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CEF-1A
Republic of the Philippines
COMMISSION ON ELECTIONS
Application No.
Precinct No.
Instructions : (1) Accomplish separately in three copies; (2) print legibly; (3) check the appropriate box.
Part 1
Name
Disabled / Person
with Disability
Illiterate
Assisted by:
Last
First
Gender
Male
Middle
RESIDENCE/ADDRESS
Province
Female
Height
City/Municipality
Barangay
Weight
DATE OF BIRTH
Month
Day
Year
PLACE OF BIRTH
CITIZENSHIP
By Birth
Naturalized
Reacquired
City/Mun
Province
(If naturalized/reacquired, state date of naturalization/reacquisition and Certificate number of naturalization/order of approval of reacquisition)
Date of Naturalization/
Month
Day
CIVIL STATUS
Year
Reacquisition
PERIOD OF RESIDENCE
No. of Years
Widow/er
Married
Legally
Separated
No. of Years
No. of Months
in the Philippines
PROFESSION / OCCUPATION
TIN
NAME OF FATHER
NAME OF MOTHER
Last
Last
First
First
Middle
Middle
Part 2
Single
OATH
DATE
Month
Day
Year
Signature of Applicant
Left Thumb
EO / Administering Officer
1.
Right Thumb
2.
3.
Part 3
Day
Year
Approved
Disapproved
Date
Member
Member
Part 4
CITY/MUN/
DISTRICT CODE
Prov Code
PRECINCT NO.
Month
Day
Year
DATE OF BIRTH
ACKNOWLEDGEMENT RECEIPT
Application No.
Application for Registration
Last
First
Middle
VOTING RECORD
DATE
Ballot No.
Voter's
Thumbmark
Signature
Chairman's Signature
CEF-1A
Republic of the Philippines
COMMISSION ON ELECTIONS
Application No.
Precinct No.
Instructions : (1) Accomplish separately in three copies; (2) print legibly; (3) check the appropriate box.
Part 1
Name
Illiterate
Assisted by:
Last
First
Gender
Male
Middle
RESIDENCE/ADDRESS
Province
Female
Height
City/Municipality
Weight
DATE OF BIRTH
Barangay
Month
Day
Year
PLACE OF BIRTH
CITIZENSHIP
By Birth
Naturalized
City/Mun
Reacquired
Province
(If naturalized/reacquired, state date of naturalization/reacquisition and Certificate number of naturalization/order of approval of reacquisition)
Date of Naturalization/
Month
Day
Year
CIVIL STATUS
Reacquisition
Single
PERIOD OF RESIDENCE
No. of Years
Married
Legally
Separated
No. of Years
No. of Months
in the Philippines
PROFESSION / OCCUPATION
TIN
NAME OF FATHER
NAME OF MOTHER
Last
Last
First
First
Middle
Middle
Part 2
Widow/er
OATH
DATE
Month
Day
Year
Signature of Applicant
Left Thumb
1.
EO / Administering Officer
Right Thumb
2.
3.
Part 3
Day
Year
Approved
Disapproved
Date
Member
Member
Part 4
CITY/MUN/
DISTRICT CODE
Prov Code
PRECINCT NO.
Month
Day
DATE OF BIRTH
Year
CEF-1A
Republic of the Philippines
COMMISSION ON ELECTIONS
Application No.
Precinct No.
Instructions : (1) Accomplish separately in three copies; (2) print legibly; (3) check the appropriate box.
Part 1
Name
Illiterate
Assisted by:
Last
First
Gender
Male
Middle
RESIDENCE/ADDRESS
Province
Female
Height
City/Municipality
Weight
DATE OF BIRTH
Barangay
Month
Day
Year
PLACE OF BIRTH
CITIZENSHIP
By Birth
Naturalized
City/Mun
Reacquired
Province
(If naturalized/reacquired, state date of naturalization/reacquisition and Certificate number of naturalization/order of approval of reacquisition)
Date of Naturalization/
Month
Day
Year
CIVIL STATUS
Reacquisition
Single
PERIOD OF RESIDENCE
No. of Years
Married
Legally
Separated
No. of Years
No. of Months
in the Philippines
PROFESSION / OCCUPATION
TIN
NAME OF FATHER
NAME OF MOTHER
Last
Last
First
First
Middle
Middle
Part 2
Widow/er
OATH
DATE
Month
Day
Year
Signature of Applicant
Left Thumb
1.
EO / Administering Officer
Right Thumb
2.
3.
Part 3
Day
Year
Approved
Disapproved
Date
Member
Member
Part 4
CITY/MUN/
DISTRICT CODE
Prov Code
PRECINCT NO.
Month
Day
DATE OF BIRTH
Year