1.

Particulars of candidate:

(a)

Full names

(b)

Full residential address

(c)

Full postal address

(d)

Registration number

I comply with the qualifications set out in section 6 of the Veterinary and Para-Veterinary Professions Act, 1982, for election as a member of the South African Veterinary Council. At the request of the persons indicated in paragraph 2 below, I am prepared to accept nomination as a candidate for an election of members of the said Council.

Signature of candidate

Date

2.

Particulars of persons making nomination

First nominator:

(a)

Full names

(b)

Postal address

(c)

Registration number

Second nominator:

(a)

Full names

(b)

Postal address

(c)

Registration number

We hereby nominate the person indicated in paragraph 1 above, as a candidate for an election of members of the South African Veterinary Council.

Signature of first nominator

Signature of second nominator

Date

Date