10. Addition of the Fourth Schedule to the principal enactment

The principal enactment is hereby amended by the addition immediately after the Third Schedule to such enactment of the following new Schedule :—

“FOURTH SCHEDULE

CERTIFICATE OF ELIGIBILITY TO VOTE ISSUED TO A PERSON WHO IS SUBJECT TO A

DISABILITY IN TERMS OF THE REFERENDUM ACT, NO. 7 OF 1981

(SECTION 23 (2) (c))

PART I

DECLARATION BY THE APPLICANT/VOTER

Full Name : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Address : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Occupation : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Date of Birth : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

NIC/Driving Licence /Passport No. : . . . . . . . . . . . . . . . . . . . . . . . . .

Elections (Special Provisions)

I, . . . . . . . . . . . . . . . . . . . . . . of . . . . . . . . . . . . . . . . . . . . . being a voter registered in the . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . District, being subject to a disability, declare that the above particulars are true and accurate and do hereby apply for the issue of a Certificate of

Eligibility entitling me to vote at the forthcoming . . . . . . . . . . . . . .

. . . . . . . . (Name of Election) as a person subject to a disability, as provided for by law.

Date : . . . . . . . . . .

Name of Voter : . . . . . . . . . . . . . . . . .

Signature of Voter : . . . . . . . . . . . . . .

CERTIFICATE OF GRAMA NILADHARI

I Certify that the information given above is correct and that the following information relating to the application of . . . . . . . . . . . . .

(Name of Applicant/Voter) is correct according to the records maintained by me.

Name : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No. on the voters list : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Province : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

District : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Electoral Division : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other relevant information : . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Date : . . . . . . . . . .

Signature of Grama Niladhari : . . . . . . . .

Name of Grama Niladhari : . . . . . . . . . . .

Division : . . . . . . . . . . . . . . . . . . . . . . . .

Seal : . . . . . . . . . . . . . . . . . . . . . . . . . . .

PART II

CERTIFICATE OF THE GOVERNMENT MEDICAL OFFICER

I have personally examined . . . . . . . . . . . . of . . . . . . . . . . . . . . . .

who has applied to be entitled to vote as a person subject to a disability, at the forthcoming . . . . . . . . . . . . . . . . . . . . . . . . . (Name of Election)

and do hereby certify that . . . . . . . . . . . . . . . . . . (Name of Voter/

Applicant) is entitled/not entitled to vote as a person subject to a disability, as provided for by law.

Date : . . . . . . . . . .

Name of Government

Medical Officer: . . . . . . . . . . . . . . . .

Signature of Government

Medical Officer: . . . . . . . . . . . . . . . .

Seal: . . . . . . . . . . . . . . . . . . . . . . . . . .”.