Republlc of the Phlhpplues

COiVllYlISSION ON ELECTIONS
Manila

CERTIFICATE OF CANDIDAC
SEN.A!1rOR
INSTRUCTIONS; (Read well before filling up this form.) .
1. File this In·FIVE (5) LEGIBLE copies. . . . . .' .
2., File this certificate of candidacy with the Law Department, COME~EC Main Offlce.: Intramuros, Manila, starting November 20, 2009 up to
midnight of November 30, 2009.' . .
3. Attach to this certmcete tile Certificate of Party Nomination unless y,'u are an independent candidate. After midnight of November 30, 2009, no
certificate of nomination shall be accepted.' .
'I, . Titles such as 'Dr., Atty., Don, Glnoo, Senor, Datu, Hadjl, Sultan, Bali:Senora, reapltan Dr Similar titles are expressly prohibited.
5': This certificate shall be sworn beFore a 'notary public' or any offiCI~1authorized to administer oath. COI"1ELEC offiCials are not "uthor/zed to
====="" administer oath. .

3. MY GENDER IS:
o [Io1ale ~emale

5. MY DATE OF BIRTH IS :
}f.:1)-j0-Fq[~~J.
Month oav Year
6. MY l~LACE OF BIRTH IS :
clty/Mun j/lf17/lfl f::1+
. --:'XifPT']c"7)''''''V7Jl PI{;-;:t"
Province ._.!_v/~.i~~(::-:';a.. !:~~_.. .__
.
8. ~CIVIL STATUS IS : ,
'7. I AM OFFICIAllY
NO~INAT~,:t (Atti!p~E1pll\j%~~mln~f}(zt'-l' .. . . ILJ Single D Widow/er
.......................................
M Political Pal
f: < •••.••• , ••••••••• r ....••.••..•••....••....• _..•..
o Married· D legally Separated
9. MY RESIDENCE!
,t(DDRESS IS: 9.1 Province n ~ 0 i . ifVll f1i ,111 I i U: IIi
.. r···l .... r.. ·~'*·'::
:.. ·l····r····,. .. ·~.. ··r .. "}""
i,Mi6'!
..·..r···l"··r .. ·' .... '· .. ,.. ··:
i j j i i i D Annulled / Divorced

..:i·;·_r~!~)~h·-;:[·;j'f~1.~!:.::i.1[~]:~:~i~·:i
Full Name or Spouse, if married

.t~t:.@rJ~~?rMj.T~J·iif~.·.-.r.~ii]~::I:
9.4 House No.1 Street I Subdivision .'. .. .
10; MY PRQFESSION
OCCUPATION IS·:
OR

[~:1.IpLl;::Tf{.€?lffJjz:;;?:::~~J([Xj~tT:::.=l:~CqIqlp:I:~:Jlpl~I:j1!.q.[Br~~!::1 12.
.BfUJ fi 0 eft..:; ff~
...... -- ..._---.---------------.--._-_._------
1 AM A REGISTERED VOTER OF
.. __ .. _- ..-

11. MY POST OFFICE AOORF.'fS FOR. ereCTION PURPOSES IS : (CoJrd be the same as No;9)
3 f. l/Y1pcj{/I+["·" /MYFMtYT' 'TP/~E7<- /I:>¥2.' If ,~I1~(IV(t Nit- recinct \~l(P -:l; A .
....•................. \ -- ········ ..···· ·········'0 · ··· .. ····· .. ··· .. ·· ".iiii::jiijj(j;" /fit iCI"······
.... iJiiiiV" "Mii>Liil:-if'; ..o: r;'
13. MY PERIOD OF RESIDENCE IN THE PHILIPPINES Bl:F-ORl: MA¥ho, 2010 IS:! /J. C~~/MUn
" <: [o";~'1
t _._,',__. ~
No. or Months
-
!.¥i:i.l
:..~.:.-'.. - . ~
No. or Year~ . .
.
. ..
Province
._..• 1/1..... QJ-- j.JfiIF/VfC,q" .. ·.. ·
_ ~7!. " __
.
,
14: I AM A NATURAL BORN FILIPINO CITIZEN. " . ROLUb THUMBPittNT
15. I AM NOT A PERMANENT RESIDENT Of, OR IMMIGRANT TO/A FOREIGN
, .
COUNTRY, . .
16.IAM ELIGIBLE FOR-THE OFFICE I SEEK TO BE ELECTED TO,
17. I WILL SUPPORT AND DEFEND THE CONSTITUTION Of THa REPUBLIC THE or
Pt'ULIPPINES AND WILL MAINTAIN TRUE FAITH AND ALLEdIANCETHERETO. I
WILL OBEY THE LAYVS, LEGAL ORDERS AND DECREES PRq~ULGATI:D BY THE
DULY CONSTITUTED AUTHORITIES. I IMPOSE THIS OBLIGA1l0N UPON MYSELF
.' VOLUNTARILY, WITHOUT MENTAL RESERVATION OR PURPO$E OF EVASION .

•••••••••• •••••••••••.•.•• .•••••.•••• .•.. c •••..•..••••.•••• " ••••••••.••••.••••..•••••.•..••••.••••••••••••••• ~ •••••••••••••••••••••••••••••• ~ •••••..•••••••••••• ~:~~~.':'.~~ •••• :--;:,.: ••.•••••••••••.

o~nl
SUB.,CIUBED AND S~ORN
'..
to b,s?J? . methis --2-
'l",-.JIV
day of
.'.
Nov~inber,2009, at
.
.
PA<lG C I iv,1 ' affiant
' exhlbltrngto
... : me his/her
CTC(Identlfication Card No. 0 '/ ~ 7~ 2 U~o/~t{.>Issued by : __ S'c=~:.:S~. Of) : _~--- _
. ~~ -- - .
Doc. NO.._--'-_n-'a:-- __
Page No. 2Jl ..
Book No..
Series of 200_1
1 '
(bO:;;A"'h~~UGNA
. NOTARY PlIBLIC .
UNTIL DECEMBER 31. eo 10
APPOINTMENT NO. 16q (2009-20m)
ROll NO. 5q471
IBP NO. LAN 066701 RIZAL
PTR NO.OOQ9558JS..29'091MAJ{ATI