Request for Mail-in Ballot | City of Port Coquitlam

First & Last Name

Phone

Address

City

Province

Postal Code

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

Yes

Provide the address or legal description of the property in Port Coquitlam for which you are entitled to vote:

I request that you provide me with a mail ballot package in the following way:

Keep it at City Hall for me to pick up

Keep it at City Hall for the someone else to pick up on my behalf

(Provide name and address of person picking up below)

Mail by Canada Post to mailing address I provided above

Mail by Canada Post to a different address

(Provide different address below)

Name of individual picking up ballot

First & last name

Address

City

Province

Postal Code

Address

Address 2

City/Town

Province/State

Postal Code/ZIP

Country

Provide one piece of identification that proves your identity and place of residence.

One file only.
128 MB limit.
Allowed types: jpg, jpeg, png, pdf.

Declaration

I hereby declare that I am 18 years of age or older on October 17, 2026.

I hereby declare that I am a Canadian Citizen.

I hereby declare that I am a resident of British Columbia for at least the last six months.

I hereby declare that I am a resident of Port Coquitlam (for any length of time) OR an owner of real property in Port Coquitlam for at least the last 30 days.

I hereby declare that I am not disqualified by law from voting in an election or otherwise disqualified by law.

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) for the purposes of processing your input. If you have any questions or concerns about the collection of this information, please contact the City’s Records and FOIPPA Administrator at 604.927.5250 or [email protected].

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