Republic of the Philippines ]

Province of South Cotabato ] S.S.

Municipality of Tupi ]

AFFIDAVIT OF ASSISTOR

I, ________________________________, Filipino, of legal age, single/married and residing at

Barangay _______________________, Tupi, South Cotabato, after being duly sworn to in
accordance with law, hereby depose and say:

1. That I am of voting age and thus qualified to be an assistor of an illiterate or

disabled voter during the October 25, 2010 Barangay and SK Election;

2. That I will assist in preparing the ballots of the following illiterate or disabled
voter/s:

Name Precinct No. Barangay

_______________________________ ________________ ________________________________

_______________________________ ________________ ________________________________

_______________________________ ________________ ________________________________

3. That the foregoing voter/s:

_______ is/are my relative/s within the 4th civil degree of consanguinity or affinity

_______ belong/s to the same household as I am;

4. That I undertake to accomplish the ballot strictly in accordance with the

preferences of the voter/s I am assisting and that I shall refrain from revealing the contents
thereof to any person;

5. That this affidavit is executed in compliance with COMELEC Resolution No.

9030 promulgated on September 21, 2010 issued for the October 25, 2010 Synchronized
Barangay and SK Election.

IN WITNESS WHEREOF, I have hereunto set my hand and affixed my signature on

this __________________________ at Tupi, South Cotabato, Philippines.

_____________________________________
Affiant
CTC No. ____________________________
Issued on __________________________
Issued at Tupi, South Cotabato

SUBSCRIBED AND SWORN to before me this ___________ at Tupi, South Cotabato,

Philippines.

WITNESS MY HAND AND SEAL.

Doc. No. _______;

Page No. _______;
Book No. _______;
Series of 2010.