Republic of the Philippines

Mindanao State University-Iligan Institute of Technology

MSU-IIT DOST SCHOLARS ASSOCIATION
Andres Bonifacio Ave, Iligan City, 9200 Lanao del Norte

C E R T I FI CAT E
OF
CAN D ID ACY

Name: Position Aspired: ____________________

Instructions:

a. Please print all entries legibly.

b. This form, duly accomplished, must be filed together with the requirements to
MIDSA COMELEC Associate Chairman on or before SEPTEMBER 5, 2017 at 5:00PM.

I, whose name and other personal circumstances are herein stated, do hereby filed
this certificate of candidacy for MIDSA Election 2017 and I do hereby declare my intentio n
and desire to run for the particular position of and further state that:

1. I was born on _______________________.

2. My home address is _________________________________________________

__________________________________________________________________________
My current address is ________________________________________________
___________________________________________________________________________
My contact number(s) is (are) _________________________________________

2.I have been elected to the following position:

Year Elective Position Held Name of Organization

https://www.facebook.com/M IDSAOnline midsa@g.msuiit.edu.ph

 Republic of the Philippines
Mindanao State University-Iligan Institute of Technology
MSU-IIT DOST SCHOLARS ASSOCIATION
Andres Bonifacio Ave, Iligan City, 9200 Lanao del Norte

4. I possess all the qualifications to the position for which I file this COC;

5. I have read and understood the provisions of Cons & By-Laws of MIDSA and the
guidelines, pertinent to and governing the qualifications of candidates, the prohibited acts or
activities during the campaign period and other similar matters.

IN WITNESS WHEREOF, I hereunto affix my signature on this COC, this ____ day
of September 2017 at MIDSA Office.

______________________________
Signature over printed name

Assessed by:

BLESSED CECILLIA FERNANDEZ

MIDSA COMELEC Associate Chairman

Approved by:

RENZ ALFRED FERNANDO

MIDSA COMELEC Chairman

https://www.facebook.com/M IDSAOnline midsa@g.msuiit.edu.ph