CBFSP FORM NO.

2016-01A
(in 3 copies)
Republic of the Philippines
COMMISSION ON ELECTIONS
Intramuros, Manila

COMMITTEE ON THE BAN ON FIREARMS AND SECURITY PERSONNEL

(CBFSP)

National and Local Elections

May 09, 2016

APPLICATION FOR AUTHORITY TO BEAR FIREARMS

with AFFIDAVIT OF UNDERTAKING

Please attach latest

NAME :______________________________________________________ 2x2 photo
AGENCY : ___________________________________________________ (taken within the
last six months)
ADDRESS :__________________________________________________
__________________________________________________

I, ____________________________________________ of legal age, Filipino, and with office address

located at ________________________________________________________________________________,
after having been duly sworn to in accordance with law, do hereby undertake that:

1. I am presently an Official of _______________________________________________________

(Department/Agency), as _____________________________________________________________
(position/rank and employment status), performing actual law enforcement functions and
receiving regular compensation for the services rendered in the said agency. Attached
hereto as Annex “A” is a certified true copy of my Certificate of Appointment (for appointed
officials);

2. I am authorized to apply for a Certificate of Authority-Law Enforcement Agency (CA-

LEA) under COMELEC Resolution No. 10015.

3. The firearms I will bear and carry are described in Form 16A-01A attached hereto and
contained in the compact disc (CD). The data therein are real, true and correct,
particularly the following:

a. Kind;
b. Make/Model;
c. Caliber;
d. Serial number;
e. CFR No./LCR No./MR No./ARE No.;
f. PTCFOR No. /Mission Order No. /Letter Order No.

4. All the applicable and required permits and license are still valid, updated and will not
expire during the election period from January 10, 2016 (SUN) to June 08, 2016 (WED).
Attached hereto as Annex “B” are photocopies of the said licenses and permits.

5. I understand that any misrepresentation or false statement in this Undertaking or its

attachments shall be a ground for the denial of the application or the revocation of an
approved Certificate of Authority. This is without prejudice to the filing of the appropriate
criminal, civil, administrative, and/or election offense charge/s.

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AFP/PNP/LEA - Individual
6. The statements stated herein are all willingly, freely and voluntarily executed to attest to
the truth of the foregoing facts in connection with this application above-mentioned.

IN WITNESS WHEREOF, I have hereunto affixed my signature and seal of my office on

this ____day of __________, 201____, in the City/Municipality of _____________________________,
Philippines.

_________________________________
Public Official
(Name and Signature)

Republic of the Philippines)

City/Municipality of _____________________________ )S.S.

SUBCRIBED AND SWORN TO BEFORE me this ____ day of ________________

201___, in the City/Municipality of _____________________________, Republic of the Philippines
personally appeared to me ___________________________ with Identification No. _____________
issued by _____________ on _______________________ in _________________.

Notary Public/Administering Officer

Document No.: ___________

Page No. : ___________
Book No. : ___________
Series of 201 ____

N.B. Please attach Form 16A-01A and Annexes

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AFP/PNP/LEA - Individual
Form 16A-01A

NAME PUBLIC OFFICIAL : ___________________________________________________________________________

POSITION : ___________________________________________________________________________

AGENCY : ___________________________________________________________________________

KIND / DESCRIPTION FIREARM CFR No./ LCR No./ MR

MAKE / MODEL CALIBER PTCFOR NO. / MO NO./ LO No.
OF ISSUED FIREARM SERIAL NO. No./ ARE No.

NOTE: TO BE SUBMITTED IN THREE (3) COPIES; attach photocopies of licenses and permits

I hereby certify the firearms described are: (1) duly registered firearms, and (2) covered by duly issued and valid MOs, LO or PTCFORs.

___________________________________________________________________
PUBLIC OFFICIAL
(Name, Position and Signature)

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