CEF-1A

Republic of the Philippines

COMMISSION ON ELECTIONS
Application No. Precinct No.
Instructions : (1) Accomplish separately in three copies; (2) print legibly; (3) check the appropriate box.
Part 1
Name Illiterate Person with Disability
Last Assisted by:
First
(Please fill-up Assistor's Oath)
Middle Gender
RESIDENCE/ADDRESS Province Height Weight
City/Municipality Barangay DATE OF BIRTH
- -
House No. / Street
PLACE OF BIRTH
CITIZENSHIP By Birth Naturalized Reacquired
(If naturalized/reacquired, state date of naturalization/reacquisition and Certificate number of naturalization/order of approval of reacquisition)
Date of Naturalization/ Certificate No./Order of Approval CIVIL STATUS
Reacquisition Single Widow/er
PERIOD OF RESIDENCE Married Legally
No. of Years No. of Months No. of Years Separated
In the City / Mun in the Philippines Name of Spouse, if married
PROFESSION / OCCUPATION TIN - -
NAME OF FATHER NAME OF MOTHER
Last Last
First First
Middle Middle
Part 2 OATH
DATE - -
1. 2. 3.
Part 3 ACTION BY THE ELECTION REGISTRATION BOARD
Month Day Year
Approved - - With precinct assignment No.
Disapproved Date Reason for disapproval
Part 4
Prov Code PRECINCT NO.
DATE OF BIRTH
Last
First
Middle
Downloaded from: http://www.comelec.gov.ph
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Month Day Year
CITY/MUN/
DISTRICT CODE
Left Thumb Right Thumb
Member
(Signature above Printed Name)
Chairman of the Board
APPLICATION FOR REGISTRATION
Day Year
VOTER IDENTIFICATION NUMBER (To be filled out by Election Officer)
(Signature above Printed Name)
Member
Above Printed Name
EO / Administering Officer
(Signature above Printed Name)
(Signature above Printed Name)
I do solemnly swear that the above statements regarding my person are
true and correct; that I possess all the qualifications and none of the
disqualification of a voter; that I have no pending application for registration in
any city/municipality; and that I am not registered in any precinct in the
Philippines.
Signature of Applicant Month
Month Day Year
(Voters Registration Record upon approval by the ERB)
PERSONAL INFORMATION (To be filled out by Applicant)
ROLLED THUMBPRINTS / SPECIMEN SIGNATURES
City/Mun
Province
Female Male
Month Day Year
ACKNOWLEDGEMENT RECEIPT Application No.
Application for Registration
EO/Interviewer Signature above Printed Name
This is to acknowledge receipt of your Application for
registration. You are not yet registered unless approved by the
Election Registration Board (ERB). You need not appear in the
ERB hearing unless required through a written notice.
S A N T O S
D O L L Y A N N J O Y
A B E L L A N A
Q U E Z O N C I T Y B A T A S A N H I L L S
L T. 1 5 B L K. 3 T A R N A T E S T R E E T
FILIPINO
1 9 0 7 1 9
1 2 2 3 1 9 9 4
QUEZON CITY
S A N T O S S A N T O S
D A N I L O R O D A L L A
A B E L L A N A
Downloaded from: http://www.comelec.gov.ph CEF1-A: COPY FOR THE ELECTION OFFICER (BACK)
VOTING RECORD
DATE Ballot No.
Voter's
Chairman's Signature
Thumbmark Signature
CEF-1A
Republic of the Philippines
COMMISSION ON ELECTIONS
Application No. Precinct No.
Instructions : (1) Accomplish separately in three copies; (2) print legibly; (3) check the appropriate box.
Part 1
Name Illiterate Person with Disability
Last Assisted by:
First
(Please fill-up Assistor's Oath)
Middle Gender
RESIDENCE/ ADDRESS Province Height Weight
City/Municipality Barangay DATE OF BIRTH
- -
House No. / Street
PLACE OF BIRTH
CITIZENSHIP By Birth Naturalized Reacquired
(If naturalized/reacquired, state date of naturalization/reacquisition and Certificate number of naturalization/order of approval of reacquisition)
Date of Naturalization/ Certificate No./Order of Approval CIVIL STATUS
Reacquisition Single Widow/er
PERIOD OF RESIDENCE Married Legally
No. of Years No. of Months No. of Years Separated
In the City / Mun in the Philippines Name of Spouse, if married
PROFESSION / OCCUPATION TIN - -
NAME OF FATHER NAME OF MOTHER
Last Last
First First
Middle Middle
Part 2 OATH
DATE - -
1. 2. 3.
Part 3 ACTION BY THE ELECTION REGISTRATION BOARD
Month Day Year
Approved - - With precinct assignment No.
Disapproved Date Reason for disapproval
Part 4
Prov Code PRECINCT NO.
DATE OF BIRTH
Downloaded from: http://www.comelec.gov.ph
APPLICATION FOR REGISTRATION
(Voters Registration Record upon approval by the ERB)
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PERSONAL INFORMATION (To be filled out by Applicant)
Male Female
Month Day Year
City/Mun
Province
Month Day Year
Member Chairman of the Board Member
ROLLED THUMBPRINTS / SPECIMEN SIGNATURES
I do solemnly swear that the above statements regarding my person are
true and correct; that I possess all the qualifications and none of the
disqualification of a voter; that I have no pending application for registration in
any city/municipality; and that I am not registered in any precinct in the
Philippines.
Month Day Year Signature of Applicant
Above Printed Name
Left Thumb Right Thumb
EO / Administering Officer
(Signature above Printed Name)
(Signature above Printed Name) (Signature above Printed Name)
(Signature above Printed Name)
VOTER IDENTIFICATION NUMBER (To be filled out by Election Officer)
CITY/MUN/
DISTRICT CODE
Month Day Year
S A N T O S
D O L L Y A N N J O Y
A B E L L A N A
Q U E Z O N C I T Y B A T A S A N H I L L S
L T. 1 5 B L K. 3 T A R N A T E S T R E E T
FILIPINO
1 2 2 3 1 9 9 4
QUEZON CITY
S A N T O S S A N T O S
D A N I L O R O D A L L A
A B E L L A N A
1 9 0 7 1 9
CEF-1A
Republic of the Philippines
COMMISSION ON ELECTIONS
Application No. Precinct No.
Instructions : (1) Accomplish separately in three copies; (2) print legibly; (3) check the appropriate box.
Part 1
Name Illiterate Person with Disability
Last Assisted by:
First
(Please fill-up Assistor's Oath)
Middle Gender
RESIDENCE/ ADDRESS Province Height Weight
City/Municipality Barangay DATE OF BIRTH
- -
House No. / Street
PLACE OF BIRTH
CITIZENSHIP By Birth Naturalized Reacquired
(If naturalized/reacquired, state date of naturalization/reacquisition and Certificate number of naturalization/order of approval of reacquisition)
Date of Naturalization/ Certificate No./Order of Approval CIVIL STATUS
Reacquisition Single Widow/er
PERIOD OF RESIDENCE Married Legally
No. of Years No. of Months No. of Years Separated
In the City / Mun in the Philippines Name of Spouse, if married
PROFESSION / OCCUPATION TIN - -
NAME OF FATHER NAME OF MOTHER
Last Last
First First
Middle Middle
Part 2 OATH
DATE - -
1. 2. 3.
Part 3 ACTION BY THE ELECTION REGISTRATION BOARD
Month Day Year
Approved - - With precinct assignment No.
Disapproved Date Reason for disapproval
Part 4
Prov Code PRECINCT NO.
DATE OF BIRTH
Downloaded from: http://www.comelec.gov.ph
APPLICATION FOR REGISTRATION
(Voters Registration Record upon approval by the ERB)
C
O
P
Y

F
O
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T
H
E

C
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N
T
R
A
L

F
I
L
E
PERSONAL INFORMATION (To be filled out by Applicant)
Male Female
Month Day Year
City/Mun
Province
Month Day Year
Member Chairman of the Board Member
ROLLED THUMBPRINTS / SPECIMEN SIGNATURES
I do solemnly swear that the above statements regarding my person are
true and correct; that I possess all the qualifications and none of the
disqualification of a voter; that I have no pending application for registration in
any city/municipality; and that I am not registered in any precinct in the
Philippines.
Month Day Year Signature of Applicant
Above Printed Name
Left Thumb Right Thumb
EO / Administering Officer
(Signature above Printed Name)
(Signature above Printed Name) (Signature above Printed Name)
(Signature above Printed Name)
VOTER IDENTIFICATION NUMBER (To be filled out by Election Officer)
CITY/MUN/
DISTRICT CODE
Month Day Year
S A N T O S
D O L L Y A N N J O Y
A B E L L A N A
Q U E Z O N C I T Y B A R A N G A Y H I L L S
L T. 1 5 B L K. 3 T A R N A T E S T R E E T
1 2 2 3 1 9 9 4
QUEZON CITY
1 9 0 7 1 9
S A N T O S S A N T O S
D A N I L O R O D A L L A
A B E L L A N A