Downloaded From: http://www.comelec.gov.

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Republic of the Philippines

COMMISSION ON ELECTIONS

APPLICATION FOR REACTIVATION OF REGISTRATION RECORD

I,

, Filipino, born on
First Name/Middle Name/Last Name month/day/year

a duly registered voter in Precinct No. City/Municipality of ,

of Barangay Province of . .

, ,

single/widow/er/legally separated/married to

_____ , do hereby apply for

the reactivation of my registration record which was deactivated due to (please check appropriate box):

__

1. Sentence by final judgment to suffer imprisonment for not less than one (1) year; 2. Conviction, by final judgment, or crime involving disloyalty to the duly constituted government, etc;

I | __

3. Declaration of insanity or incompetence by a competent authority; 4. Failure to vote in two (2) successive preceding regular elections; 5. Loss of Filipino Citizenship; or 6. Exclusion by a court order.

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That said ground no longer exists, as evidenced by the attached certification/order of the court (in case of 1,2,3,5 and 6).

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IN WITNESS WHEREOF, I have hereunto affix my signature this , Province of

day of Philippines.

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(Signature above Printed Name) SUBSCRIBED AND SWORN to before me on the above date.

EO/Chairman of the Election Registration Board (Signature above Printed Name)

N o t i c e t o t h e a p p l i c a n t : If your biometrics, i.e. at the back.

photograph, signature a n d fingerprints had not been captured digitally, please accomplish the form

Downloaded From: http://www.comelec.gov.ph

AppI cation No.

Instructions : (1) Accomplish separately in three (3) copies; (2-) print legibly; (3) check the appropriate box. PART 1 NAME
Last First Middle)
: i

Precinc* No.

PERSONAL INFORMATION (To be filled out by Applicants)

^] Illiterate

r !

J....1. T~"T
> M |

Disabled / Person with Disability

Assisted b y : .
(Please fill-up Assistor's O a t h )

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T"

T T T

GENDER
J Male Height J Female Weight

RESIDENCE/ADDRESS
City/Municlpallty

Province Barangay

Ml!

rTTTTTTT"
I I I . I l l II. 1
| | By birth

DATE OF BIRTH

House No. / Street

Month

Day

I I j 1 i I j 1 J L i J J. i CITIZENSHIP
Month

Year

PLACE OF BIRTH
| | Reacquired Clty/Mun Province

Naturalized

(If naturallzed/reacqulred, state date of naturallzatlon/reacqulsltlon and Certificate Number of naturallzatlon/order of approval of reacquisition)

Date of Naturalization/ Reacquisition

m-m -LLTij
No. of Months

Day

Year

Certificate No./Order of Approval

CIVIL STATUS
[ | Single ^jwidow/er

PERIOD OF RESIDENCE
No. of Years In the City / Mun

M l

No. of Years r* 1 In the Philippines j j j

Married

^Legally Separated

Name of Spouse, If married

PROFESSION / OCCUPATION NAME OF FATHER

Last

TIN NAME OF MOTHER

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First

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Last

Middle:

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First

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OATH

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Middle!

PART 2

ROLLED THUMBPRINTS / SPECIMEN

SIGNATURES

I d o solemnly swear that the a b o v e statements regarding my person are t r u e a n d c o r r e c t ; t h a t I p o s s e s s all t h e q u a l i f i c a t i o n s a n d n o n e of t h e disqualifications of a voter; that I have no pending application for registration In any city/municipality.

f
Month Day
J -

f
L.

JLLJ
Year

S i g n a t u r e of A p p l i c a n t A b o v e Printer/ N a m e

Left T h u m b

Right T h u m b

E O / A d m i n i s t e r i n g Officer (Signature a b o v e Printed N a m e )

2.

3.

PART 3
_ Approved Disapproved

ACTION BY THE ELECTION REGISTRATION

_ r
Day

BOARD

i.

i.

L
Date

QTIJ
Reason for Disapproval

Year

With Precinct Assignment No.

Member Signature above Printed N a m e

Chairman of the Board Signature above Printed Name

Member Signature above Printed Name

PART 4
OTY/MUN/ DISTRICT C O D E

VOTER IDENTIFICATION NUMBER (To be filled out by Election

Officer)
NAME C O D E

PRECINCT NO

DAY DATE OF BIRTH

Downloaded From: http://www.comelec.gov.ph CEF-1C

COMMISSION ON ELECTIONS

Republic of the Philippines

APPLICATION FOR REACTIVATION OF . REGISTRATION RECORD

i,

, Filipino, born on
First Name/Middle Name/Last Name month/day/year

a duly registered voter in Precinct No. City/Municipality of ,

of Barangay Province of , do hereby apply for

single/widow/er/legally separated/married to

the reactivation of my registration record which was deactivated due to (please check appropriate box):

I I __ __
_ u

I I

1. Sentence by final judgment to suffer imprisonment for not less than one (1) year; 2. Conviction, by final judgment, or crime involving disloyalty to the duly constituted government, etc; 3. Declaration of insanity or incompetence by a competent authority; 4. Failure to vote in t w o (2) successive preceding regular elections; 5. Loss of Filipino Citizenship; or 6. Exclusion by a court order.

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UJ UJ

That said ground no longer exists, as evidenced by the attached certification/order of the court (in case of 1,2,3,5 and 6 ) .

IN WITNESS WHEREOF, I have hereunto affix my signature this , Province of

day of , Philippines.

_ 20

at

8
SUBSCRIBED AND SWORN to before me on the above date.

(Signature above Printed Name)

EO/Chairman of the Election Registration Board (Signature above Printed Name)

Notice to the applicant: If your biometrics, i.e. photograph, signature and fingerprints had not been captured digitally, please accomplish the form at the back.

Downloaded From: http://www.comelec.gov.ph Application No. P r e c i n c t No.

Instructions : (1) Accomplish separately in three (3) copies; (2) print legibly; (3) check the appropriate box. PART 1 NAME Last First i PERSONAL INFORMATION (To be filled out by Applicant)
t i l l !

Assisted by (Please fill-up Assistor's Oath)

GENDER

1 Illiterate

1 uisaDiea/ Vkcto* J^^tCVwt*M^

Middle ! RESIDENCE/ADDRESS City/Municipality f j ] [ I

I [ i

Province

| i Barangay I

Male Height

Female Weight

DATE OF BIRTH

House No. / Street i CITIZENSHIP

BY Birth

Month

Day

Year

I J Reacquired

PLACE OF BIRTH

^Naturalized

City/Mun Province
CIVIL STATUS

(If naturalized/reacquired, state date of naturalization/reacquisition and Certificate Number of naturalization/order of approval of reacquisition)

Date of Naturalization/
.

Month
. ; r

Day
1

Year
' ; . J

Certificate No./Order of Approval ; i

No. of Years

Reacquisition PERIOD OF RESIDENCE

No. of Years

i - I

i - j

No. of Months

In the City/Mun

In the Philippines i

~] Legally Separated Name of Spouse, if married Married ..i i I I J ! i i

i
L.

Q ]single

^jwidow/er

. PROFESSION/OCCUPATION NAME OF FATHER ~l Last First i

i i i i i i

TIN

NAME OF MOTHER Last [ I j I | j I i ! First r r r Middle; I j I

Middle;

.L..J i i i i L.J i I J
OATH

I
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1f T i l
! ! ! ! !

PART 2

ROLLED THUMBPRINTS / SPECIMEN SIGNATURES

I do solemnly swear that the above statements regarding my person are true and correct; that I possess all the qualifications and none of the disqualifications of a voter; that I have no pending application for registration in any city/municipality; and that I am not registered in any precinct in the Philippines
DATE i Month ;-! Day
Year

Signature of Applicant Above Printed Name

Left Thumb

Right Thumb

EO / Administering Officer (Signature above Printed Name) PART 3 Approved Disapproved Date Reason for Disapproval Chairman of the Board (Signature above Printed Name)

2.

3.

ACTION BY THE ELECTION REGISTRATION BOARD With precinct assignment No.

Member (Signature above Printed Name) PART 4

CITY/MUN DISTRICT CODE

Member (Signature above Printed Name) Officer)

NAME CODE

VOTER IDENTIFICATION NUMBER (To be filled out by Election

YIAR DATE OF BIRTH

ACKNOWLEDGEMENT R E C E I P T Application No. j Application for Registration Last First Middle [ j

i.

" 1 T i ,J j.

This is to acknowledge receipt of your Application for registration. You are not yet registered unless approved by Election Registration Board/(ERB). You need not appear In the ERB hearing unless required through a written notice.
h e

i.

_.

JL..

EQ/Interviewer Signature Above Printed Name

Downloaded From: http://www.comelec.gov.ph

Republic of the Philippines

COMMISSION ON ELECTIONS

APPLICATION FOR REACTIVATION OF REGISTRATION RECORD

I,

First Name/Middle Name/Last Name

, Filipino, born on of Barangay , Province _ of

month/day/year

a duly registered voter in Precinct No. City/Municipality of

, , do hereby apply for

single/widow/er/legally separated/married to

the reactivation of my registration record which was deactivated due to (please check appropriate box):

I J [_ I __ _ _ I

1. Sentence by final judgment to suffer imprisonment for not less than one (1) year; 2. Conviction, by final judgment, or crime involving disloyalty to the duly constituted government, etc; 3. Declaration of insanity or incompetence by a competent authority; 4. Failure to vote in two (2) successive preceding regular elections; 5. Loss of Filipino Citizenship; or 6. Exclusion by a court order.

That said ground no longer exists, as evidenced by the attached certification/order of the court (in case of 1,2,3,5 and 6).
UJ

P 2

IN WITNESS WHEREOF, I have hereunto affix my signature this , Province of

day of , Philippines.

,20

at

(Signature above Printed Name) SUBSCRIBED AND SWORN to before me on the above date.

EO/Chairman of the Election Registration Board (Signature above Printed Name)

Notice to the applicant: If your biometrics, I.e. photograph, at the back.

s i g n a t u r e

and fingerprints had not been captured digitally, please accomplish

t h e

lomi

Downloaded From: http://www.comelec.gov.ph

Application No.

Precinct No. ir
!

[, Instructions ; (1) Accornplish separately In three (3) copies; (2} print legibly; (3) check the appropriate box, PART 1 NAME
Last Fin* ! [ 1 j f | T 1 i

PERSONAL INFORMATION (To be filled out by

Applicants) J Illiterate Assisted by:.

Middle!

1 Province i j i ! i |

r~ T I T ' i 1 I1 i 1 1 i

TTl 1 i !
! ! 1

Disabled / Person with Disability

(Please fill-up Assistor's Oath)

GENDER
J Male Height 1 Female Weight

RESIDENCE/ADDRESS
City/Municipality

-J 1.1 ..1..1...L1...L.L
1iJL JLt j.. l. j

Barangay

DATE OF BIRTH

LL...J

LIL.

..L....L.
I : ! i

4 l_1
I :

House No. / Street

Li.
CITIZENSHIP

T"""T
_] Naturalized

Month

Day

Year

y birth

,t. J Reacquired

PLACE OF BIRTH
City/Mun Province _ _ _ _ _

(If naturalLzed/reacqulred, state date of naturallzatlon/reacqulsltlon and Certificate Number of naturalization/order of approval of reacquisition)

Date of Naturalization/ Reacquisition

Month

Day

Year
f

......

...J
No. of . . Months .

! L...L...i
No. of Years In the Philippines

.....

Certificate No./Order of Approval

CIVIL STATUS

PERIOD OF RESIDENCE
No. of Years In the City / Mun j i i

II

Legally Separated Name of Spouse, if married

J Single Married

[]widow/er

PROFESSION / OCCUPATION NAME OF FATHER

U s t

TIN ! |

I
Last

NAME OF MOTHER
I

- I

1 1

i i

|
!

j |

T
i
i i i :

Rnt Middle!

j
OATH

First

!
r

!
:

.1 t J...J

Middle I

.........._..........

PART 2

ROLLED THUMBPRINTS / SPECIMEN

SIGNATURES

I do solemnly swear that the above statements regarding my person are true and correct; that I possess all the qualifications and none of the disqualifications of a voter; that I have no pending application for registration in any city/municipality.

Month

J J

Day

"| f" J 1.

Year

Signature of Applicant Above Printed Name

Left Thumb
2.

Right Thumb
3.

EO / Administering Officer (Signature above Printed Name)

PART 3
Month Day

ACTION BY THE ELECTION REGISTRATION BOARD ...J

J

_ Approved " 1 Disapproved

i..'

..J Date

E D
Reason for Disapproval

With Precinct Assignment No.

Member Signature above Printed Name

Chairman of the Board Signature above Printed Name

Member Signature above Printed Name Officer)

NAME CODE

PART 4
CITY/MUN/ DISTRICT CODE

VOTER IDENTIFICATION NUMBER (To be filled out by Election

PRECINCT NO.

DAY DATE OF BIRTH

YEAR