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COMMISSION ON ELECTIONS FORM

May 13, 2019


National and Local Elections 1
Statement of Contributions and Expenditures SOCE

PART A: PERSONAL INFORMATION OF THE CANDIDATE


A.1. NAME OF CANDIDATE:
(SURNAME) (FIRST NAME) (MIDDLE NAME)

A.2. CANDIDATE TYPE: INDEPENDENT CANDIDATE (Indicate "N/A" for Part A.3.)
(Use "X" in appropriate box)
CANDIDATE WITH SUPPORT OF A POLITICAL PARTY

A.3. NAME of POLITICAL PARTY:


(COMPLETE NAME OF THE PARTY) (ACRONYM)

ELECTIVE POSITION:
A.4. (Skip Part A.5. if national position)
A.5. CONSTITUENCY OF THE ELECTIVE POSITION:

(DISTRICT) Indicate "LONE" if only 1 (CITY/MUNICIPALITY) (PROVINCE/REGION)

CONTACT DETAILS: MOBILE/PHONE NOS.:


A.6.
E-MAIL ADDRESS:

A.7. PERMANENT ADDRESS:


(HOUSE NO./UNIT) (NAME OF BUILDING/SUBDIVISION) (STREET NAME)

(BARANGAY) (DISTRICT/AREA) (CITY/MUNICIPALITY) (PROVINCE)

PART B: CONTRIBUTIONS RECEIVED (Itemized entries in the schedule of contributions, indicate "0.00" if none received)
B.1. CASH CONTRIBUTIONS RECEIVED FROM OTHER SOURCES: ₱0.00
B.2. IN-KIND CONTRIBUTIONS RECEIVED FROM OTHER SOURCES: ₱0.00
B.3. CASH CONTRIBUTIONS RECEIVED FROM POLITICAL PARTY: (for candidates with parties only) ₱0.00
B.4. IN-KIND CONTRIBUTIONS RECEIVED FROM POLITICAL PARTY: (for candidates with parties only) ₱0.00
TOTAL CONTRIBUTIONS RECEIVED ₱0.00

PART C: EXPENDITURES INCURRED (Itemized entries in the schedule of expenditures, indicate "0.00" if none received)
C.1. EXPENDITURES PAID OUT OF PERSONAL FUNDS / RESOURCES:
C.2. EXPENDITURES PAID OUT OF CASH CONTRIBUTIONS:
C.3. EXPENDITURES INCURRED USING IN-KIND CONTRIBUTIONS:
TOTAL EXPENDITURES INCURRED ₱0.00

PART D: CERTIFICATION & ACKNOWLEDGMENT


The undersigned candidate, after being duly sworn to, hereby depose and state that:
(1) This disclosure and its attachments, are supported by receipts, vouchers, and other documents reflecting the full, true, accurate, and
complete contributions received and expenditures incurred by the undersigned candidate and his/her duly authorized representative;
(2) The expenditures incurred are for lawful purposes and the contributions were not received from persons or entities prohibited by law to
give contributions.
(3) The undersigned consents on the general use and sharing of information obtained in this disclosure and its attachments for legitimate and
authorized purposes.
IN WITNESS WHEREOF, the undersigned hereunto affix his/her signature on [date signed].

AFFIX SIGNATURE HERE



NAME AND SIGNATURE

SUBSCRIBED AND SWORN TO before me on date notarized , affiant exhibiting his/her


issued by expiring on [date of expiry].
(Type of identification document) (ID Number) (Government Agency issuing the ID)

Doc. No.:
Page No.:
Book No.:
Series of (Place Notarial Seal & Signature here)

THIS SECTION IS FOR COMELEC USE ONLY - DO NOT ENCODE / WRITING ANYTHING BEYOND THIS LINE
Indicate "✓" beside form code/document name if submitted, " ✗" if not.
☐ SCR (Sched of Contributions Rcvd) ☐ Contribution Receipts
☐ SOE (Sched of Expenditures) ☐ Expenditure Receipts
☐ SUO (Sched of Unpaid Obligations) ☐ Obligations Payable
☐ SLE (Sum. Report of Lawful Exp.) NO. OF PAGES: _________
☐ Others: pls. specify: (This space is for the receiving date/time stamp of the receiving office)
FORM
COMMISSION ON ELECTIONS
May 13, 2019
Schedule of Contributions Received
2
National and Local Elections

SCR

NAME OF CANDIDATE: Type of Contribution


(SURNAME) (FIRST NAME)

DATE RECEIPT FULL NAME OF DESCRIPTION


ADDRESS OF CONTRIBUTOR AMOUNT/VALUE OF CONTRIBUTION
RECEIVED NUMBER CONTRIBUTOR (for in-kind contributions)

(Cash or
In-kind)

TOTAL CONTRIBUTIONS RECEIVED ₱0.00

CERTIFICATION ACKNOWLEDGMENT
I hereby certify that:(1) the contributions listed above were made to me as a candidate; (2) all SUBSCRIBED AND SWORN TO BEFORE ME this
entries specified above are true & correct; (3) they are supported by the official receipts issued affiant exhibiting his/her
by me upon acceptance; (4) the contributions are from sources not prohibited by the Omnibus issued by the [issuing office] [date of expiry].
Election Code and other pertinent laws.
DATA PRIVACY ACT
The undersigned consents on the general use and sharing of information obtained in this disclosure
and its attachments for legitimate and authorized purposes.
Doc. No. ________;
Page No. ________;
Book No. ________;
NAME AND SIGNATURE DATE SIGNED Series of ________. NOTARY PUBLIC
COMMISSION ON ELECTION FORM
May 13, 2019
National and Local Elections 3
Schedule of Expenditures SCE

NAME OF CANDIDATE:
(SURNAME) (FIRST NAME) (MIDDLE NAME)

RECEIPT/ INVOICE FULL NAME OF BUSINESS FIRM ADDRESS OF BUSINESS FIRM TIN OF CONTRACTOR or BUSINESS Exp Type AMOUNT/VALUE OF
DATE INCURRED DESCRIPTION OF EXPENSE
NUMBER OR CONTRACTOR OR CONTRACTOR FIRM (A-K) EXPENDITURE

TOTAL EXPENDITURES INCURRED ₱0.00

CERTIFICATION ACKNOWLEDGMENT
I hereby certify that: (1) the expenses listed above were incurred by me as a candidate or by my duly SUBSCRIBED AND SWORN TO BEFORE ME this [date of oath]
authorized representative/s; (2) all entries specified above are true and correct; (3) they are supported by the affiant exhibiting his/her
official receipts, invoices or other similar documents; (4) the expenses comply with Section 102 of the issued by the [issuing office] expiring on [date of expiry].
Omnibus Election Code.
DATA PRIVACY ACT
The undersigned consents on the general use and sharing of information obtained in this disclosure and its
attachments for legitimate and authorized purposes.
Doc. No. ________;
Page No. ________;
Book No. ________;
Series of ________.
NAME AND SIGNATURE DATE SIGNED NOTARY PUBLIC
COMMISSION ON ELEC
May 13, 2019

Local Elections
Summary Report of Lawful E
PART A: PERSONAL INFORMATION OF
A.1. NAME OF CANDIDATE: 0
(SURNAME)

A.2.
CANDIDATE TYPE:
(Use "X" in appropriate box)

A.3. NAME of POLITICAL PARTY: 0


(COMPLETE NAME OF THE P

A.4. ELECTIVE POSITION: 0


A.5. CONSTITUENCY OF THE ELECTIVE POSITION:

0 0
(DISTRICT) Indicate "LONE" if only 1 (CITY/MUNICIPALITY

PART B: SUBTOTAL OF LAWFUL EXPENDITURES P


Travel expenses of candidate and campaign personnel during the campaign and inciden
A
Compensation of campaigners, clerks, stenographers, messengers, and other persons em
B
Telephone, mobile phone usage fees, prepaid phone load, internet access, postages, freig
C
Stationery, printing and distribution of printed materials relative to candidacy;
D
Employment of watchers at the polls
E
Rent, maintenance and furnishing of campaign headquarters, office or place of meetings
F
Political meetings and rallies & the use of sound systems, lights and decorations during
G
Newspaper, radio, TV and other advertisements to promote the candidacy, includ
H placements
PART C: EXPENDITURES INCURRED
Employment of counsel
I
Copying and classifying lists of voters, investigating and challenging the right to vote o
J lists

Printing of sample ballots in such color, size and maximum number as may be authoriz
K
TOTAL EXPEN

PART D: CERTIFICATION & ACKNO


The undersigned candidate, after being duly sworn to, hereby depose and state that:
(1) This disclosure and its attachments, are supported by receipts, vouchers, and o

contributions received and expenditures incurred by the undersigned candidate and his
(2) The expenditures incurred are for lawful purposes and the contributions were
contributions.
(3) The undersigned consents on the general use and sharing of information obtained i
purposes.
IN WITNESS WHEREOF, the undersigned hereunto a

AFFIX SIGNATURE HERE


SUBSCRIBED AND SWORN TO before me on

(Type of identification document) (ID Number)

Doc. No.:
Page No.:
Book No.:
Series of
ISSION ON ELECTIONS FORM

Local Elections
4National and
SLE
Report of Lawful Expenditures
AL INFORMATION OF THE CANDIDATE
0 0
(FIRST NAME) (MIDDLE NAME)

INDEPENDENT CANDIDATE (Indicate "N/A" for Part A.3.)

CANDIDATE WITH POLITICAL PARTY

0 0
(COMPLETE NAME OF THE PARTY) (ACRONYM)

0 (Skip Part A.5. if national position)

0 0
(CITY/MUNICIPALITY) (PROVINCE/REGION)

UL EXPENDITURES PER EXPENSE TYPE/CATEGORY


g the campaign and incidental personal expenses
₱0.00

ngers, and other persons employed in the campaign


₱0.00

ternet access, postages, freight and courier charges


₱0.00

ative to candidacy;
₱0.00

₱0.00

s, office or place of meetings


₱0.00

hts and decorations during said meetings and rallies


₱0.00
mote the candidacy, including website/internet ad
₱0.00
SUBTOTAL ₱0.00
NCURRED (Itemized entries in Schedule of Expenditures)

₱0.00
allenging the right to vote of persons registered in the
₱0.00

number as may be authorized by the Commission


₱0.00
TOTAL EXPENDITURES INCURRED ₱0.00

IFICATION & ACKNOWLEDGMENT


y depose and state that:
receipts, vouchers, and other documents reflecting the full, true, accurate, and complete

dersigned candidate and his/her duly authorized representative;


d the contributions were not received from persons or entities prohibited by law to give

g of information obtained in this disclosure and its attachments for legitimate and authorized

the undersigned hereunto affix his/her signature on [date signed].

Err:511

date notarized , affiant exhibiting his/her


issued by expiring on [date of expiry].
(Government Agency issuing the ID)

(Place Notarial Seal & Signature here)


COMMISSION ON ELECTIONS FORM
May 13, 2019
National and Local Elections 5
Schedule of Unpaid Obligations SUO

NAME OF CANDIDATE: DESCRIPTION OF THE


(SURNAME) (FIRST NAME) (MIDDLE NAME)
OBLIGATION

PURPOSE REMAINING
DATE CONTRACT / LOAN ADDRESS OF AMOUNT/VALUE OF
NAME OF CREDITOR (for incurring OBLIGATION (Partial
INCURRED NO. CREDITOR OBLIGATION
obligation) Payments were made)

(i.e.
loan, etc.)

TOTAL UNPAID OBLIGATIONS ₱0.00

CERTIFICATION ACKNOWLEDGMENT
SUBSCRIBED AND SWORN TO BEFORE ME this [date of oath]
I hereby certify that: (1) the obligations listed above were incurred by me as a
candidate or with my authority by my duly authorized representative; (2) all entries affiant exhibiting his/her
specified above are true & correct ; (3) they are supported by contracts, issued by the [issuing office] expiring on [date of expiry].
promissory notes & other similar documents.
DATA PRIVACY ACT
The undersigned consents on the general use and sharing of information obtained in this
disclosure and its attachments for legitimate and authorized purposes.
Doc. No. ________;
Page No. ________;
Book No. ________;
NAME AND SIGNATURE DATE SIGNED Series of ________. NOTARY PUBLIC