Republic of the Philippines

COMMISSION ON ELECTrONS
Manila
TIME:
BY:
CERTIFICATE OF
SENATOR
INSTRUCTIONS: (Readwell before filling up this form.)
1. file this in fNE (5) LEGIBLEcopies.
2. file this certificate of candidacy with the Law Department, CO~lElEC Main Office, Intramuros, Manila, starting November 20, 2009 up to
midnight of November30, 2009.
3. Attach to this certificate the Certificate of Party Nomination unless you are an independent candidate. After midnight of November 30, 2009, no
certificate of nomination shall be accepted.
4. Titles such as 'Dr., A.tty., Don, Ginoo. Senor, Datu, Hadji, Sultan, Bait Senora, Kapitan or similar titles are expressly prohibited.
S. This certificate shall be sworn before a notary public or any o,fficlal authorized to administer oath. COMElEC offiCials are not authorized to
administer oath.
~))'l:,·,;tt.;t,~ ," ; . . ,.,~.~", . ,- .' ~ r ·r~'~;\;lIIJ!t
~
;:.~6,er1by !lnnounce my calldidacy fo~ the position 0f·SENATOR, Rspllblle of the PhilippineS, irt the May .10, 2~:t(n~'1!~1IJrts;
n~l~~~r~r
"
h~ving been sworn to in accordance with law, hereb!.s~~~,th~ following:
1
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1. MY NAME IS : 3. MY GENDER IS : 4. MY AGE ~S :'

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:::::.:.:::::::' Male DFema'e "
1.1 Last Name
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5. MY.DATE OF BIRTH IS :
1.2 First Nama

1.3 r·liddleName
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Month 'Day reer
6. MY PLACE OF BIRTH IS :
2, I AM GENERALLY OR POPULARLY KNOWN BY THE NICKNAME OR STAGENAME
(Indicate only one nicknameor stagename) City/Mun ~flMPt1~. J}?/JtlII:ft .
•• _ .• - - ',' - .,. - • ., • - ',. - -,- - - ~ - -,. - -, - -., - - ",- - - " - -,. - - .• - - ',' - - r - •.•• - ',' • ',' - -,. - - •. - - •••.•••• ',' - "," - -,

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~------~~--~--~~--~--~----~--~------------------------------~~8.MYCIVILSTATUSIS:
7. I AM OFFICIALLY NOMINATED
~NGJ t.flPfJT1.M!tLff}~7l.
BY' (Attach Certificateof Nomination)
.
Sjngle D Widow/er
...................
Political Par 8] Married 0 LegallySeparated
9. MY RESIDENCEj
ADDRESS IS:
9.2 (ily!Nunidpality
9.1 Province :~[~::~::::'::.
9.3 Barangay
• •• :::::f:::::~":::::::::::~::~:::::::' o Annulled/ Divorced

Full Name of Spouse. if married

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.....'. 10. MY PROFESSION OR
OCCUPATION IS :

11. MY POST OFFICE ADDRESS FOR ELECTION PURPOSES IS : (Couldbe the sameas No.9) 12. I AM A REGISTERED VOTER OF
Precinct •.... ..Q~~qA .
13. MY PERIOD OF RESIDENCE IN THE PHIUPPINES BEFORE MAY 10, 2010 IS :
Bgy ~AJ~..ANrON! 9. .
:,: I: City/Mun fNJ~..~11){ .
' ••...... : I: I : NO. of Montlls .. . '
,
, No. of Years
Province N.~tz.. .
~----------------------------------------------------------;
14. I AM A NATURAL BORN FILIPINO CmZEN.
15. I AM NOT A PERMANENT RESIDENT OF, OR IMMIGRANT TO, A FOREIGN
COUNTRY.
16. I AM EUGIBLE FOR 'THE OFFICE I SEEK TO BE ELECTED TO,
17. I WILL SUPPORT AND DEFEND THE CONSTITUTION OF THE REPUBLIC OF THE
PHILIPPINES AND WILL MAINTAIN TRUE FAITH AND ALLEGIANCE THERETO. I
WILL OBEY THE LAWS, LEGAL ORDERS AND DECREES PROMULGATED BY THE
DULY CONSTITUTED AUTHORITIES. I IMPOSE THIS OBLIGATION UPON MYSELF
VOLUNTARILY, WITHOUT I"IENTAL RESERVATION OR PURPOSE,9F EVASION.

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I hereby certify that the facts stated herein are true and correct of my own perso.V>''I.'.I~~]~C

. N Q\I ~ 1'\ ')onn OATH

SUBSCRiBED AND SWOR~ to betore me this __ d¥Y o!..~o!lmtk , ~g, at em' OF SANaItWn~~hibiting to me his/her
CTC/ldentification Card No•. 1\1l..?> I &'15 Rcti
Issued by : __ ..L. (3 t> ._ on : _
Doc. No. ..J)(;'
'" 1
Page No. .'''t
Book No. -----;::n:;..;---~ (Officer Authorized to Administer Oath)
Series of 200]. '-;y stamp) ArTY. BE UDD
II•• C. CONG
NOT/\;~Ypueu
fOMMISSIDNEiJ IJUT/L ;1 csc 2009
f(~p I;P.N No. 07232 -R:lf\l-S,~N !JUAN
PTR No. 007~~~O.~ Ollu6/C9- SANJUAN