OSCEs Parlamentariske Forsamling 2011-12
OSCE Alm.del Bilag 15
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EARLY ELECTIONOF DEPUTIES TO THE MAZHILISOF THE PARLIAMENT AND REGULAR ELECTION OF DEPUTIESTO THE MASLIKHATS OF THE REPUBLIC OF KAZAKHSTAN15 January 2012APPLICATION FORMFOR AN OBSERVER OF FOREIGN STATE,INTERNATIONAL ORGANIZATIONGiven names ___________________________________________________________________Surname ______________________________________________________________________Date of birth ___________________________________________ SexMaleFemale
Passport No. _______________________________ Date of issue ________________________Issued by _____________________________________________________________________Place of work ________________________________________________________________________________________________________________________________________________Position ______________________________________________________________________Country/organization, which you represent: __OSCEParliamentary Assembly____________Citizenship ____________________________________________________________________Will you observe elections within the framework of international mission?Yes No
If yes, please specify the name of international mission:___OSCEParliamentary Assembly____Election observation experience (country) ________________________________________________________________________________________________________________________________________________________________________________________________________Telephone__________________ Mobile______________________Fax____________________E-mail ________________________________________________________________________Date of arrival to the Republic of Kazakhstan _________________________________________Date of departure from the Republic of Kazakhstan ____________________________________
Signature ______________________
Date ________________________________

Note: Conduct of accreditation is to be completed on 9 January 2012.