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COMMISSION ON ELECTIONS
ANNEX “B‐1”
Manila Affix Latest
Photo Here
(1 – ½ x 1 – ½)
I hereby announce my candidacy for the position of Sangguniang Kabataan Kagawad of Barangay__________________ , Municipality of
________________, Province of __________________________ on October 25, 2010 Barangay and Sangguniang Kabataan Elections; and
after having been sworn to in accordance with law, hereby state the following:
1. MY NAME IS : 3. MY GENDER IS: 4. MY AGE IS:
Male Female ___________
1.1 Last Name
5. MY DATE OF BIRTH IS:
1.2 First Name
Month Day Year
1.3 Middle Name
2. I AM GENERALLY OR POPULARLY KNOWN BY THE NICKNAME OR STAGENAME : 6. MY PLACE OF BIRTH IS:
(Indicate only one nickname or stage name) City / Mun. ____________________________
Province ______________________________
Annulled / Divorced
10. MY POST OFFICE ADDRESS FOR ELECTION PURPOSES IS: (Indicate if the same as No. 8) 9. MY PROFESSION OR
OCCUPATION IS:
_____________________________________________________________________________________________
_________________________________
11. MY PERIOD OF RESIDENCE IN THE PHILIPPINES BEFORE OCTOBER 25, 2010 IS:
12. I AM A MEMBER OF KATIPUNAN
No. of Months No. of Years
NG KABATAAN OF:
Precinct _______________________________
13. I AM A FILIPINO CITIZEN. Barangay ______________________________
14. I AM A MEMBER OF THE KATIPUNAN NG KABATAAN IN THE BARANGAY WHERE I SEEK TO BE
City / Mun. ____________________________
ELECTED.
15. I AM A RESIDENT OF THE BARANGAY WHERE I SEEK TO BE ELECTED FOR AT LEAST ONE YEAR Province _______________________________
BEFORE THE SANGGUNIANG KABATAAN ELECTION.
16. I AM NOT A PERMANENT RESIDENT OF, OR IMMIGRANT TO, A FOREIGN COUNTRY. ROLLED THUMBPRINT
17. I POSSESS ALL THE QUALIFICATIONS AND NONE OF THE DISQUALIFICATIONS FOR THE OFFICE
I SEEK TO BE ELECTED.
18. 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. I IMPOSE
THIS OBLIGATION UPON MYSELF VOLUNTARILY, WITHOUT MENTAL RESERVATION OR
PURPOSE OF EVASION.
19. I RECOGNIZE THE AUTHORITY OF THE ELECTION OFFICER NOT TO ACCEPT MY CERTIFICATE OF
CANDIDACY IN CASE I AM NOT A MEMBER OF THE KATIPUNAN NG KABATAAN IN THE
BARANGAY. Right Thumbprint
I hereby certify that the facts stated herein are true and correct of my own personal knowledge.
_________________________________________
Signature of Candidate Above Printed Name
OATH
SUBSCRIBED AND SWORN to before me this ______ day of _________________, 2010 at ___________, affiant exhibiting to me his/her
Identification Card No. ______________________ Issued by: _____________________ On: _________________________ .
________________________________
(Officer Authorized to Administer Oath)
(Affix documentary stamp)