MEMBER, HOUSE OF REPRESENTATIVE! FINSTRUCTIONS: (Read well before ling up tis form) 1. Fle this in FIVE (5) LEGIBLE copies with the COMELEC Office concemed, during regular office hours (8:00 AM to 5:00 PM ONLY), ‘on any day from October 11-42 and 45-17, 2018. 2. Attach to this cerifcate, the Certtcate of Norrinaton and Acceptance (CONA), if any. 3. This certificate shall be sworn before a notary public or any official authorized to administer oath. COMELEC officials are not authorized to administer oath, even in thelr capacities as Notary Public. mp Repatie ofthe Pipsaes i 7a, COMMISSION ON ELECTIONS | Affix Latest EFA) Sons pose CERTIFICATE OF CANDIDACY FOR | Passport Size | 4, No filing fee shall be imposed. Thereby announce my candidacy for the position of MEMBER, HOUSE OF REPRESENTATIVES, District, City of Province of in the May 13, 2019 National and Local Elections; and after having been ‘sworn to in accordance with law, Thereby state x i [Em Lv i 17. DATE OF BIRTH : = 1 - -I 7. NICKNAME OR STAGENAME Month Oy veer LITT TT EET |__| e ptace or oxen: 3. OFFICIALLY NOMINATED BY : (Attach Carticte of Nomination) catytton Province aS TRA amet appear onthe Oia Ballt not to exceed thirty JIJI III ISIS JJ] (ast tae, Fist name OR Nckrme and Atonym of Pola Paty Aion a sted in ems 03) {incase of ealy mar femal Canoe, she hae te opton chee ee het merry red neo both) '5, RESIDENCE/ADDRESS : sino | 19, CIVIL STATUS : sae [Jurca Jsomer Ful Name of Spouse mares 20. PROFESSION OR OCCUPATION: a 52 CtyiMunicpalty [els 2) 12) 212 (ele [ella 1 rer arcasteo sore or Ey tose ares wren oF: aa = ILL IITW ves 22. Have you ever been found lable for an tffense whieh cares wit the aceon Denaty of perpetual dsqualiestion to held Dubie ofice when has: become nal 2nd ferecutoy? }6. ADDRESS FOR ELECTION PURPOSES : (Could be the same as No) x ncn ng fares are tment COME Or whe he COC wa thr ti sn athe }7. PERIOD OF RESIDENCE IN THE PHILIPPINES UP TO THE DAY BEFORE MAY 13, 2019: 24. Inthe Pippin: [2 mmorvens [ott Hes rease provide tats at te ct) Ow 72 Inthe sve sated Disc CiyProvince rectves [7 tettonts Ho. 1ecmeD kwon newncinion OF FOREIGN CLANS (iF MPLABLE,AFTADNA COPY) AL Lioneucia roe orice Toto To a TED To, 2 Lite, wine re orices oF THE COMMISION WHO TARTY (2) OAYS ATER ELECTION By, YF, TRUE AND 13, Sorrnt ano oon Te CoveTUtON WE REPT OF TE PLIFIES AN Wl a ‘won trois This OBLIGATION UG MMSE VOLATARLY, WITHOUT MENTAL RESERUATION OR PRPOSE OF EVASION. “Sesriem eo ne anes ts evan a a rama aman OTS. ma Thereby certity that the facts stated herein are true and correct to the best of my knowledge, —— TRE a esc mo aonn oe age pint anetetti one iotoen anova wat arava ‘photograph and signature bearing No, ‘sued by. oe a paceman age No. (ffx 30.00 documentary stamp) - ze TERETE Sam “tea "HS Rd CAN BE PHOTOCOPIED OR REPRODUCED ANDI AVAILABLE AT THE COMELEC OFFICES FREE OF CHARGE ‘Of MAY 8€ DOWNLOADED FROM THE COMELE OFFICIAL WEBSITE (nace. 2)Case Docket Case Title Date Filed Status