Republic ofthe Philippines

COMMlSSrON ON ELECTIONS
Manila
TIME:
CERTIFICAl'E
SENATOR
I INSTRUCTIONS:
1.
(Readwell before filling up this form.)
Filethis in FIVE (5) LEGIBLEcopies.
2. File this certificate of candidacy with the Law' Department, COMELEC Main Office, Intramuros, Manila, starting November 20, 2009 up to
midnight of November30, 2009.
3. Attach to this 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, Ginoo,Sefior, Datu, Hadji, Sultan, Bal,Senora,Kapitanor similar titles are expresslyprohibited.
5'- This certificate shall be sworn before a notary public or any official authorized to administer oath. COMELEC .officials are not authorized to
administeroath.

1. MY NAME IS : 3. MY GENDER IS : 4, MY AGE IS :

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::., [2] Male • OFemaie . ,G5, ,,'" ,' ,,

1.1 Last Name
:-tf!, J!",:!:.l! ,:,~ ;O,~«,~__:... :__,~.. !.." __;., .:,__!,,; __,.:.,:".:__ '''..:..,:,_._ __ ,
: .. ~.. -:-- . ~- . : - .'~- . -:-. -:- . -~.. : - - ~- . -:- . -f' - : - . -:-.- - ~- - : . - -:- - -:- - . ~. - ~- - : - - ~. - .:- . -;- . ': 5. MY DATE OF BIRTH IS :

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1.2 First Name
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1.3 ~1iddleName r~_r_[ ,~I __I__J~',1'~,T, ~~:.:: ; '.~-:: : T. ::~. : ~:,~: : ~',~:: T'.I :',l •..

Honth
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6. MY PLACE OF BIRTH IS :
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Day
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Year

2. I AM GENERALLY OR POPULARLY KNOWN BY THE NICKNAME OR STAGENAME

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.. _,.'_..__.. _...._ '1' • _" _. r __ , • _ ',_ •• r _ • , •• ',' • ',' • _ ~ • ~ •• __ ~ __ ..• , __ • ~ __ ,
City/Mun ,tJ1. ~,If!l{RJJ. , ' .. '
Province _J~JLO __..... ._
;7:.(f:A-:-l:/l:"l " . 0"' __ ._

~--------"~"-:~--~:~'~"~"-'~':-'-'~"~'~:~"~'~--~'-"-',~,~,~,,~'---'~:'-'~:~"~-'~--~'-'~"-:-'~'~"~---'-'~"~'·-'~:'~·~··~··~'~·'~"~:~"-:-·----'-'-'·'-'~'-+8.MYCIVILSTATUSIS:
7. I AM OFFICIAllY NOMINATED BY: (Attach Certificateof Nomination)
o Single 0 Widow/er
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o Married 0 LegallySeparated

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9, MY RESIDENCE! , • , , • : ' : : • : • , , , I

AnnulledI Divorced
ADDRESS IS:
9.1 Province
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Full Name of Spouse, if married
,9:2 ~ity/:1~ni~i~I:~ __."
,fOM 9.~ ~~ang~y, '.' , '" ',' , '. ' '.' '. ' ' : __'" '; __': __';' __,
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~~(~;,. ,:,<,', ,7.,~,~,,; f 1, «. ~,~,~f.',':L,__=.e~,~,~ 10. MY PROFESSION OR

$~.;{3:" ~ ';--:;'~'~" ~'';:'-,T'':~'~'?'+~'~":f':&'r~'fi1" '~':O'~' f;;]'~' '1''. ,c«

9.4 HouseNo./ Street I Subdivision OCCUPATION IS : r

tiff. .1}!? m,ffl,~ftfJ1)NJ'-T!qr! ,g f)

11. MY POST OFFICE ADDRESS FOR ELECTION PURPOSES IS : (Couldbe the sameas No.9) 12. I AM A REGISTERED VOTER OF

Precinct ,1!!ltf. -::e"",,""""""'"

13. MY PERIOD OF RESIDENCE IN THE PHILIPPINES BEFORE MAY 10,2010 IS :
Bgy J'JttJ, ,lhltl!QJN. .PE, ,fDl;P.,FJ;"
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,fltP--!tNII,CWf, .", .' . , ." ,.,

:0 :S-: No. of Months :C.f.: No.of Years
aty/l~un

Province .. NCtt .... _... _.. _,_.... '.,_' ,, _

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14. I AM A NATURAL BORN FILIPINO CrnZEN.
15. I AM NOT A PERMANENT RESIDENT OF, OR IMMIGRANT TO, A FOREIGN
COUNTRY.
16, I A~1 ELIGIBLE FOR'THE OFFICE I SEEK TO BE ELECTED TO.
17. I WILL SUPPORT AND DEFEND THE CONSTITUTION OF THE REPUBLIC OF THE
PHILIPPINES 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 MYSELF
VOLUNTARILY, WITHOUT MENTAL RESERVATION OR PURPOSE,9F EVASION.

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I hereby certify that the fads stated herem are true and correct of my own pez~e~~:: IA

I:t1=crofR A4 -mBJ?1f ::tl>N},

Signature of Candidate Over Printed Name

SUBSCRIBED AND SWORN to before ml£l,ls __

- tll\ID~.) dayJof . mml
'~6'er, 2009,W-Sfll'
~OF.~AN.lIillll.J
, .., ";'ii1'flBffiexhibiting to me hts/her
CT(JJdentification card No. 33~S9S ~311~'3 Issued by : __ .LL~ On : _

Doc. No. ---,jq~~,,--

__
Page No. _41:1'-0 ,
Book No. --..=It=-- __ . (Officer Authorized to Administer
Series of 20QlJ (Affix documentary stamp) ATTY. BENZ \oJ DD C. C NG
NOTARY PUBLIC
r.OMMI:=:S!ONEDUNTil3'i Dt;: 2009
18P um No. 07232 'R!Z!\l-S,~N JUAN
!~fR NQ. 0076180 - (il/I)6/0~) - S~NdUAN