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COC2016 |1

UNIVERSITY OF BATANGAS
COLLEGE OF LAW
STUDENT COUNCIL
CERTIFICATE OF CANDIDACY

2016 ELECTIONS

1x1 picture
Taken 6 mos.
before filing

NAME :____________________________________________________________________
last,
first,
middle
NICKNAME/STAGENAME:____________________________________________________
YEAR LEVEL:__________________________

CIVIL STATUS:____________________

PERIOD OF STAY IN UB COL:______________ BIRTHDAY:_______________________


GENDER:_____________

PLACE OF BIRTH:_____________ AGE: _______________

PROFESSION/OCCUPATION: ________________________________________________
POSITION:_______________________ COMPANY/AGENCY: ______________________
PARTY:_____________________________
REASON FOR RUNNING:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
You may use separate sheets when necessary.

I hereby certify that the facts stated herein are true and correct to the best of my knowledge.

Signature over printed name

Received by:
___________________________
COMELEC Officer 2016 Elections
Please submit in triplicate copies to the Election Supervisors on or before February 16, 2016

COC2016 |2

Please submit in triplicate copies to the Election Supervisors on or before February 16, 2016

COC2016 |3

UNIVERSITY OF BATANGAS
COLLEGE OF LAW
STUDENT COUNCIL
CERTIFICATE OF CANDIDACY

1x1 picture
Taken 6 mos.
before filing

2016 ELECTIONS

NAME :____________________________________________________________________
last,
first,
middle
NICKNAME/STAGENAME:____________________________________________________
YEAR LEVEL:__________________________

CIVIL STATUS:____________________

PERIOD OF STAY IN UB COL:______________ BIRTHDAY:_______________________


GENDER:_____________

PLACE OF BIRTH:_____________ AGE: _______________

PROFESSION/OCCUPATION: ________________________________________________
POSITION:_______________________ COMPANY/AGENCY: ______________________
PARTY:_____________________________
REASON FOR RUNNING:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
You may use separate sheets when necessary.

I hereby certify that the facts stated herein are true and correct to the best of my knowledge.

Signature over printed name

Received by:
___________________________
COMELEC Officer 2016 Elections
Please submit in triplicate copies to the Election Supervisors on or before February 16, 2016

COC2016 |4

UNIVERSITY OF BATANGAS
COLLEGE OF LAW
STUDENT COUNCIL
CERTIFICATE OF CANDIDACY

2016 ELECTIONS

1x1 picture
Taken 6 mos.
before filing

NAME :____________________________________________________________________
last,
first,
middle
NICKNAME/STAGENAME:____________________________________________________
YEAR LEVEL:__________________________

CIVIL STATUS:____________________

PERIOD OF STAY IN UB COL:______________ BIRTHDAY:_______________________


GENDER:_____________

PLACE OF BIRTH:_____________ AGE: _______________

PROFESSION/OCCUPATION: ________________________________________________
POSITION:_______________________ COMPANY/AGENCY: ______________________
PARTY:_____________________________
REASON FOR RUNNING:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
You may use separate sheets when necessary.

I hereby certify that the facts stated herein are true and correct to the best of my knowledge.

Signature over printed name

Received by:
___________________________
COMELEC Officer 2016 Elections
Please submit in triplicate copies to the Election Supervisors on or before February 16, 2016

COC2016 |5

UNIVERSITY OF BATANGAS
COLLEGE OF LAW
STUDENT COUNCIL
CERTIFICATE OF CANDIDACY

2016 ELECTIONS

1x1 picture
Taken 6 mos.
before filing

NAME :____________________________________________________________________
last,
first,
middle
NICKNAME/STAGENAME:____________________________________________________
YEAR LEVEL:__________________________

CIVIL STATUS:____________________

PERIOD OF STAY IN UB COL:______________ BIRTHDAY:_______________________


GENDER:_____________

PLACE OF BIRTH:_____________ AGE: _______________

PROFESSION/OCCUPATION: ________________________________________________
POSITION:_______________________ COMPANY/AGENCY: ______________________
PARTY:_____________________________
REASON FOR RUNNING:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
You may use separate sheets when necessary.

I hereby certify that the facts stated herein are true and correct to the best of my knowledge.

Signature over printed name

Received by:
___________________________
COMELEC Officer 2016 Elections
Please submit in triplicate copies to the Election Supervisors on or before February 16, 2016

COC2016 |6

UNIVERSITY OF BATANGAS
COLLEGE OF LAW
STUDENT COUNCIL
CERTIFICATE OF CANDIDACY

2016 ELECTIONS

1x1 picture
Taken 6 mos.
before filing

NAME :____________________________________________________________________
last,
first,
middle
NICKNAME/STAGENAME:____________________________________________________
YEAR LEVEL:__________________________

CIVIL STATUS:____________________

PERIOD OF STAY IN UB COL:______________ BIRTHDAY:_______________________


GENDER:_____________

PLACE OF BIRTH:_____________ AGE: _______________

PROFESSION/OCCUPATION: ________________________________________________
POSITION:_______________________ COMPANY/AGENCY: ______________________
PARTY:_____________________________
REASON FOR RUNNING:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
You may use separate sheets when necessary.

I hereby certify that the facts stated herein are true and correct to the best of my knowledge.

Signature over printed name

Received by:
___________________________
COMELEC Officer 2016 Elections
Please submit in triplicate copies to the Election Supervisors on or before February 16, 2016

COC2016 |7

UNIVERSITY OF BATANGAS
COLLEGE OF LAW
STUDENT COUNCIL
CERTIFICATE OF CANDIDACY

2016 ELECTIONS

1x1 picture
Taken 6 mos.
before filing

NAME :____________________________________________________________________
last,
first,
middle
NICKNAME/STAGENAME:____________________________________________________
YEAR LEVEL:__________________________

CIVIL STATUS:____________________

PERIOD OF STAY IN UB COL:______________ BIRTHDAY:_______________________


GENDER:_____________

PLACE OF BIRTH:_____________ AGE: _______________

PROFESSION/OCCUPATION: ________________________________________________
POSITION:_______________________ COMPANY/AGENCY: ______________________
PARTY:_____________________________
REASON FOR RUNNING:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
You may use separate sheets when necessary.

I hereby certify that the facts stated herein are true and correct to the best of my knowledge.

Signature over printed name

Received by:
___________________________
COMELEC Officer 2016 Elections
Please submit in triplicate copies to the Election Supervisors on or before February 16, 2016

COC2016 |8

UNIVERSITY OF BATANGAS
COLLEGE OF LAW
STUDENT COUNCIL
CERTIFICATE OF CANDIDACY

2016 ELECTIONS

1x1 picture
Taken 6 mos.
before filing

NAME :____________________________________________________________________
last,
first,
middle
NICKNAME/STAGENAME:____________________________________________________
YEAR LEVEL:__________________________

CIVIL STATUS:____________________

PERIOD OF STAY IN UB COL:______________ BIRTHDAY:_______________________


GENDER:_____________

PLACE OF BIRTH:_____________ AGE: _______________

PROFESSION/OCCUPATION: ________________________________________________
POSITION:_______________________ COMPANY/AGENCY: ______________________
PARTY:_____________________________
REASON FOR RUNNING:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
You may use separate sheets when necessary.

I hereby certify that the facts stated herein are true and correct to the best of my knowledge.

Signature over printed name

Received by:
___________________________
COMELEC Officer 2016 Elections
Please submit in triplicate copies to the Election Supervisors on or before February 16, 2016

COC2016 |9

UNIVERSITY OF BATANGAS
COLLEGE OF LAW
STUDENT COUNCIL
CERTIFICATE OF CANDIDACY

2016 ELECTIONS

1x1 picture
Taken 6 mos.
before filing

NAME :____________________________________________________________________
last,
first,
middle
NICKNAME/STAGENAME:____________________________________________________
YEAR LEVEL:__________________________

CIVIL STATUS:____________________

PERIOD OF STAY IN UB COL:______________ BIRTHDAY:_______________________


GENDER:_____________

PLACE OF BIRTH:_____________ AGE: _______________

PROFESSION/OCCUPATION: ________________________________________________
POSITION:_______________________ COMPANY/AGENCY: ______________________
PARTY:_____________________________
REASON FOR RUNNING:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
You may use separate sheets when necessary.

I hereby certify that the facts stated herein are true and correct to the best of my knowledge.

Signature over printed name

Received by:
___________________________
COMELEC Officer 2016 Elections
Please submit in triplicate copies to the Election Supervisors on or before February 16, 2016

C O C 2 0 1 6 | 10

UNIVERSITY OF BATANGAS
COLLEGE OF LAW
STUDENT COUNCIL
CERTIFICATE OF CANDIDACY

2016 ELECTIONS

1x1 picture
Taken 6 mos.
before filing

NAME :____________________________________________________________________
last,
first,
middle
NICKNAME/STAGENAME:____________________________________________________
YEAR LEVEL:__________________________

CIVIL STATUS:____________________

PERIOD OF STAY IN UB COL:______________ BIRTHDAY:_______________________


GENDER:_____________

PLACE OF BIRTH:_____________ AGE: _______________

PROFESSION/OCCUPATION: ________________________________________________
POSITION:_______________________ COMPANY/AGENCY: ______________________
PARTY:_____________________________
REASON FOR RUNNING:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
You may use separate sheets when necessary.

I hereby certify that the facts stated herein are true and correct to the best of my knowledge.

Signature over printed name

Received by:
___________________________
COMELEC Officer 2016 Elections
Please submit in triplicate copies to the Election Supervisors on or before February 16, 2016

C O C 2 0 1 6 | 11

UNIVERSITY OF BATANGAS
COLLEGE OF LAW
STUDENT COUNCIL
CERTIFICATE OF CANDIDACY

2016 ELECTIONS

1x1 picture
Taken 6 mos.
before filing

NAME :____________________________________________________________________
last,
first,
middle
NICKNAME/STAGENAME:____________________________________________________
YEAR LEVEL:__________________________

CIVIL STATUS:____________________

PERIOD OF STAY IN UB COL:______________ BIRTHDAY:_______________________


GENDER:_____________

PLACE OF BIRTH:_____________ AGE: _______________

PROFESSION/OCCUPATION: ________________________________________________
POSITION:_______________________ COMPANY/AGENCY: ______________________
PARTY:_____________________________
REASON FOR RUNNING:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
You may use separate sheets when necessary.

I hereby certify that the facts stated herein are true and correct to the best of my knowledge.

Signature over printed name

Received by:
___________________________
COMELEC Officer 2016 Elections
Please submit in triplicate copies to the Election Supervisors on or before February 16, 2016

C O C 2 0 1 6 | 12

UNIVERSITY OF BATANGAS
COLLEGE OF LAW
STUDENT COUNCIL
CERTIFICATE OF CANDIDACY

2016 ELECTIONS

1x1 picture
Taken 6 mos.
before filing

NAME :____________________________________________________________________
last,
first,
middle
NICKNAME/STAGENAME:____________________________________________________
YEAR LEVEL:__________________________

CIVIL STATUS:____________________

PERIOD OF STAY IN UB COL:______________ BIRTHDAY:_______________________


GENDER:_____________

PLACE OF BIRTH:_____________ AGE: _______________

PROFESSION/OCCUPATION: ________________________________________________
POSITION:_______________________ COMPANY/AGENCY: ______________________
PARTY:_____________________________
REASON FOR RUNNING:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
You may use separate sheets when necessary.

I hereby certify that the facts stated herein are true and correct to the best of my knowledge.

Signature over printed name

Received by:
___________________________
COMELEC Officer 2016 Elections
Please submit in triplicate copies to the Election Supervisors on or before February 16, 2016

C O C 2 0 1 6 | 13

UNIVERSITY OF BATANGAS
COLLEGE OF LAW
STUDENT COUNCIL
CERTIFICATE OF CANDIDACY

2016 ELECTIONS

1x1 picture
Taken 6 mos.
before filing

NAME :____________________________________________________________________
last,
first,
middle
NICKNAME/STAGENAME:____________________________________________________
YEAR LEVEL:__________________________

CIVIL STATUS:____________________

PERIOD OF STAY IN UB COL:______________ BIRTHDAY:_______________________


GENDER:_____________

PLACE OF BIRTH:_____________ AGE: _______________

PROFESSION/OCCUPATION: ________________________________________________
POSITION:_______________________ COMPANY/AGENCY: ______________________
PARTY:_____________________________
REASON FOR RUNNING:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
You may use separate sheets when necessary.

I hereby certify that the facts stated herein are true and correct to the best of my knowledge.

Signature over printed name

Received by:
___________________________
COMELEC Officer 2016 Elections
Please submit in triplicate copies to the Election Supervisors on or before February 16, 2016

C O C 2 0 1 6 | 14

UNIVERSITY OF BATANGAS
COLLEGE OF LAW
STUDENT COUNCIL
CERTIFICATE OF CANDIDACY

2016 ELECTIONS

1x1 picture
Taken 6 mos.
before filing

NAME :____________________________________________________________________
last,
first,
middle
NICKNAME/STAGENAME:____________________________________________________
YEAR LEVEL:__________________________

CIVIL STATUS:____________________

PERIOD OF STAY IN UB COL:______________ BIRTHDAY:_______________________


GENDER:_____________

PLACE OF BIRTH:_____________ AGE: _______________

PROFESSION/OCCUPATION: ________________________________________________
POSITION:_______________________ COMPANY/AGENCY: ______________________
PARTY:_____________________________
REASON FOR RUNNING:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
You may use separate sheets when necessary.

I hereby certify that the facts stated herein are true and correct to the best of my knowledge.

Signature over printed name

Received by:
___________________________
COMELEC Officer 2016 Elections
Please submit in triplicate copies to the Election Supervisors on or before February 16, 2016

C O C 2 0 1 6 | 15

UNIVERSITY OF BATANGAS
COLLEGE OF LAW
STUDENT COUNCIL
CERTIFICATE OF CANDIDACY

2016 ELECTIONS

1x1 picture
Taken 6 mos.
before filing

NAME :____________________________________________________________________
last,
first,
middle
NICKNAME/STAGENAME:____________________________________________________
YEAR LEVEL:__________________________

CIVIL STATUS:____________________

PERIOD OF STAY IN UB COL:______________ BIRTHDAY:_______________________


GENDER:_____________

PLACE OF BIRTH:_____________ AGE: _______________

PROFESSION/OCCUPATION: ________________________________________________
POSITION:_______________________ COMPANY/AGENCY: ______________________
PARTY:_____________________________
REASON FOR RUNNING:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
You may use separate sheets when necessary.

I hereby certify that the facts stated herein are true and correct to the best of my knowledge.

Signature over printed name

Received by:
___________________________
COMELEC Officer 2016 Elections
Please submit in triplicate copies to the Election Supervisors on or before February 16, 2016

C O C 2 0 1 6 | 16

UNIVERSITY OF BATANGAS
COLLEGE OF LAW
STUDENT COUNCIL
CERTIFICATE OF CANDIDACY

2016 ELECTIONS

1x1 picture
Taken 6 mos.
before filing

NAME :____________________________________________________________________
last,
first,
middle
NICKNAME/STAGENAME:____________________________________________________
YEAR LEVEL:__________________________

CIVIL STATUS:____________________

PERIOD OF STAY IN UB COL:______________ BIRTHDAY:_______________________


GENDER:_____________

PLACE OF BIRTH:_____________ AGE: _______________

PROFESSION/OCCUPATION: ________________________________________________
POSITION:_______________________ COMPANY/AGENCY: ______________________
PARTY:_____________________________
REASON FOR RUNNING:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
You may use separate sheets when necessary.

I hereby certify that the facts stated herein are true and correct to the best of my knowledge.

Signature over printed name

Received by:
___________________________
COMELEC Officer 2016 Elections
Please submit in triplicate copies to the Election Supervisors on or before February 16, 2016

C O C 2 0 1 6 | 17

UNIVERSITY OF BATANGAS
COLLEGE OF LAW
STUDENT COUNCIL
CERTIFICATE OF CANDIDACY

2016 ELECTIONS

1x1 picture
Taken 6 mos.
before filing

NAME :____________________________________________________________________
last,
first,
middle
NICKNAME/STAGENAME:____________________________________________________
YEAR LEVEL:__________________________

CIVIL STATUS:____________________

PERIOD OF STAY IN UB COL:______________ BIRTHDAY:_______________________


GENDER:_____________

PLACE OF BIRTH:_____________ AGE: _______________

PROFESSION/OCCUPATION: ________________________________________________
POSITION:_______________________ COMPANY/AGENCY: ______________________
PARTY:_____________________________
REASON FOR RUNNING:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
You may use separate sheets when necessary.

I hereby certify that the facts stated herein are true and correct to the best of my knowledge.

Signature over printed name

Received by:
___________________________
COMELEC Officer 2016 Elections
Please submit in triplicate copies to the Election Supervisors on or before February 16, 2016

C O C 2 0 1 6 | 18

UNIVERSITY OF BATANGAS
COLLEGE OF LAW
STUDENT COUNCIL
CERTIFICATE OF CANDIDACY

2016 ELECTIONS

1x1 picture
Taken 6 mos.
before filing

NAME :____________________________________________________________________
last,
first,
middle
NICKNAME/STAGENAME:____________________________________________________
YEAR LEVEL:__________________________

CIVIL STATUS:____________________

PERIOD OF STAY IN UB COL:______________ BIRTHDAY:_______________________


GENDER:_____________

PLACE OF BIRTH:_____________ AGE: _______________

PROFESSION/OCCUPATION: ________________________________________________
POSITION:_______________________ COMPANY/AGENCY: ______________________
PARTY:_____________________________
REASON FOR RUNNING:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
You may use separate sheets when necessary.

I hereby certify that the facts stated herein are true and correct to the best of my knowledge.

Signature over printed name

Received by:
___________________________
COMELEC Officer 2016 Elections
Please submit in triplicate copies to the Election Supervisors on or before February 16, 2016

C O C 2 0 1 6 | 19

UNIVERSITY OF BATANGAS
COLLEGE OF LAW
STUDENT COUNCIL
CERTIFICATE OF CANDIDACY

2016 ELECTIONS

1x1 picture
Taken 6 mos.
before filing

NAME :____________________________________________________________________
last,
first,
middle
NICKNAME/STAGENAME:____________________________________________________
YEAR LEVEL:__________________________

CIVIL STATUS:____________________

PERIOD OF STAY IN UB COL:______________ BIRTHDAY:_______________________


GENDER:_____________

PLACE OF BIRTH:_____________ AGE: _______________

PROFESSION/OCCUPATION: ________________________________________________
POSITION:_______________________ COMPANY/AGENCY: ______________________
PARTY:_____________________________
REASON FOR RUNNING:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
You may use separate sheets when necessary.

I hereby certify that the facts stated herein are true and correct to the best of my knowledge.

Signature over printed name

Received by:
___________________________
COMELEC Officer 2016 Elections
Please submit in triplicate copies to the Election Supervisors on or before February 16, 2016

C O C 2 0 1 6 | 20

UNIVERSITY OF BATANGAS
COLLEGE OF LAW
STUDENT COUNCIL
CERTIFICATE OF CANDIDACY

2016 ELECTIONS

1x1 picture
Taken 6 mos.
before filing

NAME :____________________________________________________________________
last,
first,
middle
NICKNAME/STAGENAME:____________________________________________________
YEAR LEVEL:__________________________

CIVIL STATUS:____________________

PERIOD OF STAY IN UB COL:______________ BIRTHDAY:_______________________


GENDER:_____________

PLACE OF BIRTH:_____________ AGE: _______________

PROFESSION/OCCUPATION: ________________________________________________
POSITION:_______________________ COMPANY/AGENCY: ______________________
PARTY:_____________________________
REASON FOR RUNNING:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
You may use separate sheets when necessary.

I hereby certify that the facts stated herein are true and correct to the best of my knowledge.

Signature over printed name

Received by:
___________________________
COMELEC Officer 2016 Elections
Please submit in triplicate copies to the Election Supervisors on or before February 16, 2016

C O C 2 0 1 6 | 21

UNIVERSITY OF BATANGAS
COLLEGE OF LAW
STUDENT COUNCIL
CERTIFICATE OF CANDIDACY

2016 ELECTIONS

1x1 picture
Taken 6 mos.
before filing

NAME :____________________________________________________________________
last,
first,
middle
NICKNAME/STAGENAME:____________________________________________________
YEAR LEVEL:__________________________

CIVIL STATUS:____________________

PERIOD OF STAY IN UB COL:______________ BIRTHDAY:_______________________


GENDER:_____________

PLACE OF BIRTH:_____________ AGE: _______________

PROFESSION/OCCUPATION: ________________________________________________
POSITION:_______________________ COMPANY/AGENCY: ______________________
PARTY:_____________________________
REASON FOR RUNNING:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
You may use separate sheets when necessary.

I hereby certify that the facts stated herein are true and correct to the best of my knowledge.

Signature over printed name

Received by:
___________________________
COMELEC Officer 2016 Elections
Please submit in triplicate copies to the Election Supervisors on or before February 16, 2016

C O C 2 0 1 6 | 22

UNIVERSITY OF BATANGAS
COLLEGE OF LAW
STUDENT COUNCIL
CERTIFICATE OF CANDIDACY

2016 ELECTIONS

1x1 picture
Taken 6 mos.
before filing

NAME :____________________________________________________________________
last,
first,
middle
NICKNAME/STAGENAME:____________________________________________________
YEAR LEVEL:__________________________

CIVIL STATUS:____________________

PERIOD OF STAY IN UB COL:______________ BIRTHDAY:_______________________


GENDER:_____________

PLACE OF BIRTH:_____________ AGE: _______________

PROFESSION/OCCUPATION: ________________________________________________
POSITION:_______________________ COMPANY/AGENCY: ______________________
PARTY:_____________________________
REASON FOR RUNNING:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
You may use separate sheets when necessary.

I hereby certify that the facts stated herein are true and correct to the best of my knowledge.

Signature over printed name

Received by:
___________________________
COMELEC Officer 2016 Elections
Please submit in triplicate copies to the Election Supervisors on or before February 16, 2016

C O C 2 0 1 6 | 23

UNIVERSITY OF BATANGAS
COLLEGE OF LAW
STUDENT COUNCIL
CERTIFICATE OF CANDIDACY

2016 ELECTIONS

1x1 picture
Taken 6 mos.
before filing

NAME :____________________________________________________________________
last,
first,
middle
NICKNAME/STAGENAME:____________________________________________________
YEAR LEVEL:__________________________

CIVIL STATUS:____________________

PERIOD OF STAY IN UB COL:______________ BIRTHDAY:_______________________


GENDER:_____________

PLACE OF BIRTH:_____________ AGE: _______________

PROFESSION/OCCUPATION: ________________________________________________
POSITION:_______________________ COMPANY/AGENCY: ______________________
PARTY:_____________________________
REASON FOR RUNNING:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
You may use separate sheets when necessary.

I hereby certify that the facts stated herein are true and correct to the best of my knowledge.

Signature over printed name

Received by:
___________________________
COMELEC Officer 2016 Elections
Please submit in triplicate copies to the Election Supervisors on or before February 16, 2016

C O C 2 0 1 6 | 24

UNIVERSITY OF BATANGAS
COLLEGE OF LAW
STUDENT COUNCIL
CERTIFICATE OF CANDIDACY

2016 ELECTIONS

1x1 picture
Taken 6 mos.
before filing

NAME :____________________________________________________________________
last,
first,
middle
NICKNAME/STAGENAME:____________________________________________________
YEAR LEVEL:__________________________

CIVIL STATUS:____________________

PERIOD OF STAY IN UB COL:______________ BIRTHDAY:_______________________


GENDER:_____________

PLACE OF BIRTH:_____________ AGE: _______________

PROFESSION/OCCUPATION: ________________________________________________
POSITION:_______________________ COMPANY/AGENCY: ______________________
PARTY:_____________________________
REASON FOR RUNNING:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
You may use separate sheets when necessary.

I hereby certify that the facts stated herein are true and correct to the best of my knowledge.

Signature over printed name

Received by:
___________________________
COMELEC Officer 2016 Elections
Please submit in triplicate copies to the Election Supervisors on or before February 16, 2016

C O C 2 0 1 6 | 25

UNIVERSITY OF BATANGAS
COLLEGE OF LAW
STUDENT COUNCIL
CERTIFICATE OF CANDIDACY

2016 ELECTIONS

1x1 picture
Taken 6 mos.
before filing

NAME :____________________________________________________________________
last,
first,
middle
NICKNAME/STAGENAME:____________________________________________________
YEAR LEVEL:__________________________

CIVIL STATUS:____________________

PERIOD OF STAY IN UB COL:______________ BIRTHDAY:_______________________


GENDER:_____________

PLACE OF BIRTH:_____________ AGE: _______________

PROFESSION/OCCUPATION: ________________________________________________
POSITION:_______________________ COMPANY/AGENCY: ______________________
PARTY:_____________________________
REASON FOR RUNNING:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
You may use separate sheets when necessary.

I hereby certify that the facts stated herein are true and correct to the best of my knowledge.

Signature over printed name

Received by:
___________________________
COMELEC Officer 2016 Elections
Please submit in triplicate copies to the Election Supervisors on or before February 16, 2016

C O C 2 0 1 6 | 26

UNIVERSITY OF BATANGAS
COLLEGE OF LAW
STUDENT COUNCIL
CERTIFICATE OF CANDIDACY

2016 ELECTIONS

1x1 picture
Taken 6 mos.
before filing

NAME :____________________________________________________________________
last,
first,
middle
NICKNAME/STAGENAME:____________________________________________________
YEAR LEVEL:__________________________

CIVIL STATUS:____________________

PERIOD OF STAY IN UB COL:______________ BIRTHDAY:_______________________


GENDER:_____________

PLACE OF BIRTH:_____________ AGE: _______________

PROFESSION/OCCUPATION: ________________________________________________
POSITION:_______________________ COMPANY/AGENCY: ______________________
PARTY:_____________________________
REASON FOR RUNNING:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
You may use separate sheets when necessary.

I hereby certify that the facts stated herein are true and correct to the best of my knowledge.

Signature over printed name

Received by:
___________________________
COMELEC Officer 2016 Elections
Please submit in triplicate copies to the Election Supervisors on or before February 16, 2016

C O C 2 0 1 6 | 27

UNIVERSITY OF BATANGAS
COLLEGE OF LAW
STUDENT COUNCIL
CERTIFICATE OF CANDIDACY

2016 ELECTIONS

1x1 picture
Taken 6 mos.
before filing

NAME :____________________________________________________________________
last,
first,
middle
NICKNAME/STAGENAME:____________________________________________________
YEAR LEVEL:__________________________

CIVIL STATUS:____________________

PERIOD OF STAY IN UB COL:______________ BIRTHDAY:_______________________


GENDER:_____________

PLACE OF BIRTH:_____________ AGE: _______________

PROFESSION/OCCUPATION: ________________________________________________
POSITION:_______________________ COMPANY/AGENCY: ______________________
PARTY:_____________________________
REASON FOR RUNNING:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
You may use separate sheets when necessary.

I hereby certify that the facts stated herein are true and correct to the best of my knowledge.

Signature over printed name

Received by:
___________________________
COMELEC Officer 2016 Elections
Please submit in triplicate copies to the Election Supervisors on or before February 16, 2016

C O C 2 0 1 6 | 28

UNIVERSITY OF BATANGAS
COLLEGE OF LAW
STUDENT COUNCIL
CERTIFICATE OF CANDIDACY

2016 ELECTIONS

1x1 picture
Taken 6 mos.
before filing

NAME :____________________________________________________________________
last,
first,
middle
NICKNAME/STAGENAME:____________________________________________________
YEAR LEVEL:__________________________

CIVIL STATUS:____________________

PERIOD OF STAY IN UB COL:______________ BIRTHDAY:_______________________


GENDER:_____________

PLACE OF BIRTH:_____________ AGE: _______________

PROFESSION/OCCUPATION: ________________________________________________
POSITION:_______________________ COMPANY/AGENCY: ______________________
PARTY:_____________________________
REASON FOR RUNNING:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
You may use separate sheets when necessary.

I hereby certify that the facts stated herein are true and correct to the best of my knowledge.

Signature over printed name

Received by:
___________________________
COMELEC Officer 2016 Elections
Please submit in triplicate copies to the Election Supervisors on or before February 16, 2016

C O C 2 0 1 6 | 29

UNIVERSITY OF BATANGAS
COLLEGE OF LAW
STUDENT COUNCIL
CERTIFICATE OF CANDIDACY

2016 ELECTIONS

1x1 picture
Taken 6 mos.
before filing

NAME :____________________________________________________________________
last,
first,
middle
NICKNAME/STAGENAME:____________________________________________________
YEAR LEVEL:__________________________

CIVIL STATUS:____________________

PERIOD OF STAY IN UB COL:______________ BIRTHDAY:_______________________


GENDER:_____________

PLACE OF BIRTH:_____________ AGE: _______________

PROFESSION/OCCUPATION: ________________________________________________
POSITION:_______________________ COMPANY/AGENCY: ______________________
PARTY:_____________________________
REASON FOR RUNNING:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
You may use separate sheets when necessary.

I hereby certify that the facts stated herein are true and correct to the best of my knowledge.

Signature over printed name

Received by:
___________________________
COMELEC Officer 2016 Elections
Please submit in triplicate copies to the Election Supervisors on or before February 16, 2016

C O C 2 0 1 6 | 30

UNIVERSITY OF BATANGAS
COLLEGE OF LAW
STUDENT COUNCIL
CERTIFICATE OF CANDIDACY

2016 ELECTIONS

1x1 picture
Taken 6 mos.
before filing

NAME :____________________________________________________________________
last,
first,
middle
NICKNAME/STAGENAME:____________________________________________________
YEAR LEVEL:__________________________

CIVIL STATUS:____________________

PERIOD OF STAY IN UB COL:______________ BIRTHDAY:_______________________


GENDER:_____________

PLACE OF BIRTH:_____________ AGE: _______________

PROFESSION/OCCUPATION: ________________________________________________
POSITION:_______________________ COMPANY/AGENCY: ______________________
PARTY:_____________________________
REASON FOR RUNNING:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
You may use separate sheets when necessary.

I hereby certify that the facts stated herein are true and correct to the best of my knowledge.

Signature over printed name

Received by:
___________________________
COMELEC Officer 2016 Elections
Please submit in triplicate copies to the Election Supervisors on or before February 16, 2016

C O C 2 0 1 6 | 31

UNIVERSITY OF BATANGAS
COLLEGE OF LAW
STUDENT COUNCIL
CERTIFICATE OF CANDIDACY

2016 ELECTIONS

1x1 picture
Taken 6 mos.
before filing

NAME :____________________________________________________________________
last,
first,
middle
NICKNAME/STAGENAME:____________________________________________________
YEAR LEVEL:__________________________

CIVIL STATUS:____________________

PERIOD OF STAY IN UB COL:______________ BIRTHDAY:_______________________


GENDER:_____________

PLACE OF BIRTH:_____________ AGE: _______________

PROFESSION/OCCUPATION: ________________________________________________
POSITION:_______________________ COMPANY/AGENCY: ______________________
PARTY:_____________________________
REASON FOR RUNNING:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
You may use separate sheets when necessary.

I hereby certify that the facts stated herein are true and correct to the best of my knowledge.

Signature over printed name

Received by:
___________________________
COMELEC Officer 2016 Elections
Please submit in triplicate copies to the Election Supervisors on or before February 16, 2016

C O C 2 0 1 6 | 32

Please submit in triplicate copies to the Election Supervisors on or before February 16, 2016

C O C 2 0 1 6 | 33

UNIVERSITY OF BATANGAS
COLLEGE OF LAW
STUDENT COUNCIL
CERTIFICATE OF CANDIDACY

1x1 picture
Taken 6 mos.
before filing

2016 ELECTIONS

NAME :____________________________________________________________________
last,
first,
middle
NICKNAME/STAGENAME:____________________________________________________
YEAR LEVEL:__________________________

CIVIL STATUS:____________________

PERIOD OF STAY IN UB COL:______________ BIRTHDAY:_______________________


GENDER:_____________

PLACE OF BIRTH:_____________ AGE: _______________

PROFESSION/OCCUPATION: ________________________________________________
POSITION:_______________________ COMPANY/AGENCY: ______________________
PARTY:_____________________________
REASON FOR RUNNING:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
You may use separate sheets when necessary.

I hereby certify that the facts stated herein are true and correct to the best of my knowledge.

Signature over printed name

Received by:
___________________________
COMELEC Officer 2016 Elections
Please submit in triplicate copies to the Election Supervisors on or before February 16, 2016

C O C 2 0 1 6 | 34

UNIVERSITY OF BATANGAS
COLLEGE OF LAW
STUDENT COUNCIL
CERTIFICATE OF CANDIDACY

2016 ELECTIONS

1x1 picture
Taken 6 mos.
before filing

NAME :____________________________________________________________________
last,
first,
middle
NICKNAME/STAGENAME:____________________________________________________
YEAR LEVEL:__________________________

CIVIL STATUS:____________________

PERIOD OF STAY IN UB COL:______________ BIRTHDAY:_______________________


GENDER:_____________

PLACE OF BIRTH:_____________ AGE: _______________

PROFESSION/OCCUPATION: ________________________________________________
POSITION:_______________________ COMPANY/AGENCY: ______________________
PARTY:_____________________________
REASON FOR RUNNING:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
You may use separate sheets when necessary.

I hereby certify that the facts stated herein are true and correct to the best of my knowledge.

Signature over printed name

Received by:
___________________________
COMELEC Officer 2016 Elections
Please submit in triplicate copies to the Election Supervisors on or before February 16, 2016

C O C 2 0 1 6 | 35

UNIVERSITY OF BATANGAS
COLLEGE OF LAW
STUDENT COUNCIL
CERTIFICATE OF CANDIDACY

2016 ELECTIONS

1x1 picture
Taken 6 mos.
before filing

NAME :____________________________________________________________________
last,
first,
middle
NICKNAME/STAGENAME:____________________________________________________
YEAR LEVEL:__________________________

CIVIL STATUS:____________________

PERIOD OF STAY IN UB COL:______________ BIRTHDAY:_______________________


GENDER:_____________

PLACE OF BIRTH:_____________ AGE: _______________

PROFESSION/OCCUPATION: ________________________________________________
POSITION:_______________________ COMPANY/AGENCY: ______________________
PARTY:_____________________________
REASON FOR RUNNING:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
You may use separate sheets when necessary.

I hereby certify that the facts stated herein are true and correct to the best of my knowledge.

Signature over printed name

Received by:
___________________________
COMELEC Officer 2016 Elections
Please submit in triplicate copies to the Election Supervisors on or before February 16, 2016

C O C 2 0 1 6 | 36

UNIVERSITY OF BATANGAS
COLLEGE OF LAW
STUDENT COUNCIL
CERTIFICATE OF CANDIDACY

2016 ELECTIONS

1x1 picture
Taken 6 mos.
before filing

NAME :____________________________________________________________________
last,
first,
middle
NICKNAME/STAGENAME:____________________________________________________
YEAR LEVEL:__________________________

CIVIL STATUS:____________________

PERIOD OF STAY IN UB COL:______________ BIRTHDAY:_______________________


GENDER:_____________

PLACE OF BIRTH:_____________ AGE: _______________

PROFESSION/OCCUPATION: ________________________________________________
POSITION:_______________________ COMPANY/AGENCY: ______________________
PARTY:_____________________________
REASON FOR RUNNING:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
You may use separate sheets when necessary.

I hereby certify that the facts stated herein are true and correct to the best of my knowledge.

Signature over printed name

Received by:
___________________________
COMELEC Officer 2016 Elections
Please submit in triplicate copies to the Election Supervisors on or before February 16, 2016

C O C 2 0 1 6 | 37

UNIVERSITY OF BATANGAS
COLLEGE OF LAW
STUDENT COUNCIL
CERTIFICATE OF CANDIDACY

2016 ELECTIONS

1x1 picture
Taken 6 mos.
before filing

NAME :____________________________________________________________________
last,
first,
middle
NICKNAME/STAGENAME:____________________________________________________
YEAR LEVEL:__________________________

CIVIL STATUS:____________________

PERIOD OF STAY IN UB COL:______________ BIRTHDAY:_______________________


GENDER:_____________

PLACE OF BIRTH:_____________ AGE: _______________

PROFESSION/OCCUPATION: ________________________________________________
POSITION:_______________________ COMPANY/AGENCY: ______________________
PARTY:_____________________________
REASON FOR RUNNING:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
You may use separate sheets when necessary.

I hereby certify that the facts stated herein are true and correct to the best of my knowledge.

Signature over printed name

Received by:
___________________________
COMELEC Officer 2016 Elections
Please submit in triplicate copies to the Election Supervisors on or before February 16, 2016

C O C 2 0 1 6 | 38

UNIVERSITY OF BATANGAS
COLLEGE OF LAW
STUDENT COUNCIL
CERTIFICATE OF CANDIDACY

2016 ELECTIONS

1x1 picture
Taken 6 mos.
before filing

NAME :____________________________________________________________________
last,
first,
middle
NICKNAME/STAGENAME:____________________________________________________
YEAR LEVEL:__________________________

CIVIL STATUS:____________________

PERIOD OF STAY IN UB COL:______________ BIRTHDAY:_______________________


GENDER:_____________

PLACE OF BIRTH:_____________ AGE: _______________

PROFESSION/OCCUPATION: ________________________________________________
POSITION:_______________________ COMPANY/AGENCY: ______________________
PARTY:_____________________________
REASON FOR RUNNING:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
You may use separate sheets when necessary.

I hereby certify that the facts stated herein are true and correct to the best of my knowledge.

Signature over printed name

Received by:
___________________________
COMELEC Officer 2016 Elections
Please submit in triplicate copies to the Election Supervisors on or before February 16, 2016

C O C 2 0 1 6 | 39

UNIVERSITY OF BATANGAS
COLLEGE OF LAW
STUDENT COUNCIL
CERTIFICATE OF CANDIDACY

2016 ELECTIONS

1x1 picture
Taken 6 mos.
before filing

NAME :____________________________________________________________________
last,
first,
middle
NICKNAME/STAGENAME:____________________________________________________
YEAR LEVEL:__________________________

CIVIL STATUS:____________________

PERIOD OF STAY IN UB COL:______________ BIRTHDAY:_______________________


GENDER:_____________

PLACE OF BIRTH:_____________ AGE: _______________

PROFESSION/OCCUPATION: ________________________________________________
POSITION:_______________________ COMPANY/AGENCY: ______________________
PARTY:_____________________________
REASON FOR RUNNING:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
You may use separate sheets when necessary.

I hereby certify that the facts stated herein are true and correct to the best of my knowledge.

Signature over printed name

Received by:
___________________________
COMELEC Officer 2016 Elections
Please submit in triplicate copies to the Election Supervisors on or before February 16, 2016

C O C 2 0 1 6 | 40

UNIVERSITY OF BATANGAS
COLLEGE OF LAW
STUDENT COUNCIL
CERTIFICATE OF CANDIDACY

2016 ELECTIONS

1x1 picture
Taken 6 mos.
before filing

NAME :____________________________________________________________________
last,
first,
middle
NICKNAME/STAGENAME:____________________________________________________
YEAR LEVEL:__________________________

CIVIL STATUS:____________________

PERIOD OF STAY IN UB COL:______________ BIRTHDAY:_______________________


GENDER:_____________

PLACE OF BIRTH:_____________ AGE: _______________

PROFESSION/OCCUPATION: ________________________________________________
POSITION:_______________________ COMPANY/AGENCY: ______________________
PARTY:_____________________________
REASON FOR RUNNING:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
You may use separate sheets when necessary.

I hereby certify that the facts stated herein are true and correct to the best of my knowledge.

Signature over printed name

Received by:
___________________________
COMELEC Officer 2016 Elections
Please submit in triplicate copies to the Election Supervisors on or before February 16, 2016

C O C 2 0 1 6 | 41

UNIVERSITY OF BATANGAS
COLLEGE OF LAW
STUDENT COUNCIL
CERTIFICATE OF CANDIDACY

2016 ELECTIONS

1x1 picture
Taken 6 mos.
before filing

NAME :____________________________________________________________________
last,
first,
middle
NICKNAME/STAGENAME:____________________________________________________
YEAR LEVEL:__________________________

CIVIL STATUS:____________________

PERIOD OF STAY IN UB COL:______________ BIRTHDAY:_______________________


GENDER:_____________

PLACE OF BIRTH:_____________ AGE: _______________

PROFESSION/OCCUPATION: ________________________________________________
POSITION:_______________________ COMPANY/AGENCY: ______________________
PARTY:_____________________________
REASON FOR RUNNING:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
You may use separate sheets when necessary.

I hereby certify that the facts stated herein are true and correct to the best of my knowledge.

Signature over printed name

Received by:
___________________________
COMELEC Officer 2016 Elections
Please submit in triplicate copies to the Election Supervisors on or before February 16, 2016

C O C 2 0 1 6 | 42

UNIVERSITY OF BATANGAS
COLLEGE OF LAW
STUDENT COUNCIL
CERTIFICATE OF CANDIDACY

2016 ELECTIONS

1x1 picture
Taken 6 mos.
before filing

NAME :____________________________________________________________________
last,
first,
middle
NICKNAME/STAGENAME:____________________________________________________
YEAR LEVEL:__________________________

CIVIL STATUS:____________________

PERIOD OF STAY IN UB COL:______________ BIRTHDAY:_______________________


GENDER:_____________

PLACE OF BIRTH:_____________ AGE: _______________

PROFESSION/OCCUPATION: ________________________________________________
POSITION:_______________________ COMPANY/AGENCY: ______________________
PARTY:_____________________________
REASON FOR RUNNING:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
You may use separate sheets when necessary.

I hereby certify that the facts stated herein are true and correct to the best of my knowledge.

Signature over printed name

Received by:
___________________________
COMELEC Officer 2016 Elections
Please submit in triplicate copies to the Election Supervisors on or before February 16, 2016

C O C 2 0 1 6 | 43

UNIVERSITY OF BATANGAS
COLLEGE OF LAW
STUDENT COUNCIL
CERTIFICATE OF CANDIDACY

2016 ELECTIONS

1x1 picture
Taken 6 mos.
before filing

NAME :____________________________________________________________________
last,
first,
middle
NICKNAME/STAGENAME:____________________________________________________
YEAR LEVEL:__________________________

CIVIL STATUS:____________________

PERIOD OF STAY IN UB COL:______________ BIRTHDAY:_______________________


GENDER:_____________

PLACE OF BIRTH:_____________ AGE: _______________

PROFESSION/OCCUPATION: ________________________________________________
POSITION:_______________________ COMPANY/AGENCY: ______________________
PARTY:_____________________________
REASON FOR RUNNING:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
You may use separate sheets when necessary.

I hereby certify that the facts stated herein are true and correct to the best of my knowledge.

Signature over printed name

Received by:
___________________________
COMELEC Officer 2016 Elections
Please submit in triplicate copies to the Election Supervisors on or before February 16, 2016

C O C 2 0 1 6 | 44

UNIVERSITY OF BATANGAS
COLLEGE OF LAW
STUDENT COUNCIL
CERTIFICATE OF CANDIDACY

2016 ELECTIONS

1x1 picture
Taken 6 mos.
before filing

NAME :____________________________________________________________________
last,
first,
middle
NICKNAME/STAGENAME:____________________________________________________
YEAR LEVEL:__________________________

CIVIL STATUS:____________________

PERIOD OF STAY IN UB COL:______________ BIRTHDAY:_______________________


GENDER:_____________

PLACE OF BIRTH:_____________ AGE: _______________

PROFESSION/OCCUPATION: ________________________________________________
POSITION:_______________________ COMPANY/AGENCY: ______________________
PARTY:_____________________________
REASON FOR RUNNING:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
You may use separate sheets when necessary.

I hereby certify that the facts stated herein are true and correct to the best of my knowledge.

Signature over printed name

Received by:
___________________________
COMELEC Officer 2016 Elections
Please submit in triplicate copies to the Election Supervisors on or before February 16, 2016

C O C 2 0 1 6 | 45

UNIVERSITY OF BATANGAS
COLLEGE OF LAW
STUDENT COUNCIL
CERTIFICATE OF CANDIDACY

2016 ELECTIONS

1x1 picture
Taken 6 mos.
before filing

NAME :____________________________________________________________________
last,
first,
middle
NICKNAME/STAGENAME:____________________________________________________
YEAR LEVEL:__________________________

CIVIL STATUS:____________________

PERIOD OF STAY IN UB COL:______________ BIRTHDAY:_______________________


GENDER:_____________

PLACE OF BIRTH:_____________ AGE: _______________

PROFESSION/OCCUPATION: ________________________________________________
POSITION:_______________________ COMPANY/AGENCY: ______________________
PARTY:_____________________________
REASON FOR RUNNING:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
You may use separate sheets when necessary.

I hereby certify that the facts stated herein are true and correct to the best of my knowledge.

Signature over printed name

Received by:
___________________________
COMELEC Officer 2016 Elections
Please submit in triplicate copies to the Election Supervisors on or before February 16, 2016

C O C 2 0 1 6 | 46

UNIVERSITY OF BATANGAS
COLLEGE OF LAW
STUDENT COUNCIL
CERTIFICATE OF CANDIDACY

2016 ELECTIONS

1x1 picture
Taken 6 mos.
before filing

NAME :____________________________________________________________________
last,
first,
middle
NICKNAME/STAGENAME:____________________________________________________
YEAR LEVEL:__________________________

CIVIL STATUS:____________________

PERIOD OF STAY IN UB COL:______________ BIRTHDAY:_______________________


GENDER:_____________

PLACE OF BIRTH:_____________ AGE: _______________

PROFESSION/OCCUPATION: ________________________________________________
POSITION:_______________________ COMPANY/AGENCY: ______________________
PARTY:_____________________________
REASON FOR RUNNING:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
You may use separate sheets when necessary.

I hereby certify that the facts stated herein are true and correct to the best of my knowledge.

Signature over printed name

Received by:
___________________________
COMELEC Officer 2016 Elections
Please submit in triplicate copies to the Election Supervisors on or before February 16, 2016

C O C 2 0 1 6 | 47

UNIVERSITY OF BATANGAS
COLLEGE OF LAW
STUDENT COUNCIL
CERTIFICATE OF CANDIDACY

2016 ELECTIONS

1x1 picture
Taken 6 mos.
before filing

NAME :____________________________________________________________________
last,
first,
middle
NICKNAME/STAGENAME:____________________________________________________
YEAR LEVEL:__________________________

CIVIL STATUS:____________________

PERIOD OF STAY IN UB COL:______________ BIRTHDAY:_______________________


GENDER:_____________

PLACE OF BIRTH:_____________ AGE: _______________

PROFESSION/OCCUPATION: ________________________________________________
POSITION:_______________________ COMPANY/AGENCY: ______________________
PARTY:_____________________________
REASON FOR RUNNING:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
You may use separate sheets when necessary.

I hereby certify that the facts stated herein are true and correct to the best of my knowledge.

Signature over printed name

Received by:
___________________________
COMELEC Officer 2016 Elections
Please submit in triplicate copies to the Election Supervisors on or before February 16, 2016

C O C 2 0 1 6 | 48

UNIVERSITY OF BATANGAS
COLLEGE OF LAW
STUDENT COUNCIL
CERTIFICATE OF CANDIDACY

2016 ELECTIONS

1x1 picture
Taken 6 mos.
before filing

NAME :____________________________________________________________________
last,
first,
middle
NICKNAME/STAGENAME:____________________________________________________
YEAR LEVEL:__________________________

CIVIL STATUS:____________________

PERIOD OF STAY IN UB COL:______________ BIRTHDAY:_______________________


GENDER:_____________

PLACE OF BIRTH:_____________ AGE: _______________

PROFESSION/OCCUPATION: ________________________________________________
POSITION:_______________________ COMPANY/AGENCY: ______________________
PARTY:_____________________________
REASON FOR RUNNING:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
You may use separate sheets when necessary.

I hereby certify that the facts stated herein are true and correct to the best of my knowledge.

Signature over printed name

Received by:
___________________________
COMELEC Officer 2016 Elections
Please submit in triplicate copies to the Election Supervisors on or before February 16, 2016

C O C 2 0 1 6 | 49

UNIVERSITY OF BATANGAS
COLLEGE OF LAW
STUDENT COUNCIL
CERTIFICATE OF CANDIDACY

2016 ELECTIONS

1x1 picture
Taken 6 mos.
before filing

NAME :____________________________________________________________________
last,
first,
middle
NICKNAME/STAGENAME:____________________________________________________
YEAR LEVEL:__________________________

CIVIL STATUS:____________________

PERIOD OF STAY IN UB COL:______________ BIRTHDAY:_______________________


GENDER:_____________

PLACE OF BIRTH:_____________ AGE: _______________

PROFESSION/OCCUPATION: ________________________________________________
POSITION:_______________________ COMPANY/AGENCY: ______________________
PARTY:_____________________________
REASON FOR RUNNING:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
You may use separate sheets when necessary.

I hereby certify that the facts stated herein are true and correct to the best of my knowledge.

Signature over printed name

Received by:
___________________________
COMELEC Officer 2016 Elections
Please submit in triplicate copies to the Election Supervisors on or before February 16, 2016

C O C 2 0 1 6 | 50

UNIVERSITY OF BATANGAS
COLLEGE OF LAW
STUDENT COUNCIL
CERTIFICATE OF CANDIDACY

2016 ELECTIONS

1x1 picture
Taken 6 mos.
before filing

NAME :____________________________________________________________________
last,
first,
middle
NICKNAME/STAGENAME:____________________________________________________
YEAR LEVEL:__________________________

CIVIL STATUS:____________________

PERIOD OF STAY IN UB COL:______________ BIRTHDAY:_______________________


GENDER:_____________

PLACE OF BIRTH:_____________ AGE: _______________

PROFESSION/OCCUPATION: ________________________________________________
POSITION:_______________________ COMPANY/AGENCY: ______________________
PARTY:_____________________________
REASON FOR RUNNING:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
You may use separate sheets when necessary.

I hereby certify that the facts stated herein are true and correct to the best of my knowledge.

Signature over printed name

Received by:
___________________________
COMELEC Officer 2016 Elections
Please submit in triplicate copies to the Election Supervisors on or before February 16, 2016

C O C 2 0 1 6 | 51

UNIVERSITY OF BATANGAS
COLLEGE OF LAW
STUDENT COUNCIL
CERTIFICATE OF CANDIDACY

2016 ELECTIONS

1x1 picture
Taken 6 mos.
before filing

NAME :____________________________________________________________________
last,
first,
middle
NICKNAME/STAGENAME:____________________________________________________
YEAR LEVEL:__________________________

CIVIL STATUS:____________________

PERIOD OF STAY IN UB COL:______________ BIRTHDAY:_______________________


GENDER:_____________

PLACE OF BIRTH:_____________ AGE: _______________

PROFESSION/OCCUPATION: ________________________________________________
POSITION:_______________________ COMPANY/AGENCY: ______________________
PARTY:_____________________________
REASON FOR RUNNING:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
You may use separate sheets when necessary.

I hereby certify that the facts stated herein are true and correct to the best of my knowledge.

Signature over printed name

Received by:
___________________________
COMELEC Officer 2016 Elections
Please submit in triplicate copies to the Election Supervisors on or before February 16, 2016

C O C 2 0 1 6 | 52

UNIVERSITY OF BATANGAS
COLLEGE OF LAW
STUDENT COUNCIL
CERTIFICATE OF CANDIDACY

2016 ELECTIONS

1x1 picture
Taken 6 mos.
before filing

NAME :____________________________________________________________________
last,
first,
middle
NICKNAME/STAGENAME:____________________________________________________
YEAR LEVEL:__________________________

CIVIL STATUS:____________________

PERIOD OF STAY IN UB COL:______________ BIRTHDAY:_______________________


GENDER:_____________

PLACE OF BIRTH:_____________ AGE: _______________

PROFESSION/OCCUPATION: ________________________________________________
POSITION:_______________________ COMPANY/AGENCY: ______________________
PARTY:_____________________________
REASON FOR RUNNING:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
You may use separate sheets when necessary.

I hereby certify that the facts stated herein are true and correct to the best of my knowledge.

Signature over printed name

Received by:
___________________________
COMELEC Officer 2016 Elections
Please submit in triplicate copies to the Election Supervisors on or before February 16, 2016

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