Rules Schedule 4

Municipal Association of Victoria
Nomination Form (Clause 1 of Schedule 2)

Nomination for election of President and Directors held on _____________________________________

I, the undersigned _____________________________________________________________________

being the delegate of ___________________________________________________________________
(insert name of council)

nominate ____________________________________________________________________________
(insert full name of councillor who is to be the candidate)

as a candidate for election to the following office:

[ ] President
[ ] Director for the ______________________________________________________________ region (insert name of region)
(Mark with an ‘X’ the election for which the candidate is nominated)

Signature ____________________________________________________________________________

And I, the above-named _________________________________________________________________
(insert name in full)

consent to the nomination and declare that I am the appointed

delegate of _______________________________________________________________________________ .
(insert name of council)

I acknowledge and agree that, if I am elected to hold the office for which I am nominated, my ability to hold the office and remain in such office is subject to my being able to demonstrate that I meet the Eligibility Criteria in accordance with the Fit and Proper Person Policy (as those terms are defined in MAV Rules 2022). I agree to provide information for such determination to be made at the times required in accordance with the Fit and Proper Person Policy. I also acknowledge and agree to notify the Chief Executive Officer or their delegate if at any time I no longer meet the applicable Eligibility Criteria.

Signature ____________________________________________________________________________

NOTE: A separate nomination form must be completed and delivered to the Election Manager for each election for which a candidate is to be nominated.