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PARTY INFORMATION: Accomplish this part only if you are the party treasurer
NAME of PARTY
TREASURER: (SURNAME) (FIRST NAME) (MIDDLE NAME)
NAME OF UNITED NATIONALIST ALLIANCE UNA
PARTY: (COMPLETE NAME OF PARTY) (ACRONYM)
PARTY Political Party Contact information:
TYPE: Party-List Group (Phone no. & e-mail address)
CANDIDATE INFORMATION: Accomplish this part only if you are a candidate)
NAME OF DAGSIL MARILOU DARIA
CANDIDATE: (SURNAME) (FIRST NAME) (MIDDLE NAME)
Elective District,
office MUNICIPAL Municipality/city/province
sought: COUNCILOR of elective office: MANITO,ALBAY
Name of Contact information:
party: UNA (Phone no. & e-mail address)
AGENT INFORMATION: (Person authorized to incur expenditures, whose name appears in main body)
Home/Office
Address:
Telephone &
E-mail Address:
Mobile No.:
ACKNOWLEDGMENT
REPUBLIC OF THE PHILIPPINES
City/Municipality of MANITO
Said persons acknowledged under oath to me under penalty of law, that the whole contents of this
document are true and the same are their free and voluntary acts and deeds.