2012-1 (PNP/AFPA.

EA)

APPLICATION FOR AUTHORITY TO BEAR FIREARMS IN CONNECTION WITH THE MAY 13,2013 SYNCHRONIZED AUTOMATED NATIONAL, LOCAL AND ARMM REGIONAL ELECTIONS
LIST OF PERSONNEL OF (1) PNP l ( 2 )AFP l ( 3 ) GOVERNMENT LAW ENFORCEMENT AGENCIES I (4) JUSTICES OF THE SUPREME COURT, COURT OF APPEALS, SANDIGANBAYAN AND COURT OF TAX APPEALS AND JUDGES OF THE REGIONAL TRIAL COURTS, MUNlClPAUMETRQPOLlTANlClRCUlTTRIAL COURTS I (5) SECURITY PERSONNEL OF ACCREDITED FOREIGN DlPLOMATlC CORPS AND FOREIGN MILITARY PERSONNEL COVERED BY EXISTING TREATIES
NAME OF AGENCY: ADDRESS:

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I I I I I I I I NOTE: TO BE SUBMITTED IN THREE (3) COPIES PLUS ONE (1) SOFT COPY (CD) IN EXCEL FORMAT Attachments: (7) Certifed True Copies of Current and Valid Firearms LicensehVemorandurn Receipt and Permit to Cany Firearm Outside of ResidenceA4ission OderAefter Order (2) Colored 4"x 5"picture, with description, of the authorized uniform of fhe agency/office
CERTIFICATION This is to certify that the above-lisfed personnel are in the regular plantilla of the agency, performing law enforcement functions and are receiving r %ua € I lr compensation for their services in our office and the firearms described above are duly registered CERTIFIED BY: CHlEF OF AGENCY'S PERSONNEL DlVlSfON SUBSCRIBED AND SWORN TO BEFORE me this
HEAD of AGENCY

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-day of

,2012.

Administering Officer

CBFSP FORM NO. 2012-2 (SA)

APPLICATION FOR AUTHORITY TO BEAR FIREARMS IN CONNECTION WITH THE MAY 13,2013 SYNCHRONIZED AUTOMATED NATIONAL, LOCAL AND ARMM REGIONAL ELECTIONS
LIST OF PERSONNEL OF PRIVATE-OWNED OR OPERATED SECURITY, INVESTIGATIVE, PROTECTIVE OR INTELLIGENCE AGENCIES (DEPLOYED BY PRIVATE SECURITY AGENCIES DULY LICENSED BY THE PNP I DEPLOYED BY PRIVATE DETECTIVE AGENCIES OR PRIVATE SECURITY AGENCIES DULY LICENSED I ACCREDITED BY THE PNP, IN CASE OF PROTECTION AGENTS)
NAME OF AGENCY: ADDRESS:
UUl 1 U C l HlL

I MEMORANDUM RECEIPT NO.

SPECIAL DUTY DETAIL ORDER

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NOTE: TO BE SUBMITTED IN THREE (3) COPIES PLUS ONE (I) SOFT COPY (CDI IN EXCEL FORMAT Attachments: (1) Certified True Copies of current and Valid ~ i r e a h ~ i c e n s e / ~ e b o r ~ n d u m s Receipt and Permit to Carry Firearm Outside of Residence/MissionOrderRetter Oder (2) Colored 4"x Sapicture, with description, of the authorized uniform af the agency/ofice (3) Permit to operate and accreditation by the PNP (4) Pay the application fee in the amount of P 50.00 for each personnel listed in the list CERTIFICATION This is to certify that the above-listed personnel are in the regular plantilla of the agency, performing law enforcement functions and are receiving regular compensation for their services in our office and the firearms described above are duly registered CERTIFIED BY: CHIEF OF AGENCY'S PERSONNEL DIVISION SUBSCRIBED AND SWORN TO BEFORE me this HEAD of AGENCY

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-day of

,2012.
Administering Officer

Republic of the Philippines COMMISSION ON ELECTIONS Intramuros, Manila
CBFSP Form No. 2012-3 (SD)
DATE FILED: RECEIVED BY: REFERENCE NO.:

REQUEST FOR AUTHORITY TO EMPLOY/ AVAIL/ ENGAGE SECURITY PERSONNEL AND BODYGUARD
( Note: Please file i n three (3) copies. Filing fee shall be Php 5,000.00)
I HAVE THE HONOR TO APPLY FOR AUTHqRlTY TO EMPLOY/AVAIL/ENGAGE THE SERVICE OF SECURITY PERSONNEL/ BODYGUARDPURSUANTT ~ C O M E L E C RESOLUTION NO. 9561-A:

1 NAME OF APPLICANT: .
Iam a ( check appropriate box)

0 0 0 0
3. AGE:

Public Official Position and Office: Candidate Position: Private Individual

City/Municipality/Province:

Cashier/Trearurer/Dirburring Officer o f

2. COMPLETE MAILING ADDRESS:
.. . .
...

.
.

.

_

6. CITIZENSHIP:

4. SEX:

5. CIVIL STATUS:

7. PROFESSION/OCCUPATION:

8. E-MAIL ADDRESS:

9. TELEPHONE NO:

-

10. CELLPHONE NO.:

( Attach, if any, documents t o support threats t o life and security. You may use separate, if necessary.)

Page 2 CBFSP Form No. 2012-3 (SD)

12. NUMBER OF SECURITY PERSONNELTO BE EMPLOYED:
13. OFFICEfAGENCY :

14. N M I A ES

OF PREFERRED SECURITY PERSONNEL/ BODYGUARDTO EMPLOY: Rank/ Position Unit/ Agency NATURE OF FIREARMS Serial Caliber Brand/Make License/M R No.

Name of security personnel/bodyguard t o employ

Contact #

No.

(Please use separate sheet, if necessary).

Ihave paid t h e amount o f

(P~P Date :

) thru:

(O.R.
u

No.

(for payments made at t h e Cash Division, COMELEC, Main Office, Intramuros, Manila)
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LDP Deposit Slip No.

Date :

(for Deposit thru Land Bank should be payable t o COMELEC Savings Account No. CERTIFICATION

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1 HEREBY CERTIFY THAT THE FOREGOING ARE TRUE AND CORRECT BASED ON MY PERSONAL KNOWLEDGE AND BELIEF. I UNDERSTAND THAT ANY MISREPRESENTATION HEREIN WILL BE A GROUND FOR THE DENIAL OF MY APPLICATION AND/OR FILING OF APPROPRIATE CRIMINAL AND ADMINISTRATIVE CHARGE/S. I FURTHER ACKNOWLEDGE THAT THE CBFSP HAS THE DISCRETION TO PROVIDE SECURITY PERSONNEL/BODYGUARD OTHER THAN THOSE MENTIONED IN THlS APPLICATION.

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A t t a c h latest 2x2 photo (taken w i t h i n the last six months) Applicant's signature above printed name

SUBSCRIBED AND SWORN TO BEFORE M E THlS -DAY OF AFFIANT EXHIBITING TO M E HIS/HER IDENTIFICATION CARD NO. UNTIL

, 2012, ISSUED BY

IN

,VALID

NOTARY PUBLIC
Doc. No. Page No.: Book No. Series of 2012

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CBFSP Form No. 2012-4 (OP)
No.

:
:

Date

ORDER OF PAYMENT
The Collecting Officer
Cash Unit
Please issue Official Receipt in favor of

*

in the amount of

for payment of application fdr em$loymentl availmentl engagement of security personnel1 bodyguard.
Please deposit the collection under Bank Accounffs:
No.
0012-1 042-86
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Name of Bank
Land Bank of the Philiwwines

Amount
Php

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Total

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PhP

COMMITTEE ON BAN ON FIREARMS and SECURITY PERSONNEL (CBFSP)

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