Ministry of the Interior - Cerfa n° 16199*01

WARNING: Depending on the browser used (Chrome, Firefox, Internet Explorer, Microsoft Edge, Safari ...), the document in PDF format is displayed in another page or tab or is downloaded in your Downloads folder (or another folder if you have a custom configuration on your computer or smartphone). If you are using the Firefox browser, please save the PDF document to your device before completing it.

This form is to be used if you and/or the person to whom you give power of attorney is registered on a New Caledonian voters list.

You can:

• Either fill out the online form and print it on 2 sheets (no double-sided)
• Either print the form on 2 sheets (no double-sided), then fill it by hand (legibly and without breaks)

To fill out the form:

• In the case of the elector responsible for voting for you, you must indicate his or her surname, first name, date of birth, address, commune or registration consulate.
• You do not need to complete the administration sections.

Go to the online administrative form

Verified 23 October 2023 - Directorate for Legal and Administrative Information (Prime Minister)