Personal Information

Full Name (As per National ID or Passport) *

Date of Birth (DD/MM/YYYY) *

National ID Number *

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Gender
MaleFemale

Mobile Number * (+230)

WhatsApp Availability
My mobile number is registered on WhatsApp

Alternative Contact Number (Optional)

Residential Address *

Email Address *

Constituency
1.Grand River North West and Port Louis West2.Port Louis South and Port Louis Central3.Port Louis Maritime and Port Louis East4.Port Louis North and Montagne Longue5.Pamplemousses and Triolet6.Grand Baie and Poudre d'Or7.Piton and Riviere du Rempart8.Quartier Militaire and Moka9.Flacq and Bon Acceuil10.Montagne Blanche and Grand River South East11.Vieux Grand Port and Rose Belle12.Mahebourg and PlaineMagnien13.Riviere des Anguilles and Souillac14.Savanne and Black River15.La Caverne and Phoenix16.Vacoas and Floreal17.Curepipe and Midlands18.Belle Rose and Quatre Bornes19.Stanley and Rose Hill20.Beau Bassin and Petite Riviere21.Rodrigues

Profession/Occupation

Employer Name (Optional)

Skills/Expertise (Optional, to contribute to party activities)

Required Documents

All applicants must submit the following documents:

Upload Birth Certificate

I confirm that I have attached the required documents
Yes, I have attached my National Identity Card and Birth Certificate

Additional Documents

Upload CV (Optional)

Preferred Communication Method *

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Referral Information (Optional)

Referring Member's Full Name

Contact Number of Referrer

Volunteer Interests

Would you like to volunteer for any of the following activities?

Community OutreachEvent OrganisationPublic SpeakingAdministrative SupportFundraisingDigital Campaigns (Social Media/Website Management)Other
If Other, please specify:

How Did You Hear About Us?

Social MediaWord of MouthWebsiteNews MediaOther
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Code of Conduct

I acknowledge that as a member of Nouveaux Démocrates, I will: *

• Uphold the party's values of Democracy, Ecology, and Meritocracy.

• Respect the diversity of opinions and engage constructively with fellow members.

• Avoid any actions that may bring disrepute to the party.

• Follow the party's constitution and guidelines.

I agree to the Code of Conduct

Data Protection and Privacy

By signing this form, I consent to the collection, processing, and storage of my personal information by Nouveaux Démocrates in accordance with applicable data protection laws. *

I consent to my data being used for party-related activities

Declaration

By signing this form, I declare that: *

• I support the principles, values, and objectives of Nouveaux Démocrates.

• I am not a member of any other political party in Mauritius or elsewhere.

• The information I have provided is true and accurate.

• I undertake not to speak to the press regarding party matters without authorization.

• I will avoid any conduct that could undermine public confidence in Nouveaux Démocrates.

I confirm that I have read and agreed to the declaration terms

Submission of Completed Forms

You can submit your completed form via:

• **Hard Copy:** Deliver in person at our offices.

• **Soft Copy:** Email to info@nouveauxdemocrates.com or WhatsApp at 5989 3515.

Signature

Type Your Full Name as Signature:

Date