Mail Ballot Online Application Form

Mail-in Ballot Online Submission Form

1. Elector Requesting Mail-in Ballot

2. Contact Information

3. Home Address

Address
City
Province
Postal Code

4. Non-Resident Property Elector

Are you applying for a ballot as a non-resident property elector (you own property in Port Coquitlam, but live somewhere else in BC)?

5. Delivery of Mail Ballot Package

How would you like to receive your mail ballot?
Name
Name
First
Last
Address
City
Province
Postal Code
Mail to Address
City
Province
Postal Code

6. Declaration

  • 18 years of age or older on October 15th, 2022.
  • A Canadian Citizen.
  • A resident of British Columbia for at least the last 6 months.
  • A resident of Port Coquitlam (any length of time) OR an owner of Real Property in Port Coquitlam for at least the last 30 days.
  • Not disqualified by law from voting in an election or otherwise disqualified by law.
  • To interfere with another person’s right to vote
  • To provide false or misleading information or to make false or misleading declarations
  • To obtain a ballot by fraudulent or improper means
  • I also understand that Election Offences, including those listed above and outlined in the Local Government Act, carry serious penalties including fines and imprisonment.
  • I declare this information to be accurate and true.
Maximum upload size: 134.22MB
1 piece for required registered voters, 2 pieces required for non-registered voters. Check to see if you’re on the voters list by calling the Election Office at 604.927.5212 or 604.927.5332.
Personal information entered on this form is collected under the authority of section 26(c) of the Freedom of Information and Protection of Privacy Act (FOIPPA) and will be used to administer mail-in ballots. If you have any questions or concerns about how your information will be used, contact the City’s Election Office at 604.927.5212 or electionoffice@portcoquitlam.ca.
Sending