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候選人退選通知書

NOTICE OF WITHDRAWAL OF CANDIDATURE

2010年坪洲鄉事委員會街坊代表選舉

2010 Peng Chau Rural Committee Kaifong Representative Election

[ 備註：在填寫此通知前，請參閱夾附的「候選人退選通知書填寫說明」。]

[Note: Before completing this notice, please read carefully the attached “Notes on Co mpleting Notice of Withdrawal of Candidature”.]

第一部份退出選舉（由候選人填寫）

Part I WITHDRAWAL(to be completed by candidate)

致：選舉主任

To : Returning Officer

1.本人是獲提名的上述選舉的候選人。現通知閣下，本人退出上述選舉。

I am a nominated candidate at the above election. I hereby give notice that I withdraw my candidature.

2.本人的個人資料如下：－

My personal particulars are as follows

中文姓名（正楷）：__________________________________________________________________ Name in Chinese (如提名表格所寫a s on the Nomination Form)

英文姓名（大楷）：_____ Name in English (in BLOCK LETTERS) (姓Surname) (名Other name)

( 如提明表格所寫as on the Nomination Form )

身分證明文件：

Identity Document

香港身分證號碼：

Hong Kong Identity Card Number

候選人簽署：日期：

Signature of candidate Date

第二部份見證（由見證人填寫）

Part II ATTESTATION (to be completed by a witness)

1.本人聲明此通知的第一部份是在本人見證下由上述候選人親自簽署。

I hereby declare that Part I of this notice was signed by the above-named candidate in my presence.

2.本人的個人資料如下：

My personal particulars are as follows

中文姓名（正楷）：( ) Name in Chinese (別名Alias) 英文姓名（大楷）：( ) Name in English (in BLOCK LETTERS) (姓Surname) (名Other name)(別名Alias)

身分證明文件：

Identity Document

身分證明文件號碼：

Identity Document Number

地址Address：

見證人簽署：日期：

Signature of Witness Date