‘tin i pction ec Rte 2048 ea rc A 1A Me 17 ordeal nd ey pai er rcpt of prs CBFSP FORM NO. 2017-02 SA fin 3 copies; with CD attached) Republic of the Philippines COMMISSION ON ELECTIONS Intramuros, Manila COMMITTEE ON THE BAN ON FIREARMS AND SECURITY PERSONNEL (CBFSP) Barangay and Sangguniang Kabataan Elections May 14, 2018 APPLICATION FOR AUTHORITY TO BEAR FIREARMS with AFFIDAVIT OF UNDERTAKING NAME OF SECURITY AGENCY: , of legal age, Filipino, after having been duly sworn to in accordance with law, do hereby undertake that: 1. Lam the of the above-named security agency (Position) and [am authorized to apply for the issuance of a Certificate of Authority - Security Agencies under COMELEC Resolution No. . My Certificate of Employment. and Authorization is attached hereto as Annex “A™. 2. Our Security Agency is duly licensed to operate by the Philippine National Police. Attached hereto as Annex “B” is a photocopy of our License to Opera‘e. 3. All the personnel in Form17A-02 attached hereto and contained ir the compact disc (CD) submitted herewith, are in the regular plantilla of our agency, receiving regular compensation for the services rendered therein and performing actual security or protection services in their assigned stations. 4. The data, including the name/s and licenses of the security personnel with details of their authorized firearms, in Form 17A-02, are real, true, and correct. 5. Our security personnel, when in the possession of firearms, shall be: a. in the agency-prescribed uniform with the agency-issued ‘dentification card prominently displayed and visible at all times, showing clearly the name and position; b. in possession of a valid License to Exercise Security Profession (LESP) with Duty Detail Order (DDO), and: c. inthe actual performance of duty at his specified place or area of duty. 6. The 4” x 5° colored picture with full description of the authorized uniform for the security personnel is in Form 17B which is attached hereto; Page 102 Security Agency7. The actual place/area of duty of the security personnel are stated in the latest Monthly Disposition Report (MDR) which is attached hereto as Annex “C”, 8, All the required licenses and permits are still valid, updated and will not expire during the election period from April 14, 2018 (Saturday) to May 21, 2018 (Monday). 9, I have paid the amount of _ eat (Pk ) as evidenced by O.R. No. dated 10.1 acknowledge that the filing fee is non-refundable, whether or not the application is approved. 11.[ understand that any misrepresentation or false statement in this Undertaking or its attachments shall be a ground for the denial of the application or the revocation of an approved Certificate of Authority. This is without prejudice to the filing of the appropriate criminal, civil, administrative, and/or election offense charge/s. 12. The statements stated herein are all willingly, freely and voluntarily executed to attest to the truth of the foregoing facts in connection with this application. IN WITNESS WHEREOF, I have hereunto affixed my signature and scal of my office on this __day of. . 201__. in the City of . Philippines. (Name and Signature} HEAD OF AGENCY OR AUTHORIZED REPRESENTATIVE Republic of the Philippines} )S.8. SUBCRIBED AND SWORN TO BEFORE me this __ day of. 201__. in the City/Municipality of _ , Republic of the Philippines, affiant personally appeared before me with Identification No. issued by on in : Notary Public/Administering Officer Document No. : Page No. Book No. Series of 201__ NB. Please attach Form 17A-02, Form 17Band Annexes Page 20f 2 Security Agencyation ted epee mc Riin He, 2068 Aah a ny Ae of 2012 RA NO. OY ond re ee ene an eae ye pe att at authored epi ny pros at erlang ration a ste prea fin cnn ie din ung ter einen duno ach hen tae shared ty the ek tHe emotes th ting te aa ee ea eo a atoms soporte te Rae sy Comme, arty hea en dt sae eons Pte a ay MeN. ono, Form 17A-02 The data in this application, including those contained in the compact disc, are submitted to the PNP/AFP for the purpose of evaluating and processing of this application. CERTIFIED LIST OF OFFICERS AND PERSONNEL with THEIR AUTHORIZED FIREARMS: NAME OF AGENCY: ADDRESS : LICENSE TO OPERATE NO: - T Firearm Firearm First, Second | Middle | Suffix | Employee | Rank/ Make/ eae Name Name |Name| No. | Position | P°SrPH" | model rea | eee ena Thereby certify that the names herein are: (1) in regular employees of the Agency, (2) performing actual security functions: receiving regular compensation for the services rendered in the Agency, and (2) duly authorized and sanctioned by the Agency to bear, carry and transport firearms in the exercise of their security functions and duties. I further certify that the firearms described are: (1) duly registered firearms, and (2) covered by duly issued and valid DDOs and LESP. Head of Agency/Head of Agency's HR Department (Name, Position and Signature) Page 1of 2 Securtty AgencyA rn ed i appt ee Rtn. 2046 and Dt Pec et of S013 A 64S at eed efi ann rt yh a cried i nth mip of an pon date prelimi, an rman an ste peal rain sna aman, ung ste prt actin hart tat share yh eee tin npn wth ning ts ‘ran an a ry eM tn cn so a a Me ro ae a Mp ey as ee wo, NAME OF AGENCY: ADDRESS 7 I hereby certify that the names herein, from pages to . are: (1) in regular employees of the Agency, (2) performing actual security functions; receiving regular compensation for the services rendered in the Agency. and (2) duly authorized and sanctioned by the Agency to bear, carry and transport firearms in the exercise of their security functions and duties. I further certify that the firearms described are: (1) duly registered firearms, and (2) covered by duly issued and valid DDOs and LESP. Head of Agency /Head of Agency's HR Department (Name, Position and Signature} Republic of the Philippines) Cityof____ SS. SUBCRIBED AND SWORN TO BEFORE me this ___ day of . in the City/Municipality of. , Republic of the Philippines personally appeared to me ________— with ‘Identification No. issued by on in : Notary Public/Administering Officer Book No.: Series of 201____ Page 2 of 2 Security Agencyaver sal et pti ares Resin No O46 dea ay Af 201218 108 ae domed cl ene acs ye pane or Agar ete of oy pre dan pre feat, ese ren cers psa mein conan Os nce ecg hr frie danni ra ers hat ae say Cin meio corp xt sae, nd ‘nay nc base ones go as Rus os Porn eas fe Nl Mase Coos oe ea Bar OME ese pa eeNY I G eN, N eea,fses at, FORM 17B ‘The data in this application are submitted to the PNP/AFP for the purpose of evaluating and processing of thie application DESCRIPTION AND PICTURE OF AUTHORIZED UNIFORM NAME OF AGENCY ADDRESS UNIFORM TYPE / WHEN TO USE COMPLETE DESCRIPTION PLEASE ATTACH 4°X5" PULL BODY PHOTO OF APPLICANT WEARING PRESCRIBED UNIFORM “rs om ay be eepoduce or adduonal sete of ica normSECURITY AGENCY 1. ___Application Form: Properly signed in the original by the Head of Agency [Properly notarized: 5 Valid notarial commission (not expired) with complete details per Notarial Rule 0 Valid (unexpired) government issued proof of identification O Proper notarial venue CAffiant personally appeared before the Notary Properly accomplished *Stating that all details are provided without blanks (non-related parts should be answered with N/A) 2, ___Attachment/s: Certificate of Employment and Authorization O Photocopy of License to Operate Certified true copy of Latest Monthly Disposition Report 3. __Form 17A-02: OProperly signed in the original C.Complete details (no blanks, others not applicable marked as N/A) (Attached to the Application. 4, __Form 17B: Cn its required form OAccurate description of uniform with picture S. __Certification under oath: Properly notarized: C Valid notarial commission (not expired) with complete details per Notarial Rule Valid (unexpired) government issued proof of identification Complete details (if not applicable marked as N/A) 6. __ Firearms License/s: Oi Valid and existing Not expired Will not expire during Election Period 7. __LESP and DDO: (Valid and existing CNot expired CO Will not expire during election Period 8. ___License to Operat O Valid and existing CINot expired C1Will not expire during election Period 9. __ Full payment of filling fee