Annex “BI Republic of the Philippines COMMISSION ON ELECTIONS Affix Latest Marita Phot Here CERTIFICATE OF CANDIDACY FOR — MEMBER, SANGGUNIANG BARANGAY [INSTRUCTIONS (Read wal Bf Ril up Wis om.) file this in THREE (3) LEGIBLE copies with the COMELEC Office concerned, during regular office hours (8:00 AM to 5:00 PM ONLY), on any day from September 23, 2017 to September 30, 2017. 2. Titles such as Br, Atty,, Don, Ginoo, Sefior, Datu, Sultan, Bal, Sefiora, Kapitan or other similar titles are expressly prohibited. 3, This certificate shall be sworn before a notary public or any official authorized to administer oath. The Election Officer may ‘administer the oath on the COCs filed within thelr area of jurisdiction, free of charge. 4, No filing fee shall be imposed. Thereby announce my candidacy for the position of MEMBER, SANGGUNIANG BARANGAY of BARANGAY. City/Municipality of Province of in the October 23, 2017 Barangay and ‘Sangguniang Kabataan (SK) Elections; and after having been sworn to In accordance with law, I hereby state the following: L.NAME: 15. AGE: we = mater erq.olermro t Stet) er "ZNICKNAME OR STAGENAME = (Indicate only one nekname or sage name) ay ver a 1 m9 bod. 17, PLACE OF BIRTH 3. RESIDENCE/ADDRESS : 31 roe cory Proce 3.2 Cty/Municralty 18, CIVIL STATUS : Single Wicowler Tar Marea Fu nace of Sue, # aries 4, ADDRESS FOR ELECTION PURPOSES : (Couki be the ame 25 No.3) 19. PROFESSION OR OCCUPATION : ‘5. PERIOD OF RESIDENCE IN THE PHILIPPINES UP TO THE DAY BEFORE OCTOBER 23, 2017; 5.1 In the Philippines: LOLA Novefveas [No of Menns TAM A REGISTERED VOTER OF: 52. In the above-stated Barangay CEES wo. orvears fof 7] No. ortontns 6. CAMAFILIPINO CITIZEN 7, LEXECUTED A SWORM RENUNCIATION OF FOREIGN CITIZENSHIP. (IF APPLICABLE, ATTACH A COPY) 8. TAM NOTA PERMANENT RESIDENT OF, OR AN IMPIGRANT TO, A FOREIGN COUNTRY. 9. TAM ELIGIBLE FOR THE OFFICE L SEEK TO Be ELECTED TO. 410, A NOT A MEMBER OF ANY POLITICAL PARTY, GROUP OR COALITION OF POLITICAL PARTIS. {LL LWILLFILE, WITH THE OFFICES OF THE COMMISSION, WETHIN THIRTY (30) ORYS AFTER ELECTION DAY, MY FUL, “TRUE AND ITEMIZED STATEMENT OF CONTRIBUTIONS AND EXPENDITURES (SOCE) IN CONNECTION WETH THE 12, WILL SUPPORT aNo DEFENO THE CONSTTTUTION OF THE REPUBLIC OF THE PHILIPPINES AND WILL MAINTAIN TRUE FAT AND ALLEGIANCE THERETO. I WILL OBEY THE LAWS, LEGAL ORDERS AND DECREES PROMULGATED BY ‘THE DULY CONSTTTUTED AUTHORITIES. 1 IMPOSE THIS OBLIGATION UPON MYSELF VOLUNTARILY, WETHOUT MENTAL RESERVATION OR PURPOSE OF EVASION. 13, GIVE CONSENT TO THE PROCESSING OF THE INFORMATION STATED HEREIN 8Y THE COMMISSION ON ELECTIONS. FOR ELECTION AND OTHER PURPOSES AS MAY BE PROVIDED BY LAW, SUCH ASP. ELS. BB] AND R.A, NO. 10173 ‘ASO KNOWN AS THE DATA PRIVACY ACT OF 2012, AMONG OTHERS, hereby certify that the facts stated herein are tue and correc tothe best of my knowledge, Trbonrs “Signature of Candidate over Printed Name oar SUBSCRIBED AND SWORN to before me this __ day of —_ , 2017, at affiant exhibiting to me an Identification document/card which contains a photograph and signature bearing No, issued by on Doc. No, Page No. Book No, Series of 017. "HS FoR cA BE PHOTOCOPED/O8REFROOUCED AN IS AVAILABLE AT THE COMELE OFFICES FREE OF CHARGE 2 ‘CRAY BE DOWNLOADED FROM THE COMELEC OFFICIAL WEBTE (em cl.) 09/01/2013, 7 (ae 1560 duet) “(Officer Authorized to Administer Oath)