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Republic of the Philippines

COMMISSION ON ELECTIONS
Manila

INSTRUCTIONS: (Read well before mUngup this form.)

1. File this 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 November 30, 2009.
3. Attach to this certificate the Certificate of Party Nomination unless you are an Independent candidate. After midnight of Novemb~r 30, 2009, no.
certifICateof nomtnation shall be accepted.
4. TItles such as 'Dr., Atty., Don, Ginoo, Senor, Datu, Hadji, Sultan, Bai, Seiiora, Kapitan or similar titles are expressly prohibited.
5. This certificate Shall be sworn before a notary public or any official authorized to administer oath. COMElEC offictals are not authorIzed to
administer oath . .
--------------------------------------------------------~
.t tll!~t~bV fell' Ult! l'~sll1bn 0; S~NAtt:)i:t;~I!!IHjblic bt
~lnitJU.,ti:!tHV eat1dltlatv the I'lHiil'P;rtE!s, j'•.•' t:r~~)••~y :id; 2CiilJ eletHCln!i
" iilld afb!t hiHltIi~bei!K sWtltH la In iittofdaftt4! with IilW, Ifeteby 'stilt~ Ehe roildwihg: - ";',
!,' 1 , .

1. MY NAME IS : 3. MY GENDER IS : 4. MVAGEIS!

1.1 Last Name

Male
...,f.t.- .....
5. MY DATE OF BIRTH IS :
1.2 first Name .
,v·
'f)': ~:-~ '1':''1;'':~'':~
:~·:·l":-:
, . '.;;I ., -;7 .
• _.!.._. '-_.'---' '._-'._.', _.'--'
1.3 ~1iddleName Month Day . Year

6. MY PLACE OF BIRTH IS :.
·2. I AM GENERALLY OR POPULARLY KNOWN BY THE NICKNAME OR STAGENAME.
(Indicate only one nickname or staqenarne) City/Mun .~lr~.ItN.J;It-'.j..flr-r.r?(7Y ..
tt#4i#tr ~AI·.Mi>'ifr·T,'.T·.~['.~:~.T :~[~:j:: .:::T.: -.t::[:: t·.: •.
1--------~----~----~~~~~~--~--~----~~~~---------------.~8.MYCNllSTATUSIS:
I ._.) Province N£.b'l?os OcaPI5NTlrI-
- - - ~- - - - - - - - - - - - - - . - - - - - - . - - -
..•

7. I AM OFFICIALLY NOMINATED

......... L.l8e&1.,-:-.. ftr.RIt

BY: (Attach Certificate of Nomination)

_ : _ _ .
o Single O· ~idowler

Politi al Pari ~ Married 0 L~alfY Separated

9. MY RESIDENCEI
ADDRESS IS:
9.1 Province o Annulled / Div~Ced

r...~~ ~~N ,
~;~I~T~~[:~::::r:::«.I::~::::::~::::::::::::'.:~::
9.2 City/Municipalily 9.3 Barangay . Full Name of Spouse, iF married - ..

:'k..: .~T~r~J~I~:~.r~r ; .: .• ltf:l.G?:fd_<;!,!

10. MY PROfESSION
_./'J I! ..
OR

:i 1i:" -r it]A')t{b';,~<" :sTii)3)/i'; ii1"i :~'ri-: ';/,/":":"

9.4 House No.1 Street! Subdivision OCCUPA nON IS :
.;.. -:".:... :-.~.. ':" ~..~ ,. kA.w.¥~gANP. /t'dn1~f{._
11. MY POST OFFICE ADDRESS FOR ELECTION PUR~OSES IS : (Could be the same as No.9)

..22. KJ/f.G$II}l-:~ .. ST,)_.WHiW. PM! /'J~.. l:JJ!_~~N.(.(r'f._ ' '"

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

~I:;: No. oHlonths ff1t! NO.ofYffirs

;'" "8 tJtuAIi~ftlfJf·;:'~'·:' -.

14. I AM A NATURAL BORN FILIPINO CmZEN.
15. I AM NOT A PERMANENT RESIDENT OF, OR IMMIGRANT TO, A FOREIGN
.- . ,'..
-
. ~.-
-'-
.•. ,

COUNTRY.
16. I AM 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. 1 IMPOSE THIS OBLIGATION UPON MYSELF
VOLUNTARILY, WITHOUT MENTAL RESERVATION OR PURPOSE F EVASION .

.......... ---_ ... _-_.",.>--_ •._- .. _---_ ..... ------._--_.--.--------_ .. -. -----.----------_.'-----------

I hereby certify that the facts stated herein are true and correct of