Republic of the Philippines

COMMISSION ON ELECTIONS
ANNEX “B‐1” 
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CERTIFICATE OF CANDIDACY FOR

SANGGUNIANG KABATAAN KAGAWAD
INSTRUCTIONS: (Read well before filling up this form.)
1. File personally or through your duly authorized representative, in THREE (3) LEGIBLE copies with the Office of the Election Officer in your city/municipality, during regular working
hours starting October 1, 2010 up to midnight of October 13, 2010. If filed through a representative, a written authority under oath must be presented
2. Your certificate of candidacy will not be accepted by the Election Officer if you are not a member of the Katipunan ng Kabataan in the barangay where you seek to be elected.
3. Title such as ‘Dr., Atty., Don, Ginoo, Senor, Datu, Hadji, Sultan, Bai, Senora, Kapitan or similar titles are expressly prohibited.
4. This certificate shall be sworn before a notary public or any official authorized to administer oath.

I hereby announce my candidacy for the position of Sangguniang Kabataan Kagawad of Barangay__________________ , Municipality of
________________, Province of __________________________ on October 25, 2010 Barangay and Sangguniang Kabataan Elections; and
after having been sworn to in accordance with law, hereby state the following:
1. MY NAME IS : 3. MY GENDER IS: 4. MY AGE IS:
Male Female ___________
1.1 Last Name
5. MY DATE OF BIRTH IS:
1.2 First Name
Month Day Year
1.3 Middle Name
2. I AM GENERALLY OR POPULARLY KNOWN BY THE NICKNAME OR STAGENAME : 6. MY PLACE OF BIRTH IS:
(Indicate only one nickname or stage name) City / Mun. ____________________________
Province ______________________________

7. MY CIVIL STATUS IS:

8. MY RESIDENCE/ 8.1 Province
Single Widow/er
ADDRESS IS:
8.2 City / Municipality 8.3 Barangay Married Legally Separated

Annulled / Divorced

8.4 House No./ Street / Subdivision Full Name of Spouse, If Married

______________________________________

10. MY POST OFFICE ADDRESS FOR ELECTION PURPOSES IS: (Indicate if the same as No. 8) 9. MY PROFESSION OR
OCCUPATION IS:
_____________________________________________________________________________________________
_________________________________
11. MY PERIOD OF RESIDENCE IN THE PHILIPPINES BEFORE OCTOBER 25, 2010 IS:
12. I AM A MEMBER OF KATIPUNAN
No. of Months No. of Years
NG KABATAAN OF:
Precinct _______________________________
13. I AM A FILIPINO CITIZEN. Barangay ______________________________
14. I AM A MEMBER OF THE KATIPUNAN NG KABATAAN IN THE BARANGAY WHERE I SEEK TO BE
City / Mun. ____________________________
ELECTED.
15. I AM A RESIDENT OF THE BARANGAY WHERE I SEEK TO BE ELECTED FOR AT LEAST ONE YEAR Province _______________________________
BEFORE THE SANGGUNIANG KABATAAN ELECTION.
16. I AM NOT A PERMANENT RESIDENT OF, OR IMMIGRANT TO, A FOREIGN COUNTRY. ROLLED THUMBPRINT
17. I POSSESS ALL THE QUALIFICATIONS AND NONE OF THE DISQUALIFICATIONS FOR THE OFFICE
I SEEK TO BE ELECTED.
18. 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 MENTAL RESERVATION OR
PURPOSE OF EVASION.
19. I RECOGNIZE THE AUTHORITY OF THE ELECTION OFFICER NOT TO ACCEPT MY CERTIFICATE OF
CANDIDACY IN CASE I AM NOT A MEMBER OF THE KATIPUNAN NG KABATAAN IN THE
BARANGAY. Right Thumbprint

I hereby certify that the facts stated herein are true and correct of my own personal knowledge.

_________________________________________
Signature of Candidate Above Printed Name

OATH

SUBSCRIBED AND SWORN to before me this ______ day of _________________, 2010 at ___________, affiant exhibiting to me his/her
Identification Card No. ______________________ Issued by: _____________________ On: _________________________ .

________________________________
(Officer Authorized to Administer Oath)
(Affix documentary stamp)

Doc. No. _____________;

Page No. _____________;
Book No. _____________;
Series of 2010.