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Republic of the Philippines

COMMISSION ON ELECTIONS
Manila

STATEMENT OF WITHDRAWAL

I, ______________________________________________________________________
(name of candidate), of legal age, Filipino and a resident of
_____________________________________________________________________________,
under oath, state as follows:

1. On _______________________________, I filed my Certificate of


Candidacy for the position of _________________________________
before the Office of the Election Officer of
_____________________________.

2. After much thought, I am hereby withdrawing my candidacy for


the position of __________________________________________.

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


________________ 2017 in Isulan, Sultan Kudarat, Philippines.

_________________________________________
(Name and Signature of Candidate; and Date)

SUBSCRIBED AND SWORN to before me this _____ day of ________________


2017 in Isulan, Sultan Kudarat, affiant exhibiting to me an Identification document/card
which contains a photograph and signature bearing No. ____________________ issued
by ________________________ on ______________.

____________________________________
(Officer Authorized to Administer Oath)

Doc. No. _____;


Page No. _____;
Book No. _____;
Series of 2018.