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COMMISSION ON ELECTIO

May 13, 2019

National and Local Election


Statement of Contributions and E
PART A: PERSONAL INFORMATION OF T

NAME OF CANDIDATE:
A.1.
(SURNAME)

A.2. TYPE CANDIDATE:


(Use "X" in appropriate box)

NAME of POLITICAL PARTY:


A.3.
(COMPLETE NAME OF THE PAR

ELECTIVE POSITION:
A.4.
A.5. CONSTITUENCY OF THE ELECTIVE POSITION:

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

CONTACT DETAILS: MOBILE/PHONE NOS.:


A.6.

E-MAIL ADDRESS:

PERMANENT ADDRESS:
A.7.
(HOUSE NO./UNIT)

(BARANGAY) (DISTRICT/AREA)

PART B: CONTRIBUTIONS RECEIVED (Itemized entries in the schedu


B.1. CASH CONTRIBUTIONS RECEIVED FROM OTHER SOURCES:
B.2. IN-KIND CONTRIBUTIONS RECEIVED FROM OTHER SOURCES:
B.3. CASH CONTRIBUTIONS RECEIVED FROM POLITICAL PARTY: (for candidates with parties on
B.4. IN-KIND CONTRIBUTIONS RECEIVED FROM POLITICAL PARTY: (for candidates with parties
TOTAL CONTRIB

PART C: EXPENDITURES INCURRED (Itemized entries in the schedu


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 EXPEND

PART D: CERTIFICATION AND 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 othe
contributions received and expenditures incurred by the undersigned and his/her du
(2) The expenditures incurred are for lawful purposes and the contributions were no
contributions.
(3) The undersigned consents on the general use and sharing of information obtain
authorized purposes.
IN WITNESS WHEREOF, the undersigned hereunto af

AFFIX SIGNATURE HERE

SUBSCRIBED AND SWORN TO before me on

(Type of identification document) (ID Number)

Doc. No.:
Page No.:
Book No.:
Series of

THIS SECTION IS FOR COMELEC USE ONLY - DO NOT ENCODE / WR


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:
MMISSION ON ELECTIONS
FORM

National and Local Elections


1
SOCE
f Contributions and Expenditures
NAL INFORMATION OF THE CANDIDATE

(FIRST NAME) (MIDDLE NAME)

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

CANDIDATE WITH POLITICAL PARTY

(COMPLETE NAME OF THE PARTY) (ACRONYM)

(Skip Part A.5. if national position)

(CITY/MUNICIPALITY) (PROVINCE/REGION)

(NAME OF BUILDING/SUBDIVISION) (STREET NAME)

(CITY/MUNICIPALITY) (PROVINCE)

VED (Itemized entries in the schedule of contributions, indicate "N/A" if none received)
CES:
URCES:

RTY: (for candidates with parties only)


PARTY: (for candidates with parties only)
TOTAL CONTRIBUTIONS RECEIVED

RED (Itemized entries in the schedule of expenditures, indicate "N/A" if none received)
RESOURCES:
NS:
IBUTIONS:
TOTAL EXPENDITURES INCURRED

IFICATION AND ACKNOWLEDGMENT


, hereby depose and state that:
by receipts, vouchers, and other documents reflecting the full, true, accurate, and complete
he undersigned and his/her duly authorized representative;
s and the contributions were not received from persons or entities prohibited by law to give

d sharing of information obtained in this disclosure and its attachments for legitimate and

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

NAME AND SIGNATURE

date notarized , affiant exhibiting his/her


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

(Place Notarial Seal & Signature here)

ONLY - DO NOT ENCODE / WRITING ANYTHING BEYOND THIS LINE


Remarks:

(This space is for the receiving date/time stamp of the receiving office)
COMMISSION ON ELECTIONS
May 13, 2019
Nati
Schedule of Contributions Received

NAME OF CANDIDATE: CONTRIBUTION


(SURNAME) (FIRST NAME)

DATE RECEIPT FULL NAME OF


ADDRESS OF CONTRIBUTOR
RECEIVED NUMBER CONTRIBUTOR

(Type and
Source)

TOTAL CONTRIBUT
CERTIFICATION A
I hereby certify that:(1) the contributions listed above were made to me as a candidate; (2) all SUBSCRIBED AND SWORN
entries specified above are true & correct; (3) they are supported by the official receipts issued by
me upon acceptance; (4) the contributions are from sources not prohibited by the Omnibus
Election Code and other pertinent laws.
I hereby certify that:(1) the contributions listed above were made to me as a candidate; (2) all
entries specified above are true & correct; (3) they are supported by the official receipts issued by affiant exhibiting his/her
me upon acceptance; (4) the contributions are from sources not prohibited by the Omnibus issued by the
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 ________.
TIONS FORM

National and Local Elections 2


eceived SCR

(MIDDLE NAME)

DESCRIPTION
AMOUNT/VALUE OF CONTRIBUTION
(for in-kind contributions)

OTAL CONTRIBUTIONS RECEIVED


ACKNOWLEDGMENT
SCRIBED AND SWORN TO BEFORE ME this
[issuing office] [date of expiry].

NOTARY PUBLIC
COMMISSION ON ELECTION
May 13, 2019
N
Schedule of Expenditures

NAME OF CANDIDATE:
(SURNAME)

RECEIPT/ FULL NAME OF


ADDRESS OF BUSINESS FIRM OR
DATE INCURRED INVOICE BUSINESS FIRM OR
CONTRACTOR
NUMBER CONTRACTOR
CERTIFICATION
I hereby certify that: (1) the expenses listed above were incurred by me as a candidate or by my duly
authorized representative/s; (2) all entries specified above are true and correct; (3) they are supported
by the official receipts, invoices or other similar documents; (4) the expenses comply with Section 102
of the 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.

NAME AND SIGNATURE DATE SIGNED


OMMISSION ON ELECTIONS
National and Local Elections
Schedule of Expenditures

(FIRST NAME) (MIDDLE NAME)

TIN OF CONTRACTOR or Exp Type


DESCRIPTION OF EXPENSE
BUSINESS FIRM (A-K)
TOTAL EXPENDITURES INCURRED
ACKNOWLEDGMENT
SUBSCRIBED AND SWORN TO BEFORE ME this [date of oath]
affiant exhibiting his/her
issued by the [issuing office] expiring on

Doc. No. ________;


Page No. ________;
Book No. ________;
Series of ________.
NOTARY PUBLIC
FORM

3
SCE

(MIDDLE NAME)

AMOUNT/VALUE OF EXPENDITURE
₱0.00

GMENT
[date of oath]

[date of expiry].

NOTARY PUBLIC
COMMISSION ON ELECTIONS
May 16, 2019

Na

Report of Lawful Expenditures

PART A: PERSONAL INFORMATION O

A.1. NAME OF CANDIDATE:


(SURNAME)

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

A.3. NAME of POLITICAL PARTY:


(COMPLETE NAME OF TH

A.4. ELECTIVE POSITION:

A.5. CONSTITUENCY OF THE ELECTIVE POSITION:

(DISTRICT) Indicate "LONE" if only 1 (CITY/MUNICIPAL

PART B: SUBTOTAL OF LAWFUL EXPENDITURES P


Travel expenses of candidate and campaign personnel during the campaign and incid
A
Compensation of campaigners, clerks, stenographers, messengers, and other persons
B
Telephone, mobile phone usage fees, prepaid phone load, internet access, postages, fr
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 meetin
F
Political meetings and rallies & the use of sound systems, lights and decorations durin
G
Newspaper, radio, TV and other advertisements to promote the candidacy, including
H placements
PART C: EXPENDITURES INCURRED (Itemized en
Employment of counsel
I
Copying and classifying lists of voters, investigating and challenging the right to vote
J lists
Printing of sample ballots in such color, size and maximum number as may be author
K
TOTAL EXPE

PART D: CERTIFICATION AND ACKN


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 h


(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 obta
authorized purposes.
IN WITNESS WHEREOF, the undersigned hereun

AFFIX SIGNATURE HERE

SUBSCRIBED AND SWORN TO before me on

(Type of identification document) (ID Number)

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

National and Local Elections


FORM

4
Summary
SLE

AL INFORMATION OF THE CANDIDATE

(FIRST NAME) (MIDDLE NAME)

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

CANDIDATE WITH POLITICAL PARTY

(COMPLETE NAME OF THE PARTY) (ACRONYM)

(Skip Part A.5. if national position)

(CITY/MUNICIPALITY) (PROVINCE/REGION)

UL EXPENDITURES PER EXPENSE TYPE/CATEGORY


ng the campaign and incidental personal expenses

engers, and other persons employed in the campaign

nternet access, postages, freight and courier charges

lative to candidacy;

rs, office or place of meetings

ghts and decorations during said meetings and rallies

e the candidacy, including website/internet ad


SUBTOTAL

NCURRED (Itemized entries in Schedule of Expenditures)

hallenging the right to vote of persons registered in the

number as may be authorized by the Commission

TOTAL EXPENDITURES INCURRED

ICATION AND ACKNOWLEDGMENT


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

ndersigned candidate and his/her duly authorized representative;


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

aring of information obtained in this disclosure and its attachments for legitimate and

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

NAME AND SIGNATURE

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 ELEC
May 13, 2019

Schedule of Unpaid Obliga

NAME OF CANDIDATE:

(SURNAME) (FIRST NAME)

DATE CONTRACT / LOAN


NAME OF CREDITOR ADDRESS OF CREDITOR
INCURRED NO.
CERTIFICATION
I hereby certify that: (1) the obligations listed above were incurred by me as a SUBSCRIBED AND SWORN TO BE

candidate or with my authority by my duly authorized representative; (2) all entries affiant exhibiting his/her
issued by the
specified above are true & correct ; (3) they are supported by contracts,
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 ________.
SSION ON ELECTIONS FORM

National and Local Election


5
SUO
e of Unpaid Obligations

REMAINING
PURPOSE
DESCRIPTION OF THE OBLIGATION
(FIRSTOBLIGATION
NAME) (MIDDLE NAME)

AMOUNT/VALUE OF OBLIGATION

(for
(i.e. loan, etc.) (Partial Payments
incurring obligation)
were made)
TOTAL UNPAID OBLIGATIONS

ACKNOWLEDGMENT
CRIBED AND SWORN TO BEFORE ME this [date of oath]

[issuing office] expiring on [date of expiry].

NOTARY PUBLIC