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I

Republic of the Philippines

COMMISSION ON ELECTIONS

Manila

COMMISSION ON ELECTIONS LA~' DEPARTMENT

CERTIFICATE 0

~~~~~P=RE~S~ID~E~N~T~~~~~4~

INSTRUCTIONS: (R e a d well bef or e filling up t h is form .)

~

i~

1.

Fil

e this in FIVE (5) LEGIBLEcopies .

 

2 .

Fi le t h i s ce r t i f i c a te

of can did ac y

w ith

t he L aw D ep a rtmen t,

C OMEL EC Main O ffi ce, Intramur os,

M ani la, star t i ng

N ovem b e r

2 0 , 2009

up to

m

id n ig ht of N o vem be r 30, 2009.

3.

Att ac h t o this c e r t i f i cate th e C e r t if i cate of Par t y N om i nat i o n u n l ess you are an in depend e nt candidate . A ft er midnight o f N o v e m be r 30 , 2 00 9 , n o

cer t i fi c at e of nominat i o n s h a ll be ac ce p ted.

 

4.

TItl es su ch as ' D r. , A t ty . , D o n , G in oo , Sen o r, D a tu , H a d ji , S ul tan, B ai , Se n or a , K ap i t a n or Simil a r tit l e s ar e e x pressly pr o h i bited.

 

5 .

This ce rtific ate s hall b e s worn admi n ister oath .

be fore a notary

public or any o fficial

au t horized

to adm i n i ster

oa t h. COMEL E C officials are not authorized

to

'

,

J

.,

for thE: posjtiqn

 

,

in the

May 10,

2010

.

 

;

4.

MY AGE IS:

49

Ye ar

l herebll/anno\lnc:e mv c:aJ;ldidac:y

of PR~IDENT,

Republic

of the Philippines,

elec:tionsi 'and after having been sworn to in accordance with law, hereby state ,!he following:
elec:tionsi 'and after having been sworn to in accordance with law, hereby state
,!he
following:
-c:
1. MY NAME IS :
1 . 1 Last N a m e
-,
' .
1 . 2 Rrst N a me
_-.-
-
-
.
.
,
.
-
1.
3 Middle Nam e
: C 0 J U A N G : C : 0 :
.
,
,
,
-_
--_
.

3. MY GENDER IS :

oMale DFemale

5. MY DATE OF BIRTH IS :

Mont h

D a y

6 . MY PLACE OF BIRTH IS :

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

( I n di c at e only one nic k na m e or st ag e nam , .- , e)

. ;

: N O : YN : O : Y

,

-

C

i ty / Mun

MANJLA

P

r ovinc e

~------------- .•. - -.-

-

- .•.• --- ------.-.---

•. -

•.•

-.--.---------·-.-

7.

I AM OFFlOALLY

9.

MY RESIDENCE!

ADDRESS IS:

NOMINATED BY: (Atta c h C ertifica t e o f No mi n a t ion )

LIBERAL _PARTY

_,

Political Pa

9.1 Pro v ince : T : A: R: LA: C :

"

• -.-.-.- •

,

.

-.-----.-

9.2 Oty/M u nid p al i ty

. -

'

9

. 3 Ba'!lng~ 'y' . ,

'

, '

'

.

,

: C : E : N : T : R : AL

:

.

-

.'

.

.

. '

-----

'

,

9, 4 ~ou se No / . St ~ee t l. Su~divi ~ l o n

'

S : I ; T : I : O :

A ' L ; T : O

•---------------+S.MYCIVILSTATUsis:

~

S i n g le

D M a rri e d

0 W id o w/ er

0

Le ga lly Separ a ted

o

Annull ed / D iv or ced

,

------

• •

,

I

.-

Fu ' l i Name of S p o u se, i f ma rri ed

---.--

-

10. MY PROFESSION OR

OCCUPATION IS :

SENATOR

11. MY POST OFFICE ADDRESS FOR ELECTION PURPOSES IS : (Cou ld b e t h e sa me a s No . 9)

SIl'I() AL 1'(),BR crY·CEl'T.TML J . l '

i-\R.-I--i-\c;_ql'Y,_ :r

~.,. MY PERIOD OF RESIDENCE IN THE PHILIPPINES BEFORE MAY 10, 2010 IS:

: 0 ; 3 :

No . of M o n ths

: 5

: 0 :

N o_of Yea rs

14.

I

AM A NATURALBORN FILIPINO CrnZEN.

15.

AM NOT A PERMANENT RESIDENT OF, OR IMMIGRANT TO, A FOREIGN COUNTRY.

I

:;>

16

J

AM ELIGIBLE FOR THE OFFICE I SEEK TO BE ELECTED TO.

12. I AM A REGISTERED VOTER OF

Precinct

Bgy

175~A- _

CENTRAL

C

l t y/ Mun TARLAC CITY

P

rovi nce

T ARLAC

-- ---~-~--,

---

- ---

D THUMBPRINT

'

1

-~

.",J.,

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.

VOLUNTARILY,WITHOUT MENTAL RESERVATION OR PURPOSE OF EVASION.

I IMPOSE THIS OBLIGATION UPON MYSELF

I hereby ce r tify that t h e facts stated herein are true and corr

Thum bpr i n t

OATH

- SUBSCRIBED _I.NO SWORN to before me this 28t h ct ay of N o vemb e r, 2009, at Quezon C i ty,

CTCjld e ntification Card No~TIN NO . 121-211-191 Issued by:

On: +

affiant e x hi b iting to me h i s/her

_

Doc. N o.

451' , ~

pag eNo.~

B

oo k N o . ----,~:c ='

Series of 20c8.

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i

'1~~~t~~~~=-::~N EMMANUELJ ~U~M. REYES

q

No t a r y Pub l i c f or an d in Q uez on

Cit y

E

IBP No. 7368 9 7 - " i I14/0 B-Tar r ac PTR. No. 5105660 -1/9/09 - pasig

RQII N § . 81922

xpir e s

on 3 ' \ D e c e m b e r

2009