Republic of the Philippines

Department of Education
Region IV
Division of Oriental Mindoro
Formon National High School
SUPREME STUDENT GOVERNMENT
Commission on Elections
Formon

CERTIFICATE OF CANDIDACY
INSTRUCTIONS: (Read well before filing up this form.)
1.) File this in ONE (1) LEGIBLE copy.

2.) File this certificate of candidacy with all the required information accurately and legally.

I hereby announce my candidacy for the position of ____________ ____, Supreme Student
Government, in the February 17, 2012 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 __________
Last Name:
5.) My date of birth is
First Name:
__ __ - __ __ - __ __ __ __
(Month) (Day) (Year)

Middle Name:

2.) I am generally or popularly known by the nickname or stagename 6.) My place of birth is
(Indicate one nickname City/Municipality: _________________________________________
or stagename)
Province:________________________________________________

7.) I am officially nominated by 8.) My civil status is

_____ (Single) _____ (Widow/er)
8.) _____ (Married) _____ (Legally Separated)
(Political Party) _____ (Annulled/Divorced)
Full name of spouse, if married:
9.) My official residence is 9.1 Province ______________________________________________________

9.2 City / Municipality ____________________________________ 9.3 Barangay _______________________________________ 10.) My profession/occupation is

9.4 House No. / Street / Subdivision _____________________________________________________________________________

11.) My Parents are 12.) My contact details are

Mother’s Maiden Name: _____________________________________________ Contact Number: ___________________________
Contact Number: _________________________________________
Occupation: __________________________ Address: _____________________________________________________________

Fathers’ Name:____________________________________________________ Contact Number: ___________________________ Facebook Email Address: __________________________________

Occupation: __________________________ Address: ______________________________________________________________

13.) I will run because 15.) I am a student of Nabunturan National

_____________________________________________________________________ Comprehensive High School.
_____________________________________________________________________ 16.) I am a natural born Filipino Citizen.
_____________________________________________________________________ 17.) I am eligible for the office I seek to be elected to.
_____________________________________________________________________ 18.) I will support and defend the Constitution and By
_____________________________________________________________________ – Laws of the Supreme Student Government of
_____________________________________________________________________ Formon National High School and will maintain
true faith and allegiance thereto. I will obey the
14.) Some of my achievements in High School are 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.
_____________________________________________________________________

I hereby certify that the facts stated herein are true and correct of my own personal knowledge.
______________________________________
Signature of Candidate Over Printed Name
______________________________________
Section / Curriculum
______________________________________
Adviser

Endorsed: Approved:

Meljohn D. Cielo Jhames Kenneth Perez Erwin Ilao

SSG COMELEC Chairperson SSG President SSG Adviser