Appoint Party Agent	
Completing this form
•	This form is used by a registered political party to appoint a party agent (and revoke a previous agent).
•	The party agent is responsible for lodging the annual financial disclosure returns for the party and any election funding owed to the party is paid through the party agent.
•	This form must be signed by both the party secretary and the party agent.
•	Further information is provided in the Guide for registering a party available at www.aec.gov.au.
•	This form is to be completed with reference to the Guide for registering a party.
•	The information on this form is collected under the Commonwealth Electoral Act 1918 (Electoral Act) and is not made public.
•	The conditions for appointing a party agent are outlined in section 292F of the Electoral Act. 

Name of political party	     	
Name of agent revoked	     	
Name of secretary	     	

I advise the revocation of the appointment of the agent named above (if applicable) and appoint the person whose details appear below as agent for the party.

Secretary signature		Date:	

New Party Agent’s details
Please note the party agent details are entered in the Register of Party Agents and are not published on the AEC website.
Title	     	
Name	     	
Street address*	     	
	address cannot be a post office box address, but can be a business address for the party	
	Suburb/town	     	State      	Postcode      	
Postal address	     				
	Suburb/town	     	State      	Postcode      	
Daytime	Telephone (   )       	After hours (   )       	
Mobile	     	Fax number (   )       	
Email address	     	
*The street address does not have to be the party agent’s residential address and can be an alternate street address such as the party’s office street address. Note: the street address will appear in published disclosure returns and consideration should be given if this is a personal, residential address. 
Please complete and return both pages

Declaration
•	I declare that I am 18 years of age and have not been convicted of an offence against the funding and disclosure provisions of the Electoral Act.
•	I consent to being appointed as the Party Agent.
•	I understand that giving false or misleading information is a serious offence.

Signature			
	Capacity      	Date      …./…./….