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 (Date )

($1$) Here insert the words “part of the Register for mental nurses", or "part of the Register for sick children's nurses ", as the case may be.

($2$) Here insert full name, including Christian names, of candidate.

($3$) Here insert candidate's address.

($4$) Here insert candidate's registration number.

N.B.—A nurse cannot nominate a candidate for election by the nurses registered in a particular part of the Register unless she is herself registered in that particular part.

(Form of declaration to be issued with the nomination papers for return by the candidate nominated)

(Date)

I consent to be nominated as a candidate for election as a representative of the nurses registered in the ($1$) to serve on the General Nursing Council for England and Wales. I declare that the statements in the nomination paper with regard to my qualifications are correct.

Name

Address

Registration Number

($1$) Here insert "general part of the Register and the part of the Register for fever nurses", or "part of the Register for mental nurses",or "part of the Register for sick children's nurses", as the case may be.

Election of 15 registered general nurses