You are on page 1of 1

Republic of the Philippines

COMMISSION ON ELECTIONS
Mauila

CERTIFICATE OF :g
SENATOR
INSTRUCTIONS: (Read well before filling up this form.)
1. Filethis In FIVE (5) LEGIBLE copies.
2. File this certificate of candidacy. with the Law Department, COMELEC Main Office, Irrtremuros , Manila, starting November ;ZO, Z009 up to
midnight of November30, 2009.
J. Attach to this certificate the Certiricate of Party Nomination unless you are: en Iodepeodeot candidate •. After midnight or November 30, 2009. no
certificate of nominationshall be accepted.
4. lltJes such as 'Dr., Alty_, con, Ginoo, Senor, Datu, HadjI, Sollan, BaT,Senora, Kapitan or srmner titles are ex.pressty prohIbited.
S. This certtrtcate shall be sworn before a notl'!lry public or any offtcle t authorlz:ed to administer oe rh, COMELEC officials are not authorized to
administer oath:'

1. MY NAME IS : 3. MY GENDER IS : 4. MYAGEIS:

l.l Last Name l/t)jA;i)) T-T -'f";"]' ':'-l-' ]--T";-' j--r' T.-; .-; .. \.. ~.. T--r"; t---"5=-Ma_le --=•... Fe_ma_le
-1--;";';' '.,;..:.'
'.;,.:.":..:..:"
''';'':'-
'.;,.:.'
':...-.j'

Cfj///;l/)+;X'-"/~j/A-Vj):;1,::~::~:: :;:::f::(:: ~::~:: :;:::f::; -:iji


"i" '~." '~'+'~"
5. MY OAi~~;rB~)~ ~: )
l.l First Name

1.3 Middle Name


>/).~;:)/!··;·\;jA"Y-~·····r··~······~··-·-f
~:II,·tJ ;J~. .t.- ;ry; .
+ ,=~, 't' '\=, ~:=+=,~ ::i
. . . " . . . . . . . . . . . . .
:'~L~
;-:··L .:-~.·:··L;·-:
. . ,' ... '... !. --', .. '... '. - -~-- ~-.:. --'-- -', .. t._:. - ,', - ,', .. :' - -:. - ,'---', --'--- :...-; - --',- -',--' 6~ MY PLACE Of BIRTH IS:
2. I AM GENERALLY OR POPULARLY KNOWN BY THE NICKNAME ORSTAGENAME Oty/Mun JPDIJ1A-O
(lndicate only ane nicknameor stagename)
:fFiii/:" -~i<./:t=:.r-.";' ':':: ';--';";' -:.-.:-.'~-'; -':" ';"';";": ":: rr: Province 171#( ~t~!)~(:::::::::
~..'/!:.._:
1------'-..•...
.o..:.; ...~..!.--.:..;.;
J ..••.••.
•.•..•.••.•••••.•••••••.• :_
..:...~ ..,... :... :.._:.._: ... :__ .:
...~ ..:..:...:...:...~ ..:.._: ... :...:
--.:..;.;~;.;..;.;..;..;~--.:...o.;..:..;.;:_'_'_':..:.:..;.:..:~:..:.:.=-:.:.-'-"'~'"'"'-....,..=-~-'-'-_t8. '-1Y CIVIL STATUS IS :

7. I AM OFFICIALLY NOMINATED BY: (Attach Cer~ncateof Nomination)


L-- IPL -l. /V) D Single D Widow/er
...... ~..... ---.--.-.----p.----.- .. -.-.--- Pclltrcal
.. - ..... ---.--._------_._--.--------------.----------
ra ·IB Married D Legally Separated

9. MY RESIDENCE/
ADDRESS IS: 9.1 Pro~nce [?l~J~Y~[~~1J:::::: o
I:::::]::J:::[::[::j:: J:: I::::::: FUII;:;e.02b.eom"ied,f- Annulled{ Divorced

:9:~ ~'tY/~IU~i~i~I~~
_~._.:_.. r : _; .:: _. ~_.. ; :... :... : _.; 9.~Ba~ar~y' _: .. ~.. _:_.. :. --:.:,::.r _.: _.,_ .. :.:. ~ _':"_:
h At.!?IW/
__"."" _
f .(!.(V{ th._.:.<;: ~;~~;~.:. _.: ~.. ~.. ; __j ft/nr~ .:IA!/Y?!/!.__
9.4 HouseNo·1 Street I SubdiVisIOn
:._:._:._..: 10. f>IY PROFESSION
OCCUPATION IS :
OR

:~U?~·tjO;Ai~~£~·~)!f1;f:?~b?JA~··¥/)P/NA:i"fC';;ryiTT·: ..!t:~f/~t:!.~!.'!!:!Y. __... _._._._""


11. MY POST OFFICE ADDRESS FOR ELECTION PURPOSES IS : (Couldbe the same as No.9) 12. I AM A REGISTERED VOTER OF

...rp_&.0f!(/.~.~<?T/t_:_:_l._??'Jy_?Ij~I!?~p.0.~.0!._0_~_?!~1?:._~!!Y
... _. Precinct 0/1 0 A
Bgy }i;(;Y ti(tJ /7A-N - .
13. NY PERIOD OF RESIDENCE IN THE PHIUPPINES BEFORE 1>1AY 10, 2010 IS :
Clty/Mun S'AtDtA ..-O~-ij"2'" _.-
~
!-1£: No. of MonU~ No.of Years
Province ~l&~~Pk·~~:::::::::·.::~
r-----------------------------------------------------------~
14. I AM A NATURAL BORN FILIPINO CmZEN.
15, 1 AM NOT A PERMANENT RESIDENT OF, OR IMMIGRANT TO, A FOREIGN
COUNTRY.
16. I AM EUGIBLE FOR·THE OFFICE I SEEK TO BE ELECTED TO.
17. I· WlLL SUPPORT AND DEFEND THE CONSTITUTION OF THE REPUB.LIC OF THE
PHILIPPlNES AND WILL MAINTAIN TRUE FAITH AND ALLEGIANCE THERETO. I
WIll OBEY HlE .LAWS, LEGAL ORDERS AND DECREES PROMULGATED BY THE
DULY CONSTITUTED AUTHORITIES. I. IMPOSE THIS OBLIGATION UPON MYSELF
VOLUNTARILY, WITHOUT MENTAL RESERVATION OR PURPOSE,QF EVASION.
• -f"'-

Thumbprint

Doc. No. -A,~F-~~-


Page No. -'P-:----'