[Form: 59-5] Under Article 136 Section 4 No. 1 R
eg si rt at oi n
No.
Date&Time Read the instructions on
the next page before completing the form.
Voter Registration Application for Overseas Electorate
Institution name Received
by
(Signature)
Full Name1) Korean 홍 길 동 (Capital letter)English HONG GIL-DONG
Passport Number J R
7 7 7 0 0 0 1
※ Please write the passport number from left to rightOverseas Electorate Classification2)
(Check one
☑)
Formerly had a domestic Residential Registration
Expired Resident Registration
Number
-
√ Never had a domestic Residential Registration
Date of Birth
(yr, mo, day)
1 9 7 0
v -0 7
-0 7
(Check one Gender☑)
Male √ Female
Parents Names3) Father's Name 홍 진 사 Mother'sName 이 애 순
Family Relation Register Information4)
(Check one
☑)
Formerly had a domestic Residential Registration
Last Address in
South Korea (City or Country) (Region) (Town)
√ Never had a domestic Residential Registration
Place of Legal Domicile (Place of Registration)
서울특별시 (City or Country) 종로구(Region) 수 송 동(Town) 146-2번지
Contact Information
※ Please write within the lines
Phone Number5) (Home or Work number)
(* (Country Code) ( Area Code ) ( Number )
1
-2 0 2
-3 8 5
-0 0 0 1
Cell Phone5)
1
-2 0 2
-3 8 5
-0 0 0 1
E-mail6)
mightysoon@hanmail.net
Address Abroad7) (Location where you
receive mailings)
※ Please write within the lines
Required
※Use only capital Roman characters
Country of
Residence
U. S. A.
Zip Code orPostal Code
20008
Address
1 MASSACHUSETTS AVENUE, N.W.
WASHINGTON D.C.
U.S.A.
Check if you use a public institution as your mailing address
Optional
※Use native l a n g u a g e of place of residence
Current Address
• Name used in
place of residence
• Attention
Polling Location Preference8)
주미국대사관
※ You must attach copies of documentation proving your citizenship and your passport, and must be able to present the original documents.
I hereby confirm that I am a citizen of the Republic of Korea in accordance with the Nationality Act. I seek to register for the 19th Parliamentary election in accordance with Article 218, Section 5 of the Public Official Election Act. I consent to the use of my personal information, not limited to family information, national identification information, incarceration records, residential information or passport information, to confirm my eligibility.
Attach- ments9)
1. A copy of your passport
2. A copy of any documents proving citizenship (recognized documents verifying nationality or documentation regarding dual citizenship)(Check one ☑)
✓ A copy of your visa
A copy of your alien registration documents The nationality choice certificate The ocumentation proving military service
A copy of your immigration documents (i.e., Green card)
The nationality acquisition certificate The foreign nationality abandonment
confirmation document
Miscellaneous ( )
A copy of documentation granting long-term residency
The retaining nationality certificate The foreign nationality renunciation certificate
2011
(year),11
(month),13
(day)National Election Commission Applicant10) :
홍 길 동
(Signature or seal)
※ Please, submit this form to the near consulate offices in person.
※ Notice
※ Instructions
1. Since this application will be decoded by machines, please be careful not to rip or damage this sheet.
2. If there are errors on this application, you may not receive important information related to political parties and candidates or the ballot. Please be careful to write legibly and check the information you have written.
3. No ballots will be sent to fraudulent applications or for those who have not self-elected to register for their vote. According to Article 247 of public election laws, those found guilty can be sentenced up to 3 years of incarceration or a maximum (KRW)\ 5,000,000 fine.
1. Your name should be written as it appears on your passport.
☞ However, in cases where the name on the family relation register differs from the name in the passport, write the name that appears on your family relation register.
2. For Overseas Electorate Classification, you must check the box to indicate if you had a domestic residential registration or the box that indicates if you have never had a domestic residential registration. For the former, you must write the domestic resident registration number you once had. For the latter, please indicate your birth date, (yr, mo, dy), and mark a check by your gender.
3. The purpose of obtaining family information is especially for those who have never had a domestic residential registration. We seek to verify their place of origin and the family relation register. Thus such person must write their mother and father’s names.
4. In the Family Relation Register category, those who once had a domestic residential registration should mark the box indicating so, and write the last address they lived in when they were in Korea. For those who have never had a domestic residential registration, they should check the corresponding box and indicate their place of origin as indicated by the family relation register.
5. For home/work and cell phone numbers, please write the contact information at which you can be reached in the country you are currently residing. Please include the country code, the area code and then your phone number.
☞ Your phone number will be used to contact you regarding election information including checking requirements, ballot information, reception of postage materials, place and duration of the vote, among other things.
6. Your email address will be used to communicate and disseminate materials produced by the National Election Commission, information regarding political parties and candidates, information regarding polling locations and dates, notification regarding registration onto the electoral register, directions and results of this application, and other relevant materials and notifications. In order to receive these things, you must write your email address.
7. You must write your current address in the country of residence carefully within the lines to receive mailings in accordance to the directions written below.
▪ In the area denoted as “Required”, please write your address and country of residence in roman characters or English ▪ In the area denoted as “Optional”, please include your address and country of residence in the
official language of the country in order to increase the ease of delivery by your local postal office.
Please indicate the name you use to receive mail and the family name or an attention line if used.
☞ For those whose mailing addresses are unstable due to work, moving or business, or for those whose postage is affected by the conditions of the country of residence, you may use a public institution, such as the consulate, as your mailing address. In this case, please check the box noting that you are using a public institution’s address and please write the name of the public institution in the address box.
8. In the area denoted as polling location preference, please write the name of the public institution that you prefer as a polling location.
9. You must include your passport and recognized official documents verifying your nationality, or documentation confirming your dual citizenship. Also, please check the relevant box indicating which documents you are submitting. When submitting documents not specified by the current categories, you must write the name of the document in the area indicated as miscellaneous.
① Recognized documents verifying nationality (Issued by the country of residence)
➩ Any one of the following documents indicating nationality issued by the country of residence: visa, immigration documents, long-term residency documentation or other foreign residence certificates.
➩ Please see http://ok.nec.go.kr to look at the types of documentation accepted by country or residence.
② Documentation regarding dual citizenship (Your dual citizenship must be officially recognized, and documentation must be issued by the Republic of Korea)
➩ Instead of the documents indicated above ①, you may use the acquisition of nationality certificate, foreign nationality renunciation certificate, retaining nationality certificate, the nationality choice certificate, the foreign nationality abandonment confirmation document, or documentation proving military service to verify dual citizenship.
☞ Attached documents should clearly show the contents of your documents and clearly show your picture, signature and date. The copies must be clean and letter-sized. When submitting the application, original documents must be shown or the application will not be accepted.
10. Towards the end, where it says “Applicant”, please write your name, and sign it or include your seal.
