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Republic of the Philippines

ANNEX B
Commission on Elections

14 MAY 2018 Synchronized Barangay and Sangguniang Kabataan Elections

STATEMENT OF EXPENDITURES
DATE O.R. NAME OF PAYEE ADDRESS DESCRIPTION OF AMOUNT
RECEIVED NUMBER GOODS AND
SERVICES

TOTAL EXPENDITURES INCURRED Php


CERTIFICATION
I hereby certify that: (1) the expenses listed above were incurred by me as a SUBSCRIBED AND SWORN to before me this _______ day of
________________2018, candidate exhibiting his/her __________________________with
candidate; (2) all entries specified above are true and correct; (3) they are supported by number ________________ issued by ____________________________________ with expiry
official receipts, invoices and other similar documents; and (4) the expenses comply with date __________________________.
the laws.

______________________________________ ADMINISTERING OFFICER


(Full Name & Signature)

______________________________
(Date Filed)

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