1

Repub llc.of thc Philippines

COMM.!:SSION ON ELECTIONS
Manita

INSTRUCTIONS: (Readwell before filling up this form.)

J. File this,in FiVE (5) LEGIBLE copies.
2. File this certificate of candidacy with the Law Department, (OMELEC 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 nominationshall be accepted.
4. Titles such as 'Dr., Atty., Don, Ginoo, Senor, Datu, Hadji, Sultan, Bai, Senora, Kapitan or similar titles are expresslyprohibIted.
5. This ~ertificate shall be sworn bBfore a notary public or any official authorized to administer oath. COMELEC orrrctars are not authorized to
<ldministeroath.
·~',t·~'-:f·c •• ':. ,. )'. '~'!I\'-",;'- ,,' .:... _,~~;"':,~~~/~~~~("
:.;~,#~r~bY~~nou\'lcC! ~y ~a~~idacy for th? position 'Of.SENATOR, ~epublic of the Philippines, in the MaV 10,';iQ~~;~J~~ir.~n5i
~~~?\~,~~r l1~v,"gbeen swor~ to In at;c:ordanceWltli law, he'~b~.~~e the fo~IOWID9: " ',',~ ';.;~\!,~~~
.
3. MY GENDER IS : 4. MY AGE IS:'
1. MY NAME IS:

l.l Last Name

o Male DFemale

5. MY DATE OF BIRTH IS :
1.2 First Name

Month
i::i3.~·.:
[~[~:H.i.'.i:-:
Day Year
1.3 f·liddle Name
6. NY PLACE OF BIRTH IS :

I~~~i~~
!~:~~i~~~;:~o,;~~;~~;;t~.
~~.~~~,
~~,~~.~.
~.~~~~~~~.~~. ~~~~~~~~1~ •.. , ..•• : ••. , .•. ,.. ',"'.
City/Mun

Province
J~.A.:N.:.~j!'..: ' : ,..: : .1...: .. .' ' : : : : : ~.. ;
~------~~--~~~~~~~~~~~~~~~~~--~~--~~~~--~~~'·8.MYCIVILSTATUSIS:
, .
7. I AM OFFICIALLY NOMINATED BY: (Attach Certificateof Nomination)
o Singre 0 Widow/er
,,..- , , ,AN".· .KftPtm.V2,AN .. f'~ Polilical Par
" .
o Married 0 LegallySeparated

>(~.:...:... D
- , - •••••• " - -,' • - r - • ., - • -, - - -.- - • ,- - - ~ - - • - - -.' • - ," - - , " - • - - •• - - •.•• - -,- - -,

9. MY RESIDENCE!
ADDRESS IS: 9.1Province :'??i!..:~ A. i /}Ij':~ .:... :.q.~~;.~ /~.:."!~! Annulled/ Divorced

9,2 City/Nunicipality 9.3 Barangay

; 'C:" '0 ':~':":'; ':'i ';7 '~j':":":" .:.. ':" .:':: ~ .: i.·it:·:";: ii :'ij;;i' ;'/:":";"':"';'r: ~!tBlLI1tL1W~:JI1.iW~~~
....... ' ' :.'-:".:
: /.: .. :.. .' : : !.. : <':'; :.:""";,, ,: :.,,'. ", .. !.,,: :" .: : : 10. r-1Y PROFESSION OR
9,4 HouseNO.1Street / Subdivision OCCUPATION IS :
: •. , •• ",- .• ,. , • , ' " -,' • 't' •• ,. - - ~ •• ~ • - .•- • -,- - ",- • - ,- " • ~ • , , - - ..•
- - - •• - . ~- • -," - - ,. " - • - - , • - -,' • '.' • ',- •••• - ., - • "," • ., " "

: N:O.:-b: : '1:7:1i ~ :gJ.: ~ : : ' . : ' . , . : . ~ ' . , : : : : ..~DkVml'l.1.aJ.Jtuntnlt .

11. MY POST OFFICE ADDRESS FOR ELECTION PURPOSES IS ; (Couldbe the sameas No,9) 12. I AM A REGISTERED VOTER OF

Precinct

13. MY PERIOD OF RESIDENCE IN THE PHILIPPINES BEFORE MAY 10, 2010 IS :

Bgy .Nf1Urw111-. ""'''''''' " .
~:i.
Cily/Mun .C&o.. ~P.I .
,-
.. ,-'. ~-6 -~ ,
No. of Years
Province . Mts:t-rty).IS.. Q(J~I\IrA-V .
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 ELIGIBLE FOR'THE OFFICE I SEEK TO BE ELEmD TO.
17. r 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 If'lPOSE THIS OBLIGATION UPON MYSELF
VOLUNTARILY, WITHOUT MENTAL RESERVATION OR PURPOSE,.9F EVASION.

J hereby certify that the facts stated Ilerein are true and corre Q',I (#;r,(f;;,eftifrnal knowledge.

SUBSCRIBED AND SWORN to before me this __

. OV '1 6 ?onU
Mo'g,OACTI"'! OF ~t..·1 ,111Ah~
!!. J v
~ay of Novembm-, at ·!'laiTiiint l".hibiting to me his/her
tTEi.ffi~Iltifu:a~~El. IJ~, '7.L\"ts<l: Issued by: On: 2D /flat ')(j\)~
'"et> ,~'f C,tl?.<:"'" 10
Doc. No. .21Y)
Page No. _---.:<::==6:-......_-'
Book No. _-=-,J=.l _ (Officer Authorized to Administer Oath)
Series of 2001, (Affix documentary stamp)-

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PTR No. OC1761C>J..~,(il/j)::~/\~~~;_. SPtNdUAN