received a degree (other than an honorary degree) in the National University of Ireland and has attained the age of
eighteen years shall be entitled to be registered as an elector in the register of electors for the National University constituency. [S. 7(1)]
Surname (as registered on University Records)
First Name(s) (as registered on University Records)
Other Form(s) of Surname Used (e.g. Irish / Maiden / Married)
(N.B. Married / Maiden Name, where applicable: if you are now registered in your maiden name, but wish to be registered in your married name, a
copy of your Marriage Certificate should be lodged with this form.)
Date of Birth
D
D
M
M
Y
Y
Are You a Citizen of Ireland?
Permanent Address:
Any change of address should always be notified to the
Registration Officer of the University.
Address to which Ballot Paper should be sent
(if different)
Previous Address (identification purposes)
Telephone / Fax / E-mail (delete as necessary)
Student Number (if known)
Degree
Year of Conferring
NUI Constituent University/
Recognised College
State the NUI Degree in respect of which the franchise is claimed:
Other NUI Qualification(s):
I declare that the particulars given in this claim form are true and accurate to the best of my knowledge and belief, and I hereby claim to be registered as a
University Elector for the constituency of National University of Ireland.
SIGNATURE
DATE
This form should be completed and returned to: The Registration Officer, 49 Merrion Square, Dublin 2, prior to February 26th, for inclusion in the Register which
comes into operation on the following June 1st.
NUI is obliged, [S.56(b) Electoral (Amendment) Act, 2001], to publish and supply, on payment of a fee, a separate Edited Register of those electors who wish to have their
names and addresses made available for ‘a purpose other than an electoral or statutory purpose’ including commercial purposes.
We wish to keep our records as accurate as possible, and therefore appreciate being informed of any pertinent amendments, eg, change of address, notification
of death of a graduate, etc.
NATIONAL UNIVERSITY OF IRELAND - OLLSCOIL NA hÉIREANN
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49 Merrion Square, Dublin 2;
Telephone:+ 353 (1) 439 2424; Fax: + 353 (1) 439 2477; Email: records@nui.ie; Web: www.nui.ie
DO YOU WISH TO BE LISTED in the NUI EDITED Register of Electors?
We wish to keep our records as accurate as possible, and therefore appreciate being informed of any pertinent amendments, eg, change of address, notification
of death of a graduate, etc.