Republic of the Philippines

COMMISSION ON ELECTIONS

Attach
2x2
ID Photo

Intramuros, Manila

INFORMATION SHEET
(Please type or print)

LOCAL MEDIA
NATIONAL AND LOCAL ELECTIONS
MAY 9, 2016
Name: _________________________________________________ Citizenship: _________________
(Surname)
(Given)
(Middle)
Date of Birth: ________________________________ Place of Birth: __________________________
Status: ______________
Residence: ___________________________________________ Tel. No.: ______________________
(City)
___________________________________________ Cel. No: ______________________
(Province)
Position/Designation: _________________________________________________________________
Organization/Agency: ________________________________________________________________
Name of Editor/Station Manager: _______________________________________________________
Business address: ____________________________________________________________________
____________________________________________________________________
Tel. Nos.: __________________________________________________________________________
Place to be Visited: __________________________________________________________________
__________________________________________________________________

_______________________
(Signature)

Requirements:
1. Endorsement letter from the newspaper, television or radio station employing the applicant.
(Editor/Station Manager)
2. 2 pcs. 2 x 2 ID photo