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Republic of the Philippines

COiVIMISSION ON ELECTIONS
Manila

!NSTRUCTIONS: (Read well before filling tJPthis form.)

1. File this in FIVE (5) LEGIBLECDpies.
2. file. thIs certificate of candidacy with the Law Department, COMELEC Main Office, Intramuros, r~anlla, starting November 20, 2009 up to
mldnl!lht 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, Ginco, Senor, Datu, Hadji,. Sultan ....BaI, SeRora. Kapitan. or similar titles are expressly prohibrted.
S. This certificate shall be sworn before a notary public or any official authorized to administer oath. COMELEC officials are not authorized to
administer oath. .
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1. M'fNAME IS: 3. MY GENDER IS : 4. MY AGE IS :

l.r.Last Name iR ;'Ejv,:U :'C'Ci\:"~" ';"'[":":";"'r" ~... :. ":"~"~"~' '";"': '": .. ';"'i 1-,';;;;~:o:.-Ma_.Ie--="",,-Fem_a_Je--l~"':";" . .;.,;.?.;.,;.9.;.:.• ..;.:.• ..;.:.,;.;." •••

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5. MY DATE OF BIRTH IS:
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L3 Midd!e Name
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- - - - ' :_"~'_':,"':'~'!"':"':"_~'H:"':"':"'!"_:_'_: ... - 6. MV PLACE OF BIRTH IS:

1:AM GENERALLY OR POPULARLY KNOWN BY THE NICKNAME OR STAGENAME City/t'lun ; MANtLA
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7. I AM OfFICIA!..L Y NOr-11NATED
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BY: (Attach Certificate of Nomination)

.r~~TI.QNA!;I.~.TA.
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o Si"l,lle 0 Widow/er

[R] Narrled 0 Legally Separated

s, MY
ADDRESS 15 :
RESIDENCE!
9.1 Pr-ovince o Annulled I Divorced

11. MV POST OfFICE ADDRESS fOR ELECTION PURPOSES IS: (COUld be the same as No.9} 12. I AM A REGISTERED VOTER OF

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Precinct .147.-.1\· .
MY P~OD OF RESIDENCE IN THE PHIUPPINES BEFORE MAY 10, 2010 IS ;
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.-BAVANLUMA2
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.IMWS .
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CIty/Muo

No. or I-.ontils :3 : 9: No. of Years

.CAVtTE , .
14. I AM A NATURAL BORN FIUPINO CmZEN.
1,5. I AM NOT A PERMANENTRESIDENT OF, OR INMIGRANT TO, A FOREIGN
COUNTRY.
1.5. I Afi1EUGIBlE FOR THE OFFICE I SEEK TO BE ELECTED TO.
17. 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 I IMPOSE THIS OBLIGATION
AUTHORITIES. UPON MYSELF
VOLUNTARILY, \NlTHOUT MENTAL RESERVATION OR PURPOSE Of EVASION.

!hereby certify that the facts stated herein are tru~:~~~r;~~~~~2~i:

,'n . ~ of Candidate Over Printed Name

OATH
SUBSCRIBED AND SWORN to before me tnts __ dayof November, 2009, atGl.UtLUN 1I L¥tiant exhibiting to me his/her
CTCjldentification Card No. W O{;q,gJ&3 Issued by: flEA - MLA.'l'I';'- On: ',-JJl:1 JAo:r

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