[INSTRUCTIONS; (Read welt before fillingup this form.

)
I. 1. File this In HVE (5) LEGIBLE copies. . .'
2. File this certif~te of candidacy with the law Department. COMELEC (',1alnOffice, Intramuros. Manila, starting November 20, 2009 up to

I
mldnight'of November 30, 4009. .
3. Attoch to this certificate the Certiflcate of Party Nomination unless you are an Independent candidate. After midnight of November 30, 2009, no
certtficate of nornrnanon shall be accepted.
4.. TItles such as 'Dr., Atty., Don, Glnoo. Senor. Datu. Hadjl. Sultan, Bal, Senora, Kapitan or similei' titles are expressly prohibited,
I. 5~ This certificate shall 'be sworn before a notary public or any offldal authorized to administer oath. COMElEC offiqal;; are not authorized to
~:=;:""",,,,===' adminlster.oath.

3. MY GENDER IS :

1.1 last Na:ne r~:]~:j:~:r:jI~:r~I.~:r~l::::t:::I:::r:::I::T.·.·L':f:::T::I:::r:.·:L:.r:::C:CI::J:::l

o Male G2J~emale. ..-£9 .. ...".
5. MY DATE OF BIRTH is ;

,::=~I~t~!:flf!~~lt[:Ff::EFFFf-+++++l++IF\
. 2.';[ J"M GENERALLY OR POPULARLY KNOWN BY THE NICI{NAME
(r"1(jjcate only one nickname or stagename)
OR STAGENAME
Cityjl'lun
f§[.¥J -[~T~j- T§:[~lg
6. MY PLACE OF BIRTH IS :
Day

.. 9.~.~.~.?~
.. C:~~'!
Year-

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~~.~~.~.~.~.~~&p.~.~~~;&~Z~~~~~.~~~:~~~~:.~~:~.~:~~~
, _............
0 .'
0
DO' Political Par .
Single
Married
Wldow/e
r

. Legally separao
ed

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__.l...L.~..L.; 10. MY PROFESSION OR
9.4 House No·1 Street 1 SubdMslon . . OCCUPATION IS:

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12.1 AMA REGISTERED VQTER OF
.
11; MY POST OFFICE AODRESS FOR.·ElECf ION PURPOSES. IS ~ (Could be the same as No.9)
Precinct _.. g!L2..'9~ " __
".
....-.__ ~~:~~_~ ..~y.~ __ jY!.-A4:.7B~~ _ ~_ _ .
1:3; MY PERIOD OF RESIDENCE IN TH~ PiiIUPP-INESm::fORI,: MAY 10, 2010I5:
6gy .".~~~~:c:-.~.!_."." _
r~'------'" r---.- ...---- City/lvf\JnMAS~:'(.x\C err"
i .! i
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No. of .M\lnth~ ir;;.l--.----.!.2. j
••••
No. of Ye~rs Province ·- .• ~i\N;,~Ta""....-·..·....··..·

· :t4·. I AM A NATURAL BORN FIUPINO CITIZEN.

· 15. I AM NOT A P.ERMANENT RESIDENT OF, OR IMMiGRANT TOI A FOREIGN
COUNTRY.
16. I AM EUGIBLEFOR THE OFFICE I SE~K TO BE ELECTED TO.
11. r WILL SUPPORTAND DEFEND THE CONSTITUTION· Of THE REPUBLIC OF TI-IE
PHILIPPII\jES.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 OBLIGATION UPON J<1YSELF
I VOLUNTARILY, WITHOUT MENTAL RESERVATION OR PURPOSE OFEVASION.

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. meT,\;. N\. ·E.s.P~-.9s/",
- SlgnatlJre of Can(1tdate over Printed Narr.e

'. . . . . . OATIl
· .SUBSCRIBED AND SWORN to before me this l.v/day of JJ«YrrftJl5l,-4.'609, at /l11t1:::J~ .f ~Aant e~hibiti':'g to me his/her
CTCfldent!flcation Card iIIo-. Q2>04q&9) 1 .Issued by : ~q ,;2'" /1" 1/.a . On; Co 2 -~ .

~;~~%:..2 f& . ~l

Book. No•. -;;:tjJ ~

Series of 200...;.0/ .