Form AIE

COMMISSION ON ELECTIONS

AUTHORITY TO INCUR ELECTION EXPENDITURES

For the 09 May 2016 National and Local Elections

Date filed:

The undersigned candidate/party treasurer hereby grants the authority to incur election expenses to

his/her agent

(Surname)

(First Name)

(Middle Name)

Said person is authorized to incur expenses for/on behalf of the candidate or party for the upcoming
2016 NLE elections. He/she is only authorized to incur expenses with a maximum limit of

(
(Amount in words)

).

(Amount in figures)

AFFIX SIGNATURE HERE

Before printing, encode name here

[NAME OF CANDIDATE OR PARTY TREASURER]

Date signed:
PARTY INFORMATION: Accomplish this part only if you are the party treasurer
NAME of PARTY
TREASURER:
NAME OF
PARTY:

(SURNAME)

(FIRST NAME)

(COMPLETE NAME OF PARTY)

PARTY Political Party

TYPE: Party-List Group

(MIDDLE NAME)

(ACRONYM)

Contact information:
(Phone no. & e-mail address)

CANDIDATE INFORMATION: Accomplish this part only if you are a candidate)

NAME OF
CANDIDATE:
Elective
office
sought:
Name of
party:

(SURNAME)

(FIRST NAME)

(MIDDLE NAME)

District,
Municipality/city/province
of elective office:
Contact information:
(Phone no. & e-mail address)

AGENT INFORMATION: (Person authorized to incur expenditures, whose name appears in main body)
Home/Office
Address:
Telephone &
Mobile No.:

E-mail Address:

DO NOT FILL UP THIS PART FOR COMELEC USE ONLY

Name &
signature of
receiving staff
Date & time this
document was
received

Receiving stamp: