Are you a citizen of Ireland?*

Yes No

Date of Birth (dd-mm-yyyy):*

TCD Student/Alumni Number*

Email*

Surname*

Other Name(s):*

Permanent Address at which you were normally resident on the 15th day of November last:

Address *

State the Address to which you desire the ballot paper to be sent to (this should be the same as your permanent address), other than in exceptional circumstances):

Any false declaration for the purpose of this claim will render the claimant liable to a penalty.

Address *

Any change in address should always be notified to the Seanad Electoral Office (i.e. Academic Registry) of the University promptly; otherwise the ballot paper may be lost, and your name removed from the electoral register).

State the degree (other than an honorary degree) with the date on which it was conferred, in respect of which the franchise is claimed (or particulars, including the date of any foundation/non-foundation scholarship obtained).

Degree*

Year*

Foundation/Non-Foundation Scholarship*

Yes No

Year

I declare that the particulars given in this online form of claim are true and accurate to the best of my knowledge and belief, and I hereby claim to be registered as a University Elector for the Constituency of Dublin University.

Full Name*

Date of Birth (dd-mm-yyyy):*

Do you agree to have your name included in the edition of the Register available to the public?*

Yes No

Note: that this may be used for commercial purpose. 

Data Protection

The data collected on this form are being obtained by Trinity College Dublin, the University of Dublin for the purposes of maintaining the Seanad Eireann Electoral Registers for the Dublin University Constituency. Personal data will not be processed, other than as permitted by law.

Those providing personal data have the right to access those data and the right to rectify them. Personal data will be processed by Trinity College Dublin, the University of Dublin, in accordance with the Data Protection Act 2018.