APPOINTMENT OF OFFICIAL AGENT
327
(16/05)
s. 69
Nomination
PLEASE PRINT IN BLOCK LETTERS OR TYPE
SEE REVERSE SIDE FOR INSTRUCTIONS
A non-partisan Office of the Legislature
PART A

FULL NAME OF NOMINEE / CANDIDATE
LAST NAME
FIRST NAME
MIDDLE NAME(S)

ELECTORAL DISTRICT
PART B

OFFICIAL AGENT
LAST NAME
FIRST NAME
MIDDLE NAME(S)
RESIDENTIAL ADDRESS 
CITY / TOWN
POSTAL CODE
RESIDENTIAL

 In accordance with section 275 of the Election Act, I request that my residential
address be obscured for the purposes of public inspection.
ADDRESS
YES
PART C – OFFICIAL AGENT CONTACT INFORMATION

SERVICE ADDRESS
THE INFORMATION BELOW IS PUBLISHED AND WILL BE AVAILABLE
FOR PUBLIC INSPECTION (SEE REVERSE SIDE)
CONTACT NAME

SERVICE ADDRESS
SERVICE EMAIL
CITY / TOWN

SERVICE PHONE
POSTAL CODE
EFFECTIVE DATE OF APPOINTMENT:
(YYYY/MM/DD)
PART D

I consent to my appointment as official agent for the above-named
individual. I am aware of the duties and responsibilities of this position
under the Election Act.
SIGNATURE OF OFFICIAL AGENT
DATE: (YYYY/MM/DD)
WARNING: Signing a false statement is a serious offence and is subject to significant penalties [s. 266].
PART E
CHIEF ELECTORAL OFFICE USE ONLY

SIGNATURE OF NOMINEE / CANDIDATE
DATE: (YYYY/MM/DD)
DATE RECEIVED: (YYYY/MM/DD)
THIS FORM IS AVAILABLE FOR PUBLIC INSPECTION. This information is collected under the authority of the Election Act and the Freedom of Information and Protection of Privacy Act.
PLEASE KEEP A COPY FOR YOUR RECORDS
The information will be used to administer provisions under the Election Act. Questions can be directed to: Privacy Officer,
Elections BC 1-800-661-8683, [email protected] or PO Box 9275 Stn Prov Govt, Victoria BC V8W 9J6
APPOINTMENT OF OFFICIAL AGENT - 327
INSTRUCTIONS
PRINT IN BLOCK LETTERS OR TYPE, EXCEPT WHERE A SIGNATURE IS REQUIRED.
PART A
 Name of nominee/candidate.
 Name of the electoral district in which the nominee/candidate wishes to seek election.
PART B
 Name and residential address of official agent.
 The protection of personal information only applies to residential address.
PART C
 S
ervice address is the address where documents can be served or delivered to a candidate. Documents delivered to
this address are deemed to have been delivered or personally served on the candidate [Election Act, sections 68 and
69]. This address will be published on the Elections BC website and in local newspapers. Service contact
information is available for public inspection [Election Act, sections 275 and 71(1) and (2)].
 Service phone number and service email address of contact individual.
 The effective date of appointment means the day on which the official agent assumes that position.
PART D
 T
he official agent must sign this appointment form indicating their consent and acknowledging the duties and
responsibilities of the position. The official agent may act on the candidate’s behalf throughout the election process.
The official agent can appoint scrutineers and accept notices on the candidate’s behalf.
Persons who do not have full capacity to enter into contracts are disqualified from acting as an official agent.
PART E
 The appointment must be signed by the nominee/candidate.
Signing a false statement is an offence and is subject to the following penalties: a fine of up $20,000; imprisonment for a
term not longer than two years; or both [Election Act, s. 266].
For more information
Phone toll-free 1-800-661-8683 / TTY 1-888-456-5448
or contact
Elections British Columbia
Mailing Address: PO Box 9275 Stn Prov Govt, Victoria, BC V8W 9J6
Location: 1112 Fort Street, Victoria, BC
Phone: 250-387-5305
Fax: 250-387-3578
Toll-free Fax: 1-866-466-0665
Email: [email protected]
Website: elections.bc.ca