[ARTICLE 14]
REFERENDA ACT
Declaration for the Holding of a Referendum

We the undersigned persons being persons registered as voters for the election of members of the House of Representatives (the first *(1) ..............persons undersigned being the proposers) demand that the question whether the following provisions of law, that is to say *(2)
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should not continue in force shall be put to those entitled to vote in a referendum under Part V of the Referenda Act.

Signature

Legally valid identification document number

Address

Electoral Division

Notes:
(1) a number not being less than five and not more than ten being proposers in terms of article 15(2) of the Referenda Act.
(2) insert here the details of the provisions on which the question is to be put.