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Approved Body Application Form

You can enter the details of this form online, and then print out the document by selecting the View Document button at the bottom of the page.

1.	Name of referendum for which you are applying

2.	Name of organisation

3.	Address of organisation

4.	Are you a political party registered on the Register of Political Parties? (If the answer is yes, go directly to question 9)
	YesNo
5.	What type of body is your organisation?
	Corporate Body or branch of same established in the State? Unincorporated Body or branch of same established in the State?
6.	Registered company number (if available)

7.	Which of the following are you governed by (please select and enclose copy of document)
	Constitution Memorandum of Association Written Rules Other written document
8.	Number of members in organisation (according to the most recent,dated, membership list)


9.	Please state your interest in the referendum

10.	Name of person nominated to be an authorised person for the purposes of the Referendum Act

11.	Address of person nominated to be an authorised person for the purposes of the Referendum Act

12.	Contact Details:
Phone:
Mobile:
Email:

Signature of Authorised Officer

_________________________________
Date
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