Republic of the Philippines

COMMISSION ON ELECTIONS
Manila

CERTIFICATE OF
SEN
INSTRUCTIONS: (Read well beFore fillingup this form.)
1. File this in FIVE(5) LEGIBLEcopies.
2. File this certificate of candidacy with the Law Department, COMELEC Main Office, Intramuros, Manila, starting November 20, 2009 up to
midnight of November 30, 2009.
3. Attach to this certificate the Certificate of Party Nomination unless you are an Independent .candidate. After midnight of November 30, 2009, no
certificate of nomination shall be accepted. .
4. Titles such as 'Dr., Atty., Don, Glnoo, Senor, Datu, Had);, Sultan, Bai, Senora, Kapitan or similar tlUes are expressly prohibited.
5. This certificate s.hal! be sworn before a notary p ub ltc Dr any official authorized to admtnlster oath. COMELEC officials are not authorized to
administer oath.
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fol' th~ pO$~tion' ~f SENATOR, ~epu~n~:Of the PhiUp?i,neS; in ~h~ ~.av :1.0, ~o~~ ~I.e.~ti.o.ns
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1. MY NAME IS : 3. MY,GENDER IS: 4. MYAGEIS:
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1.1 last Name
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6. MY PLACe OF BIRTH IS:
2. I AM GENERALLY OR POPULARLY KNOWN BY THE-NICKNAME OR STAGENAME
(Indicate only one nickname or stagename) Clty/Mun ~~. F. ...
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7. I AM OFFICIALLY NOMINATED BY: (Attach Certificate of Nomination)'
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D Single D Widowfer
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[] Married. D Legally Separated

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9. MY RESIDENCEj
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ADDRESS IS: .', " ."... ~ . _.,.- _.' _
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Full Name of Spouse, if married
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OCCUPATION IS:
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11. MY POST OFFICE ADDRESS FOR ELECTION PURPOSES IS : (Could be the same as NO.9) 12. I AM A REGISTERED VOTER OF
Prednct l+.6:3 5,A
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13. My PERIOD OF RESIDENCE IN THE PHILIPPINES BEFORE MAY 10, 2010 IS :
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:0 :8 :. No. of Months
:.?~?,: No. of Years

14. I AM A NATURALBORN FILIPINO·CrnZEN.

15. I AM NOT A PERMJ,\NENTRESIDENT OF; OR IMMIGRANT TO, A FOREIGN
COUNTRY.
16. r AM ELIGIBLE FOR TIiE OFFICE 'ISEEKTOBE'EtECfED TO,
11. I WILL SUPPORT AND DEF.END 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. 1 IMPOSE THIS OBLIGATION UPON MYSELF
VOLUNTARILY, WITHOUT MENTAL RESERVATION OR PURPOSE OF EVASION.
Thumbprint

I hereby certify that the facts stated herein are true a~~O"ect of ;,~~n pe~~dge.
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Signature of Candidate Over Printed Name

exhibiting to me his/her
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