Republic of the Philippines

COMMISSION ON ELECTIONS
. Mallila

CERTIFICATE OF
.SEN
IrOSTRUCTIONS:(Read.••~I before fillingup this form.)
I I. HI<! this In FIVE (5) LEG)BLE copies.
I 2. File this certiflcate~ of candidacy with the Law Department, COI~ELEC Main Of lice, tnrrarnurcs, l~ariiIa, starting November 20, 2009 up to
midnight 01 November 30, 2009.

! 3. Attach to th-is certificate the Certificate

ce-urcetc of romloancn shall be accepted.
of Party Nomination unless you are an independent candidate. After midnight-of November 30, 2009, no

I
4. Titles such as 'Dr., Atty., Don, Ginoo, Senor, Datu, Hadjij Sultan, Bai, Sefiora, Kaplron or slm}lar titles are expressly prohibited. .
. 5. This certificate shall be s'Worn beroee e ~otary public or any official authorh:.ed to administer oath. COMELECcfflelills are not authoriz~d to

,;:

17. 111M OFFICIALLY NOMiNATED BY: (Attach CertifiCateor Nom'nalloll)

~t~~~A~G.
. ...
~AGONG LlPUNAN (KBL}
Ii ie I Parly)
, _ .
9. MY
"ADDRESS IS:
RESIDENCe{

9.2 CHy/fIolunicipality
9.1 province· [¢, #.~::y:'~:.;::
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9.3
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F3arangay
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9.4 ~looS' No.! Street / Subdivision OCCUPATION IS :.

:N6j~·E·T··:···:··~··:··T··:··-:···:·T-:-·~···:···:·······:··:··~--·:··:··-:··:··:···i··:··: .... __... ~~~~~._.
llJ1Y P.OST OFFICE.~PORES!'i FOR ELECTION PURPOSES IS : (Could be tile same as NO.9:TeleFax: (02)421-11-29 12. I·AM A REGISTERED VOTER OF
Union Square Condo 145 15th Avenue:-Cubao, Quezon city .- . Precinct ASCLUSTEREDINA
...... . .. . - ..
, - - " ~.. - .. - , ,
Bgy. $tA.-fuciA:···········
13. I~Y PERIOD OF RESIDENCE IN THE PHILIPPINES BEFORE MAY 10, 2010 IS : e'tr/Mun . -AstURIAs· .
i ·0~~( No. or ~Ionlhs [ f/\ No. cr reors
Province CEBU
__ . 14. I At·1 A NATURAL BORN FI.UPINO CmZEN.
15. I AM NOT A PER~IANENTRESIDENT OF, OR lfvl fvlIG RANT TO, A FOREIGN
COUNTRY. .
l6. I At-l ELIGIBLE FOR THE OFFICE I SEEK TO BE ELECTED TO.
17 . ...1 WIll SUPPORT AND DEFEND THE CONSTITUTION Or- THE REPUBLIC OF THE
PHiliPPINES AND WILL MAINTAIN TRUE FAITH AND •..••.LLEGIANCE THERETO. t
WILL OBEY THE LAWS, LEGAL ORDERS AND DECREES PROMULGATED BY THE
DULY CONSTITUTED AUTHORITIES. I IMPOSE TliIS 06LlGATlOr~ UPON MYSELF
VOLUNTARILY, WITHOUT MENTAL RESERVATION OR PU OF EVASION. .

I h~reby cCltlfy that the facts stated herein a:r~e

~tr~~~~t~~~~~~~~~fl~t-t1-

. . ~ ~ OATH t\ () .
.. SUBSCRIBED ANO.SWORN to before me this
Identlrlcatlon Card No. _ 2313
day .or ~ L~:
200~, at ~_, affiant exhib;~ing to me his/her
Issued by IBP. National Office _ 0.1: L.fchm" Member Cebu Chapter. ~
I '
Doc. No.4<fr
Page No. __ '
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BO<Jf; No. I NIlll0riled toI\tJmirister Oath) IIOq ;J " :\.~ V f."·1Ja It.. ~C . <. •
p...TD h';~'";"- ~;ti;:~eER 31, 20'l..p7. ..:::
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I Integrated Bar of the Phi lippines Under signature o(lBP President Teofilo S. Pilando (per attaphed pholQcol2%J'
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