POLITICAL PARTY
DECLARATION OF
PRIMARY PURPOSE
A non-partisan Office of the Legislature
476
(16/03)
SEE REVERSE SIDE FOR INSTRUCTIONS
THIS FORM IS AVAILABLE FOR PUBLIC INSPECTION

FULL NAME OF POLITICAL PARTY
I, the undersigned, declare that:
(a)I am authorized to act on behalf of the above-named political party;
(b)the above-named political party is an organization that has as a primary purpose the fielding of candidates for election to the
Legislative Assembly; and
(c) to the best of my knowledge, information and belief, the contents of this declaration are true and correct.

NAME OF PRINCIPAL OFFICER OF POLITICAL PARTY (PLEASE PRINT)

SIGNATURE OF PRINCIPAL OFFICER OF POLITICAL PARTY
DATE: (YYYY / MM / DD)
WARNING: Signing a false declaration is a serious offence and is subject to significant penalties.
CHIEF ELECTORAL OFFICE USE ONLY
DATE RECEIVED: (YYYY / MM / DD)
This form is available for public inspection.
PLEASE KEEP A COPY FOR YOUR RECORDS
REGISTRATION NO.
This information is collected under the authority of the Election Act and the Freedom of Information and Protection of
Privacy Act. The information will be used to administer provisions of 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
POLITICAL PARTY
SOLEMN DECLARATION OF
PRIMARY PURPOSE - FORM 476
PLEASE PRINT IN BLOCK LETTERS AND SIGN WHERE REQUIRED
INSTRUCTIONS:
nn Enter the full name of the political party.
oo P
rint the name of a principal officer for the political party. This principal officer must also be listed on the form
484-Administration filed by the political party.
pp Signature of the principal officer for the political party.
For more information
Toll-free 1-800-661-8683 / TTY 1-888-456-5448
or contact
Elections BC
Mailing Address: PO Box 9275 Stn Prov Govt, Victoria, BC V8W 9J6
Phone: 250-387-5305
Fax: 250-387-3578
Toll-free Fax: 1-866-466-0665
Email: [email protected]
Website: elections.bc.ca