COMMISSION ON ELECTIONS

May 13, 2019 FORM

National and Local Elections RCF
Report of Contractor and Business Firms
PART A: INFORMATION OF THE CONTRACTOR OR BUSINESS FIRM
NAME of CONTRACTOR
(Natural persons & sole
proprietors) (SURNAME) (FIRST NAME) (MIDDLE NAME)

NAME of BUSINESS FIRM:

NAME of PRESIDENT OR
GENERAL MANAGER:
(SURNAME) (FIRST NAME) (MIDDLE NAME)

CONTACT DETAILS: Mobile/Phone Nos.:

E-Mail Address:

OFFICE ADDRESS:
(STREET NO.) (STREET NAME) (BUILDING/SUBDIVISION)

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

Taxpayer Identification No. (Refers to the TIN of the contractor or business firm)

PART B: LIST OF ELECTION-RELATED BUSINESS TRANSACTIONS

AMOUNT OF GOODS
NAME OF CLIENT RECEIPT DESCRIPTION OF SERVICES
DATE OF TRANSACTION PURCHASED / VALUE OF SERVICES
(CANDIDATE OR PARTY) NUMBER RENDERED/GOODS PURCHASED
RENDERED

PART D: CERTIFICATION AND ACKNOWLEDGMENT

The undersigned contractor, president/general manager of company 0

after being duly sworn, do hereby certify that the foregoing transactions for goods/services were made for the purpose of the elections, that all the
information provided and stated in this report are true & correct; and that he/she complied with his/her duty to require every agent of a candidate or party
treasurer to present his/her written authority to incur electoral expenditures on behalf of such candidate or party treasurer as mandated by Section 112 of the
Omnibus Election Code.

AFFIX SIGNATURE HERE 

Input complete name of signatory here ➔ (DATE SIGNED)
Input job title/position of signatory here ➔ [job title/position in the company]

SUBSCRIBED AND SWORN TO BEFORE ME this , affiant exhibiting his/her

issued by , with expiry date on
[Identification (ID) Type] [Serial No. of ID] [Government Agency issuing the ID]
.
[Expiry date of ID]

Document No.:
Page No.:
Book No.:
Series of .
NOTARY PUBLIC