Annex F-12

Republic of the Philippines

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COMMISSION ON ELECTIONS
Manila

CERTIFICATE OF CANDIDACY FOR

MEMBER, SANGGUNIANG PANLUNGSOD

(1-1/2 x 1-1/2)

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

1. File this in FIVE (5) LEGIBLE copies with the COMELEC Office concerned, during regular office hours (8:00 AM to 5:00 PM

ONLY), on any day from October 12, 2015 to October 16, 2015.

2.
3.

Attach to this certificate, the Certificate of Nomination and Acceptance (CONA), if any.
This certificate shall be sworn before a notary public or any official authorized to administer oath. COMELEC officials are not
authorized to administer oath, even in their capacities as Notary Public.
No filing fee shall be imposed.

4.

I hereby announce my candidacy for the position of M EM BER , SAN GGUN I AN G PAN LUN GSOD , ______________
District,
THIRD
TUGUEGARAO Province of ______________________
City of __________________,
, in the May 09, 2016 National and Local Elections; and
CAGAYAN
after having been sworn to in accordance with law, I hereby state the following:
1. NAME :

14. GENDER :

1.1 Last Name

C A T A BAY

1.2 First Name

Male

MA R T I N

1.3 Middle Name

2. NICKNAME OR STAGENAME : (Indicate only one nickname or stage name)

MA R

11

0 5

1 951

Month

Day

Year

17. PLACE OF BIRTH :

City/Mun

3. OFFICIALLY NOMINATED BY : (Attach Certificate of Nomination)

Province

NATIONAL UNITY PARTY (NUP)

(Political Party/Coalition of Political Parties)

Single

MA R

(Last Name, First Name OR Nickname and Acronym of Political Party Affiliation as stated in Items 1 to 3)
(In case of a legally married female candidate, she has the option to choose either her maiden name, married name or both)

Full Name of Spouse, if married

CA GA YA N

5.2 City/Municipality

T UGU EGA RAO

RIZALINA C. CATABAY

5.3 Barangay

19. PROFESSION OR OCCUPATION :

C A T A G G A M A N VIEJO

RETIRED MILITARY OFFICER

5.4 House No./ Street / Subdivision

P R OV I NC I A L

20.

R O A D

I AM A REGISTERED VOTER OF:

6. ADDRESS FOR ELECTION PURPOSES : (Could be the same as No.5)

I WILL BE A REGISTERED VOTER OF:

#14 PROVINCIAL ROAD, CATAGGAMAN VIEJO, TUGUEGARAO CITY

Barangay

7. PERIOD OF RESIDENCE IN THE PHILIPPINES UP TO THE DAY BEFORE MAY 09, 2016 :
7.1
7.2

Widow/er

Married

5. RESIDENCE/ADDRESS :
5.1 Province

TUGUEGARAO CITY
CAGAYAN

18. CIVIL STATUS :

4. Name to appear on the Official Ballot not to exceed thirty (30) characters :

1 4

63

Female

16. DATE OF BIRTH :

A NO G

C AT AB AY

15. AGE :

In the Philippines:

6 3

In the above-stated District/City:

6 3

No. of Years

0 6

No. of Months

No. of Years

0 6

No. of Months

CATAGGAMAN VIEJO

City/Mun

TUGUEGARAO

Province

CAGAYAN
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8.
9.
10.
11.
12.

I AM A FILIPINO CITIZEN.
I AM NOT A PERMANENT RESIDENT OF, OR AN IMMIGRANT TO, A FOREIGN COUNTRY.
I EXECUTED A SWORN RENUNCIATION OF FOREIGN CITIZENSHIP. (IF APPLICABLE, ATTACH A COPY)
I AM ELIGIBLE FOR THE OFFICE I SEEK TO BE ELECTED TO.
I WILL FILE, WITH THE OFFICES OF THE COMMISSION, WITHIN THIRTY (30) DAYS AFTER ELECTION DAY, MY FULL,
TRUE AND ITEMIZED STATEMENT OF CONTRIBUTIONS AND EXPENDITURES (SOCE) IN CONNECTION WITH THE
ELECTION.
13. 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 OF EVASION.

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I hereby certify that the facts stated herein are true and correct to the best of my knowledge.

MARTIN A. CATABAY
Signature of Candidate Over Printed Name
OATH

SUBSCRIBED AND SWORN to before me this ____ day of _____________, 2015, at ______________, affiant exhibiting to me an
Identification document/card which contains a photograph and signature bearing No. ____________________ issued by __________________ on
_______________.
Doc. No. _______;
Page No. _______;
Book No. _______;
Series of 2015.

(Affix P15.00 documentary stamp)

THIS FORM CAN BE PHOTOCOPIED OR REPRODUCED AND IS AVAILABLE AT THE COMELEC OFFICES FREE OF CHARGE
OR MAY BE DOWNLOADED FROM THE COMELEC OFFICIAL WEBSITE (www.comelec.gov.ph)

___________________________________
(Officer Authorized to Administer Oath)
09/15/15