Republic 9f the Phillppines .

COMMlS810NON ELECTIONS
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INSTRUCTIONS: (Read well before filling up this form.) ,

1. File this In ,FlVE (5) LEGIBLE copies.; . . ". .
2. File this certificate of candidacy with the Law Department, COMElEC Main ornee,lntramuros, Manila, starting November 20, 2009 up to
midnight of November 30, 2009. . , .' '. " .
3. Attach to tills certificate the Certificate of Party Nomination unless you are an independent candidate. After midnight of November 30, 2009, no
certificate of nomination shall be accepted. .
4. . Titles such as 'Dr., Atty., Don, Glnoo, Senor, Datu, Hadjl, Suftan, Bal, Senora, Kapitan or similar titles are expressly pr-:hlbited. .
5. This certificate shall be sworn before a notary publlc or any offtelal authorized to' administer oatil. COMELEC offiCials are not authorized) to
administer oath.

7. I Af'" OFfICIALLY NOMINATED BY: (Attach Certificate or Nomination)

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ADDRESS IS : . . 9.1 Province ~!~r!J.~l~__
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r:·JII1LI!t~{~~rJ~[fLJtr~Ifr~L~IJ!flf]!fI~I~1~[~~~~~Cr~ 12. I AM A REGISTERED VQTER OF

11: MY POST OfFICE ADDRESS FOR ELECTION PURPOSES IS : (Could be the sameas No.9)

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:13. MY PERIOI:> OF RESIDENCE IN THE PHILIPPINES BEF.OREMAY 10,2010 IS:
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No. of Months
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No. of Yea~
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pro~lnce ..M'e"J1YIX :M.kI:,J. 1#:..,,'__
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14. I AM A NATURAL BORN FIUPINO CITIZEN.
15. I AM NOT A PERMANENT RESIDENT OF, OR IMMIGRANT TO, A FOREiGN
COUNTRY. '
", I AM EUGIBLE FOR THE OFFICE I SEEK TO BE ELECTED TO.
J,' I WILL SUPPORT AND DEFEND THE CONSTITUTION OF THE REPUBLlC OF THE
PHIUPPINES AND WILL MAINTAIN TRUE FAITH AND ALLEGIANCE THERETO. I
WILL OBEY THE LAWS, LEGAL ORDERS AND DECREES PROMULGATED BY THE
,DULY CONSTITUTED AUTHORITIES. I IMPOSE THIS iOBUGA110N UPOI\! .MYSELF
VOLUNTARILY, WIl1--l0UT MENTAL RESERVATION OR PURPOSE OF EVASION.

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I hereby certify that the facts stated herein are true and

Signature of Candidate Over Printed Name

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