Form SER-C

COMMISSION ON ELECTIONS
DATE OF ELECTIONS

Statement of Expenses on Public Rally (Candidate)

May 09, 2016

NAME OF
CANDIDATE:

PART A: PERSONAL INFORMATION OF THE CANDIDATE

0
0
CANDIDATE'S TIN:

0
(SURNAME)

(FIRST NAME)

INDEPENDENT (no political party nomination)

Candidate Type: (Mark

with "X")

ELECTIVE POSITION: 0

CONTACT NUMBER: 0
0

(COMPLETE NAME OF PARTY)

(ACRONYM)

District/City/Municipality/ Province/Region :

Home/Office Address:

0
NUMBER

DATE OF RALLY:

E-MAIL ADDRESS: 0

WITH POLITICAL PARTY NOMINATION

NAME OF PARTY:

0
STREET NAME

6-May-16

(MIDDLE NAME)

0
BUILDING/SUBDIVISION

0
BARANGAY

CITY/MUNICIPALITY

PROVINCE/REGION

Rally Venue & Address: Anting-Anting Sports Center, Barangay Poblacion, Santo Nino, Laguna

PART B: CONTRIBUTIONS RECEIVED BY CANDIDATE FOR THE PUBLIC RALLY

DATE of Receipt of
CONTRIBUTIONS

Receipt No.

CONTRIBUTOR'S Taxpayer ID
No. (TIN)

NAME OF CONTRIBUTOR

April 15, 2016

1098768

484-197-778

SONATA DIAY TUMULTULONG

ADDRESS OF CONTRIBUTOR

Contribution Type (Cash/In-Kind)

NO. 321, MANSION STREET, CHOIR SUBDIVISION, BARANGAY

POBLACION, EXCLUSIVE AREA, SANTO NINO, LAGUNA

AMOUNT / VALUE
20,000.00

SOUND SYSTEM

TOTAL CONTRIBUTIONS (IN CASH & IN KIND) RECEIVED FOR THE PUBLIC RALLY

20,000.00

PART C: EXPENSES INCURRED BY THE CANDIDATE FOR THE PUBLIC RALLY

DATE EXPENSE was
INCURRED

RECEIPT NUMBER
1098768

BUSINESS FIRM/
CONTRACTOR'S TIN
484-197-778

NAME OF BUSINESS FIRM OR CONTRACTOR

SONATA DIAY TUMULTULONG

ADDRESS OF BUSINESS FIRM OR CONTRACTOR

DESCRIPTION OF EXPENSE

NO. 321, MANSION STREET, CHOIR SUBDIVISION, BARANGAY

POBLACION, EXCLUSIVE AREA, SANTO NINO, LAGUNA

AMOUNT
20,000.00

SOUND SYSTEM

May 6, 2016, 6-9 p.m.

TOTAL EXPENSES INCURRED FOR THE PUBLIC RALLY

PART D: CERTIFICATION & ACKNOWLEDGMENT

SUBSCRIBED & SWORN TO before me this 30-Dec-99
I hereby certify that: (1) the expenses listed in Part C were made by me as candidate or by my duly authorized representative; (2) the contributions affiant exhibiting his/her
listed in Part B were received by me as candidate or by my duly authorized representative; (3) all entries specified above are true & correct; (4) both
contributions & expenses are supported by receipts, invoices, & similar documents; (5) the expenses were incurred in accordance with the Omnibus 0
Election Code & other pertinent laws.
(Expiry Date of ID)
Doc. No.: ______
Page No.: ______
7-May-16
Book No.: ______
00
DATE SIGNED
Series of 2016.

(Gov't-Issued Identification)

(ID Number)

0
(Issuing Government Agency)

20,000.00

Form SER-P

COMMISSION ON ELECTIONS
DATE OF ELECTIONS

Statement of Expenses on Public Rally (Party)

May 09, 2016

PART A: PERSONAL INFORMATION OF THE CANDIDATE

Name of PARTY
TREASURER:

(SURNAME)

(FIRST NAME)

POLITICAL PARTY

PARTY TYPE:
(Mark with "X")

PARTY'S TIN:

(MIDDLE NAME)

E-MAIL ADDRESS:

PARTY-LIST ORGANIZATION

CONTACT NUMBER:

NAME OF PARTY:
(COMPLETE NAME OF PARTY)

(ACRONYM)

Home/Office Address:
(OF THE PARTY)

NUMBER

STREET NAME

DATE OF RALLY:

BUILDING/SUBDIVISION

BARANGAY

CITY/MUNICIPALITY

PROVINCE/REGION

Rally Venue & Address:

PART B: CONTRIBUTIONS RECEIVED BY THE PARTY FOR THE PUBLIC RALLY

DATE of Receipt of
CONTRIBUTIONS

Receipt No.

CONTRIBUTOR'S Taxpayer ID
No. (TIN)

NAME OF CONTRIBUTOR

ADDRESS OF CONTRIBUTOR

Contribution Type (Cash/In-Kind)

AMOUNT / VALUE

TOTAL CONTRIBUTIONS (IN CASH & IN KIND) RECEIVED FOR THE PUBLIC RALLY

PART C: EXPENSES INCURRED BY THE PARTY FOR THE PUBLIC RALLY

DATE EXPENSE was
INCURRED

RECEIPT NUMBER

BUSINESS FIRM/
CONTRACTOR'S TIN

NAME OF BUSINESS FIRM OR CONTRACTOR

ADDRESS OF BUSINESS FIRM OR CONTRACTOR

DESCRIPTION OF EXPENSE

AMOUNT

TOTAL EXPENSES INCURRED FOR THE PUBLIC RALLY

PART D: CERTIFICATION & ACKNOWLEDGMENT

SUBSCRIBED & SWORN TO before me this
I hereby certify that: (1) the expenses listed in Part C were made by me as party treasurer or by my duly authorized representative; (2) the
contributions listed in Part B were received by me as party treasurer or by my duly authorized representative; (3) all entries specified above are
true & correct; (4) both contributions & expenses are supported by receipts, invoices, & similar documents; (5) the expenses were incurred in
accordance with the Omnibus Election Code & other pertinent laws.

DATE SIGNED

affiant exhibiting his/her

expiring on
(Gov't-Issued Identification)

(ID Number)

, and issued by
(Expiry Date of ID)

Doc. No.: ______

Page No.: ______
Book No.: ______
Series of 2016.

.
(Issuing Government Agency)

NOTARY PUBLIC