=' COMMISSION ON ELECTIONS

LAW D,EPARTMENT '

J

Republic of the Philippines

COM:1YllSSION ON ELECTIONS
Manila

CERTIFICATE 0
SEN'
INSTRUCTIONS: (Read vvell before filling up this form.)
1. File this In -AVE (5) LEGIBLE copies.. .
2., File this certificate of candidacy with the Law Department, COMEj;;ECMain Office; Intramuros, Manila. starting November 20, 2009 up to
midnight of November 30, 2009.' , ' .:,
3. Attach to this certificate the Certificate of Party Nomination unless YGlU are an independent candidate. After midnight of November 30, 2009, no
certincate Of nomination ,shall be accepted: ' ,
4 •. Tltles such as 'Dr" Atty., Don, Glnoo, Senor, Datu, Hadjr, sultan, 6aIJ.:;5efiori3,KapItan or similar- titles are expr-essly prohIbited.
5. This certificate shall be sworn before a 'notary ,public or any officl#i authortzed to administer oath. COI",ELEC'offtclals are not autnonzed to
administer oath. . I~

4. MY AGE IS:
21, r-,lale OFemale,
' LJ<2..
__._,_</2 .__
,
S. MY DATE OF BIRTH IS:
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"'1: I: : l"\; ;1
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.. l~_~L._~_:_
Month Day Year

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7. I AM OFFICIAll Y NO~INAT~,'2 (Att:~~ CT?t;J~natlnt.'~ ' , 0 Single 0 Widow/er
.-.--.------... -.----.--... --..--..--.l~·---·-·-·---poiitic,;n;,;,--·,---L.------- ..--.. -.... ---;.-r.~.- ..--..... ----..------- l2l Married, 0 Legally Separated
9. MY RESIDENCE/ .--.,-- .. ,.- ....---, .. -.,.--,-.--.- .. , ... -.---' .•.,:.. --_,.... c •.. r ,_. __ •__ ._,_._ ••

ADDRESS IS: 9.1 provincejci p. j Vi\ ili'Ci i i i j.!, j i i j i i j D Annulled I Divorced

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11. ~Y POST OFFICE ADDIlF~S
J:::IfI~I:t:I(:r~I~:J:::i-:l
FOR ElECTION PURPOS',ES IS: (CoJrd be the same as No:9) , 12_ I AM A REGISTERhD VQTER OF
..,
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l:Q.:~~1 No. of Months
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No. of Year~
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Pro~lnce
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I AM A NATURAL BORN FIUPINO anZEN_ " , ROLU:b THUMBPRINT
15. I AM NOT A PERMANENT RESIDENT OF, OR IMMIGRANT TO,iA FOREIGN
. .
COUNTRY. ' ,
16. I AM ELIGIBLE FOR THE OFFICE I SEEI< TO BE ELECTED TO.
17. I WILLSUPPORT AND DEFEND THE CONSTTruTION Of llilt: REPUBUC OF THE
PHIUPPINES AND WILL MAINTAIN TRUE FAITH AND, ALLEcj6:ANCETHERETO. I
WILL OBEY TI-lE LAYVS, LEGAL ORDEORS AND DECREES PRqWiULGATED BY THE
DULY CONSTITUTED AUTHORITIES; I IMPOSE THIS OBLIGAiION UPON MYSELF
VOLUNTARILY, WITHOUT MENTAL RESERVATION OR PURPOSE OF EVASION .

••••• ! ••••••••••••••••••••••••••••••••••••••••••.•••••••••.••.•••••••••• .:•••••••••.•••••••••••.

~ATH
_ SUBS.CRIBED AND SV'fP.~!o.b~.FOn';
Cl C(Identlficatlon Card No. U' ' 0Ct;2 ~ r
me,this~
Issued
, 'day of NOn~~r,
by : x:,f::::::'-
2009, at PA-<;:,\(;..,
On: ,:zC4.JYi
'-1' J
_ aff.ia~e~JPiii':'g
~ V--r
to me his/rer

Doc. No. t!
Page No. let
Book No.. __ --+I _
Series of 20o;:r.