2Form for petition Empowered by s 28(3)
Application for inquiry into conduct of referendum
No:
In the High Court of New Zealand
Registry:
In the matter of the referendum held on [date] on [issue].
Applicant
| *Select one. |
- through a lawyer, who is [name, address]; or
- through its spokesperson.
Application
| *Select those that apply. |
- the conduct of the referendum:
- the conduct of [name of person complained of, address], who was connected with the referendum:
- the declared result of the referendum was wrong:
- irregularities in the conduct of the referendum materially affected the result:
- irregularities in the conduct of any person connected with the referendum materially affected the result.
| *Select those that apply. |
| *Select one. |
- determine the total number of valid votes recorded for the options in the referendum:
- declare the referendum void.
Address for service
Signature:
(Spokesperson for applicant/Person on behalf of spokesperson for applicant*)
| *Select one. |
Appendix
| Members of applicant group | |||
| Name | Address | Electoral district | Signature |



