Form 3—Ballot paper under Part 3 of ChapForm 3—Ballot paper under Part 3 of Chapter 3

## Form 3—Ballot paper under Part 3 of Chapter 3 (regulation 90A) Fair Work (Registered Organisations) Act 2009, section 102 | BALLOT OF MEMBERS OF(Name of constituent part of organisation)BALLOT PAPER IN RESPECT OF PROPOSED WITHDRAWAL FROM AMALGAMATED ORGANISATIONCLOSING DATE OF BALLOT: (Date) | (Initials, or facsimile of initials, of the person conducting the ballot) | | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------ | ------------------------------------------------------------------------- | Directions to Voter 1. Record your vote on the ballot paper as follows:  if you approve the withdrawal of the constituent part from the amalgamated organisation referred to in the question set out below, write “YES” in the space provided opposite the question;  if you do not approve the withdrawal of the constituent part from the amalgamated organisation referred to in the question set out below, write “NO” in the space provide opposite the question. 2. Do not place on this paper any mark or writing by which you may be identified. QUESTION FOR VOTERS: | DO YOU APPROVE THE PROPOSED WITHDRAWAL OF (name of constituent part of organisation whose members are voting) FROM (name of amalgamated organisation from which withdrawal is proposed) AND ITS REGISTRATION AS A SEPARATE ORGANISATION UNDER THE FAIR WORK (REGISTERED ORGANISATIONS) ACT 2009? | | | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ | --- |