Resolution No 9853 PDF

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VOTING RECORD
Voter's
DATE Ballot No. Chairman's Signature
Thumbmark Signature
<
Tit
K
CEF-1B
Republic of the Philippines APPLICATION FOR TRANSFER/

COMMISSION ON ELECTIONS
TRANSFER WITH REACTIVATION
A P P L I C A T I O N FOR T R A N S F E R OF R E G I S T R A T I O N R E C O R D
DUE T O C H A N G E OF R E S I D E N C E
J within the same city/municipality/district to another city/municipality/district
I f , Filipino, born on
First name Middle name/Last name month/day/year
a duly registered voter in Precinct No. of Barangay
City/Municipality of , Province of , single/widow/er/legally
separated/married to . do hereby apply for the transfer of my registration
record due to transfer of my residence to:
House No./Street. .
Sitio Barangay:
City/Municipality: Province:
That I have resided in my new residence for years and months.
(To be filled out by applicant applying for transfer with reactivation.)
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Further, I do hereby apply for the reactivation of my registration record which was deactivated due to (please
check appropriate box):
< Q 1. Sentence by final judgment to suffer imprisonment for not less than one (1) year;
_; [ ] 2. Conviction, by final judgment, of crime involving disloyalty to the duly constituted government, etc;
UJ .—.
<J I 3. Declaration of insanity or incompetence by a competent authority;
jE C 4. Failure to vote in two (2) successive preceding regular elections;
5. Loss of Filipino. Citizenship; or

U. | |
>. L_J 6. Exclusion by a court order.
0-
O
<-> That said ground no longer exists, as evidenced by the attached certification/order of the court (in case of
1,2,3, 5 and 6).
IN WITNESS WHEREOF, I have hereunto affix my signature this day of , 20 at ,
Province of , Philippines.
(Signature above Printed Name)
SUBSCRIBED A N D S W O R N to before me on the above date.
EO/Chairman of the Election Registration Board

Notice to the applicant: Please accomplish the form at the back and have your blometric data i.e., your photograph, signature and fingerprints
captured digitally if: l.) transfer is within the same city/municipality and you have not previously undergone validation procedure; or 2.) transfer is
to another city/munidpality.
Application No. Precinct No.
Instructions : (1) Accomplish separately in three copies; (2) print legibly; (3) check the appropriate box.
PART 1 P E R S O N A L I N F O R M A T I O N (To be filled out by Applicant)

NAME
Last f i l l ! •
Assisted by
•
Disabled/
First i
i l l ! (Please fill up Assistor's Oath)
GENDER [^Male | [Female

Middle j
RESIDENCE/ADDRESS Province Height Weight
City/Municipality Barangay DATE OF BIRTH
I I I !
House No./ Street Month Day Year
PLACE OF BIRTH
CITIZENSHIP
L_> Birth
• Naturalized • Reacquired
(If naturaiized/reacquired, state date of naturalization/reacquisltlon and Certificate Number of naturalization/order of approval of reacqulsltiuri)
City/Mun
Province
Month Day Year CIVIL STATUS

Date of Naturalization/ Certificate No./Order of Approval
Reacquisition ^Single jjwidow/er
PERIOD OF RESIDENCE
No. of Years No. of Months No. of Years MamuiJ Legally
In the City /Mun i Separated
In the Philippines j j I
Name of Spouse, if married
PROFESSION/OCCUPATION TIN
N A M E O F FATHER NAME O F M O T H E R
Last I f Last ! j j I
First |f| First | | ]
Middle; Middle i l l !
PART 2 OATH ROLLED THUMBPRINTS / SPECIMEN SIGNATURES
I do solemnly swear that the above statements regarding my person are true and
correct; that I possess all the qualifications and none of the disqualifications of a voter;
that I have no pending application for registration in any city/municipality; and that I
am not registered in anyprecinct in the Philippines.
DATE
Month Day Year Signature of Applicant
Above Printed Name
Left Thumb Right Thumb
EO / Administering Officer 3.
PART 3 A C T I O N BY T H E E L E C T I O N R E G I S T R A T I O N B O A R D
• Approved
[Disapproved Date
With precinct assignment No.
Reason for disapproval
Member Chairman of the Board Member

Signature above Printed Name Signature above Printed Name Signature above Printed Name
PART 4 V O T E R IDENTIFICATION NUMBER (To be filled out by Election Officer)

CITY/MUN
DISTRICT CODE
PRECINCT N( YEAR
DATE OF BIRTH

• COMMISSION ON ELECTIONS
A P P L I C A T I O N FOR T R A N S F E R OF R E G I S T R A T I O N R E C O R D
DUE T O C H A N G E OF R E S I D E N C E
J within the same city/municipality/district J to another city/municipality/district
I, , Filipino, born on
separated/married to , do hereby apply for the transfer of my registration
House No./Street.
Sitio Barangay:

Bt
UJ
U Further, I do hereby apply for the reactivation of my registration record which was deactivated due to (please
[ ] 1. Sentence by final judgment to suffer imprisonment for not less than one (1) year;
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2. Conviction, by final judgment, of crime involving disloyalty to the duly constituted government, etc;
m
__ 3. Declaration of insanity or incompetence by a competent authority;
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4. Failure to vote in two (2) successive preceding regular elections;
5. Loss of Filipino Citizenship; or
t
o
6. Exclusion by a court order.
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That said ground no longer exists, as evidenced by the attached certification/order of the court (in case of
1,2,3, 5 a n d 6).
IN WITNESS WHEREOF, I have hereunto affix my signature this day of , 20 at ,


Notice to the applicant: Please accomplish the form at the back and have your biometric data i.e., your photograph, signature and fingerprints
captured digitally if: 1.) transfer is within the same city/municipality and you have not previously undergone validation procedure; or 2.) transfer is
Instructions : (1) Accomplish separately In three copies; (2) print legibly; (3) check the appropriate box.
PART 1 P E R S O N A L I N F O R M A T I O N (To be filled out by Applicant)
Last i •
Assisted by
Illiterate
r—-[Disabled/
1
ff&nnto>*>
l
!©H_«.VoA« n i
First !
1 1 1 1 !.. ( P l e a s e fill up A s s i s t o r ' s Oath)
Middle i
GENDER Q Ma|e j-| Fema|0
RESIDENCE/ADDRESS Province I
: i 1 1 I i
J i I J i I J.... Height Weight
f 1 i 1 f ! T ! 1 ' ' ! ! T i 1 f ! i f 1 f ' 1 f ' f
| | | | | | : ; | ; ] | | | j | : | | j j ^ i j l
r
i i i i
PLACE OF BIRTH
v CITIZENSHIP ^ J B y Birth ~j Naturalized
(If naturallzed/reacquired, state date o f naturalization/ieacquisitlon a n d Certificate Number of naturalization/order of a p p r o v a l o f reacquisition)

^Reacquired City/Mun
Province
r Date of Naturalization/ J_?... ,.J? L.,

a
.- ,- . .
Ye ar
, Certificate No./Order of Approval CIVIL STATUS
Reacquisition i i ^Single ^Jwidow/er
<
PERIOD OF RESIDENCE
No. of Years
In the City/Mun i | I
No. of Months
In the Philippines
No. of Years • Married Legally
Separated
PROFESSION/OCCUPATION . T I N i.
N A M E OF FATHER N A M E OF MOTHER
Last I j I I I Last | j | j |
First j I First I j j
• 7 1 T : T : r I i I I j
Middle I i t i l l Middle
PART 2 O A T H ROLLED THUMBPRINTS / SPECIMEN SIGNATURES
correct; that I possess all the qualifications and none of the disqualifications of a voter,
that I have no pending application for registration in any city/municipality; and that I
am not registered in any precinct in the Philippines
DATE
Above Printed Name
EO / Administering Officer 3.
PART 3 A C T I O N BY T H E E L E C T I O N R E G I S T R A T I O N B O A R D
Day
r . —
I ;
[Approved With precinct assignment No.
t j.
[Disapproved Date

PART 4 VOTER I D E N T I F I C A T I O N NUMBER (To be filled out by Election Officer)

CITY/MUN
DISTRICT CODE
PRECINCT NO. YEAR
DATE OF BIRTH
ACKNOWLEDGEMENT RECEIPT
Application No.
Application for Registration
This is to acknowledge receipt of your Application for
registration. You are not yet registered unless approved by
Last : the Election Registration Board/(ERB). You need not appear
in the ERB hearing unless required through a written notice.
First f
i i i L...L.
Middle | [ [ i l l
EO/Interviewer Signature Above Printed Name
CEF-1B

APPLICATION FOR TRANSFER OF REGISTRATION RECORD

DUE TO CHANGE OF RESIDENCE
• within the same city/munidpality/district j to another city/municipality/district
, Filipino, born on
I,
separated/married to _, do hereby apply for the transfer of my registration
House No./Street.^
Sitio Barangay:

UJ
Further, I do hereby apply for the reactivation of my registration record which was deactivated due to (please
Q 1. Sentence by final judgment to suffer imprisonment for not less than one (1) year;
Q_] 2. Conviction, by final judgment, of crime involving disloyalty to the duly constituted government, etc;
Q.
PI 3. Declaration of insanity or incompetence by a competent authority;
• 4. Failure to vote in two (2) successive preceding regular elections;

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• 5. Loss of Filipino Citizenship; or
t • 6. Exclusion by a court order.
o
u That said ground no longer exists, as evidenced by the attached certification/order of the court (in case of
1,2,3, 5 and 6).
IN WITNESS WHEREOF, I have hereunto affix my signature this day of , 20 at


Notice to the applicant: Please accomplish the form at the back and have your blometric data i.e., your photograph, signature and fingerprints
captured digitally if: 1.) transfer is within the same city/municipality and you have not previously undergone validation procedure; or 2.) transfer is
Instructions : (1) A c c o m p l i s h separately in t h r e e copies; (2) print legibly; (3) c h e c k the a p p r o p r i a t e box.
PART 1 PERSONAL INFORMATION (To be filled out by Applicant)

I [Disabled/
•illiterate
Last ! I I I I I I I
Assisted by:
First
1 11 1 1 j 11 j1 11 1 I1 ill |[""'I'""]jJ| (Please fill-up Assistor's Oath)
Middle I i j I j i ; i i | ] i j 1 ! | | j | 1 I 11I 1 1 GENDER
^Male | |Female
RESIDENCE/ADDRESS Province i i Height Weight

r
r
--I i
f |"II
,.i 1 i I . A I J i L PLACE O F BIRTH
CITIZENSHIP Birth ^Naturalized ^Reacquired City/Mun

(If naturalized/reacqulred, state date o f naturalization/reacquisition and Certificate Number of naturalization/order of approval of reacquisition) Province
Month Day Year Certificate No./Order of Approval CIVIL STATUS

Date of Naturalization/
Reacquisition • i ^Single jjwidow/er
PERIOD OF RESIDENCE
No. of Years No. of Months No. of Years ^Married "jLegaliy
In the City /Mun i i Separated
In the Philippines j j I
PROFESSION/OCCUPATION . TIN [ i L
I-i j
N A M E O F FATHER NAME OF MOTHER
Last ! j 1 j Last
First j j | j First
Middle j j i i I Middle

correct; that I possess all the qualifications and none of the disqualifications of a voter,
that I have no pending application for registration in any city/municipality, and that I
am not registered in any precinct in the Philippines
DATE
Above Printed Name
EO / Administering Officer
PART 3 ACTION BY THE ELECTION REGISTRATION BOARD
^Approved With precinct assignment No.
^Disapproved Date

PART 4 VOTER IDENTIFICATION NUMBER (To be filled out by Election Officer)

DISTRICT CODE
YEAR
DATE OF BIRTH
Republic of the Philippines APPLICATION FOR REACTIVATION OF

COMMISSION ON ELECTIONS REGISTRATION RECORD
First Name/Middle Name/Last Name month/day/year
a duly registered voter in Precinct No. of Barangay ,

City/Municipality of , Province of . ,
single/widow/er/legally separated/married to . _____ , do hereby apply for
the reactivation of my registration record which was deactivated due to (please check appropriate box):
__ 1. Sentence by final judgment to suffer imprisonment for not less than one (1) year;
2. Conviction, by final judgment, or crime involving disloyalty to the duly constituted government, etc;
I | 3. Declaration of insanity or incompetence by a competent authority;
__ 4. Failure to vote in two (2) successive preceding regular elections;
I I 5. Loss of Filipino Citizenship; or

!_
E __ 6. Exclusion by a court order.
_i
That said ground no longer exists, as evidenced by the attached certification/order of the court (in case
i
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of 1,2,3,5 and 6).
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IN WITNESS WHEREOF, I have hereunto affix my signature this day of 20 at

O
u-
, Province of Philippines.
t
s
SUBSCRIBED AND SWORN to before me on the above date.

N o t i c e t o t h e a p p l i c a n t : If your biometrics, i.e. photograph, signature a n d fingerprints had not been captured digitally, please accomplish the form
at the back.
AppI cation No. Precinc* No.
Instructions : (1) Accomplish separately in three (3) copies; (2-) print legibly; (3) check the appropriate box.
PART 1 PERSONAL INFORMATION (To be filled out by Applicants)
•
NAME
r Disabled / Person
^] Illiterate
Last ! with Disability
J....1.
First T~"T Assisted b y : .
>M| (Please fill-up Assistor's O a t h )
Middle)
: i "] T"
T T T GENDER
J Female
J Male
RESIDENCE/ADDRESS Province
Height Weight
City/Municlpallty Barangay
DATE OF BIRTH
Ml! rTTTTTTT"
House No. / Street I I I . I l l II. Month Day Year
I I j 1 i I j 1 PLACE OF BIRTH
1CITIZENSHIP
J L i J J. i | | By birth • Naturalized | | Reacquired Clty/Mun
(If naturallzed/reacqulred, state date of naturallzatlon/reacqulsltlon and Certificate Number of naturallzatlon/order of approval of reacquisition) Province
Month Day
Date of Naturalization/ Year Certificate No./Order of Approval CIVIL STATUS
Reacquisition
m-m-LLTij [ | Single ^jwidow/er
PERIOD OF RESIDENCE Married ^Legally

No. of Years No. of Months No. of Years
r—* 1 Separated
In the City / Mun
J M l In the Philippines j j j Name of Spouse, If married
PROFESSION / OCCUPATION TIN

NAME OF FATHER NAME OF MOTHER
Last
1 ' j j j I i i
1
i
T
j ! ! | Last j
1 i ! i
j i j 1 i j j j j ]
i • >
First ! ! ! ! ! J ! !1 I1 T | j First ! j !'""![""

• < •
! : : : i
. T 1 1 i i T i T i i i i i i i l i
Middle: ! 1 i 1 i i : i i I j j Middle! j j
j J. i....I_„.i 1 I....L J....1 t....i...i j
I d o solemnly swear that the a b o v e statements regarding my person are

t r u e a n d c o r r e c t ; t h a t I p o s s e s s all t h e q u a l i f i c a t i o n s a n d n o n e of t h e
disqualifications of a voter; that I have no pending application for registration
In any city/municipality.
f f
Month Day
J - L. JLLJ S i g n a t u r e of A p p l i c a n t
Year
A b o v e Printer/ N a m e
Left T h u m b Right T h u m b
E O / A d m i n i s t e r i n g Officer
2. 3.
(Signature a b o v e Printed N a m e )

Day Year
QTIJ
_ r
_ Approved With Precinct Assignment No.
i. i. J L
Disapproved Date
Reason for Disapproval

Signature above Printed N a m e Signature above Printed Name Signature above Printed Name

OTY/MUN/
DISTRICT C O D E NAME C O D E
PRECINCT NO DAY
DATE OF BIRTH
CEF-1C

COMMISSION ON ELECTIONS . REGISTRATION RECORD
i, , Filipino, born on
City/Municipality of , Province of
single/widow/er/legally separated/married to , do hereby apply for
I I 1. Sentence by final judgment to suffer imprisonment for not less than one (1) year;
I I 2. Conviction, by final judgment, or crime involving disloyalty to the duly constituted government, etc;
__ 3. Declaration of insanity or incompetence by a competent authority;
__ 4. Failure to vote in t w o (2) successive preceding regular elections;

_
u • 5. Loss of Filipino Citizenship; or
6. Exclusion by a court order.
Ja That said ground no longer exists, as evidenced by the attached certification/order of the court (in case
of 1,2,3,5 and 6 ) .
UJ
UJ
IN WITNESS WHEREOF, I have hereunto affix my signature this day of _ 20 at
, Province of , Philippines.
8 (Signature above Printed Name)

Notice to the applicant: If your biometrics, i.e. photograph, signature and fingerprints had not been captured digitally, please accomplish the form
at the back.
Application No. P r e c i n c t No.
Instructions : (1) Accomplish separately in three (3) copies; (2) print legibly; (3) check the appropriate box.

NAME
I 1 I 1 uisaDiea/ Vkcto*
Last t i l l !
First i
J Illiterate J^^tCVwt*M^
Assisted by (Please fill-up Assistor's Oath)
• •
Middle ! GENDER
Male Female
i i i i
RESIDENCE/ADDRESS Province | i
Height Weight
f j ] [ I I [ i
I I ! i ! !
House No. / Street Month Day Year
i i I i i I PLACE OF BIRTH
CITIZENSHIP • BY Birth ^Naturalized J Reacquired City/Mun
(If naturalized/reacquired, state date of naturalization/reacquisition and Certificate Number of naturalization/order of approval of reacquisition) Province
Date of Naturalization/ Month Day Year Certificate No./Order of Approval CIVIL STATUS
. . ; r 1 ; r ' ; . J
Reacquisition | i i - I ; i - j j ; ; i
^jwidow/er
•
Q]single
PERIOD OF RESIDENCE ~] Legally
No. of Months No. of Years Married
No. of Years
Separated
In the City/Mun j I j In the Philippines i i |
. PROFESSION/OCCUPATION TIN
..i i J L.

~l Last Last [ I I I !
First i I I First i i
r r r
Middle; i i i i i i
j | j
.L..J i i i i L.J i I J
I i !
Middle; I j
i
i
i
l I 1f T i l
! • ! ! ! ! ! !
I do solemnly swear that the above statements regarding my person are

true and correct; that I possess all the qualifications and none of the
disqualifications of a voter; that I have no pending application for registration in
any city/municipality; and that I am not registered in any precinct in the
Philippines
DATE i ;-!
Above Printed Name Left Thumb Right Thumb
EO / Administering Officer 2. 3.
Approved With precinct assignment No.
Disapproved Date
Reason for Disapproval

(Signature above Printed Name) (Signature above Printed Name) (Signature above Printed Name)

CITY/MUN
DISTRICT CODE NAME CODE
YIAR
• DATE OF BIRTH •
ACKNOWLEDGEMENT R E C E I P T
Application No. j
" 1 T i t h
Election Registration Board/(ERB). You need not appear
e
Last ,J j. I In the ERB hearing unless required through a written notice.
First
Middle [ j
i. l J i J _ I i. _. I JL..
EQ/Interviewer Signature Above Printed Name

COMMISSION ON ELECTIONS REGISTRATION RECORD
City/Municipality of , Province of ,
single/widow/er/legally separated/married to _ , do hereby apply for
I J 1. Sentence by final judgment to suffer imprisonment for not less than one (1) year;
[_ 2. Conviction, by final judgment, or crime involving disloyalty to the duly constituted government, etc;
I I 3. Declaration of insanity or incompetence by a competent authority;
__ 4. Failure to vote in two (2) successive preceding regular elections;

_
5. Loss of Filipino Citizenship; or
_ 6. Exclusion by a court order.
That said ground no longer exists, as evidenced by the attached certification/order of the court (in case
of 1,2,3,5 and 6).
UJ
P IN WITNESS WHEREOF, I have hereunto affix my signature this day of ,20 at
2 , Province of , Philippines.

Notice to the applicant: If your biometrics, I.e. photograph, signature and fingerprints had not been captured digitally, please accomplish the lomi
at the back.

i—r
• !
[, Instructions ; (1) Accornplish separately In three (3) copies; (2} print legibly; (3) check the appropriate box,
PART 1 PERSONAL INFORMATION (To be filled out by Applicants)

NAME
Last ! r~ T I T ' TTl
J Illiterate
• Disabled / Person
with Disability
Fin* [ 1 j f | T 1
i
! i 1 I1 1 i !
Assisted by:.
(Please fill-up Assistor's Oath)
Middle! 1 i 1 1 i ! ! 1
GENDER
J Male 1 Female
RESIDENCE/ADDRESS Province i j i ! i |
-J 1.1 ..1..1...L1...L.L Height Weight
L—L...J L—I—L. ..L....L. 4„—l_—1 1—i—J—L J—L—t j..—l.—j

I ! I T"""T
: i :
PLACE OF BIRTH
Li. ,t.
i
CITIZENSHIP • «y birth _] Naturalized J Reacquired City/Mun _ _ _ _ _
(If naturalLzed/reacqulred, state date of naturallzatlon/reacqulsltlon and Certificate Number of naturalization/order of approval of reacquisition) Province
...... f .....
Reacquisition J Single []widow/er
...J ! • L...L...i
PERIOD OF RESIDENCE
In the City / Mun

No. of Years
j i i
No. of
. . Months
.
In the Philippines
No. of Years
I—I
• Married Legally
Separated
PROFESSION / OCCUPATION TIN ! I - I

I
J L
U s t
i ! 1 I I 1 1 i | i | Last j
T
Rnt
j i !
First | i ! ! !
.......—.„.._.......... —
Middle!
.1 t J...J Middle I r
i i i : i :

in any city/municipality.
"| f"
I J J J 1.
Month
Day Year Signature of Applicant
2. 3.

Month Day
_ Approved With Precinct Assignment No.

...J J I i..' ] - r
E D
..J L
"1 Disapproved
Date Reason for Disapproval


CITY/MUN/
DISTRICT CODE NAME CODE
PRECINCT NO. DAY YEAR

DATE OF BIRTH
1
CEF-1D
APPLICATION FOR CHANGE / CORRECTION OF ENTRIES /
f\ Republic of the Philippines
I N C L U S I O N O F R E C O R D I N T H E BOOK O F V O T E R S AND
R E I N S T A T E M E N T O F NAME I N T H E L I S T O F V O T E R S .
APPLICATION FOR CHANGE/CORRECTION OF ENTRIES
• Change of name by reason of marriage |~

or by virtue of a c o u r t order
THE ELECTION R E G I S T R A T I O N BOARD

|
1 Correction of wrong or misspelled
| name in t h e list of voters
• Correction of any
other e n t r y
City/Municipality o f
Province o f
T h r o u g h : T h e Election O f f i c e r
Dear Sir/Madam:
I, , Filipino, b o r n o n
First name/Middle name/Last name month/day/year
a d u l y r e g i s t e r e d voter, do h e r e b y r e q u e s t t h a t m y as r e c o r d e d in t h e list
(information to be changed or corrected)
for Precinct No. , w i t h address a t
(Sitio, Barangay, Municipality)
be c h a n g e d f r o m to.
(Present data) (New data)
T h a t said c h a n g e / c o r r e c t i o n is n e c e s s a r y a n d v a l i d as e v i d e n c e d b y t h e a t t a c h e d c e r t i f i c a t i o n / o r d e r o f
the court.
(Signature above Printed N a m e )
SUBSCRIBED A N D SWORN t o b e f o r e m e o n t h e a b o v e d a t e .
UJ
2 E O / C h a i r m a n o f t h e Election R e g i s t r a t i o n B o a r d
z
APPLICATION FOR INCLUSION OF RECORDS I N THE BOOK OF VOTERS / REINSTATEMENT
u O F NAME I N T H E L I S T O F V O T E R S
• •
UJ
X Inclusion of VRR in the precinct book of Reinstatement of registered voter whose
r-
voters name has been o m i t t e d in the list of voters
tt
O
u.
THE ELECTION REGISTRATION BOARD
>-
a. City/Municipality o f
O Province o f
u
T h r o u g h : T h e Election O f f i c e r
Dear Sir/Madam:
I, _, Filipino, b o r n o n
with address a t ,
a duly registered voter, do h e r e b y r e q u e s t t h a t m y n a m e w h i c h has been o m i t t e d in t h e list of v o t e r s / m y
r e g i s t r a t i o n r e c o r d w h i c h h a s n o t b e e n i n c l u d e d in t h e p r e c i n c t b o o k o f v o t e r s o f P r e c i n c t n o . ,
be r e i n s t a t e d / i n c l u d e d t h e r e i n .
The said r e i n s t a t e m e n t o f n a m e / i n c l u s i o n o f r e g i s t r a t i o n r e c o r d is n e c e s s a r y a n d v a l i d .
(Signature above Printed N a m e )

SUBSCRIBED A N D S W O R N t o b e f o r e m e o n t h e a b o v e d a t e .
EO/Chairman o f t h e Election Registration Board

Notice to t h e applicant: I f your biometrics, i.e. photograph, signature and fingerprints had n o t been captured digitally, please accomplish
the f o r m at the back.
Application No Precinc No, •

— .
I * I 1 1 1 I I \ I I- I I
I n s t r u c t i o n s : (1) Accomplish separately in three copies; (2) print legibly; ( 3 ) check the appropriate box. -"
PART 1 P E R S O N A L I N F O R M A T I O N (To b e filled o u t by Applicant)
.„ I P e r s o n wit
Last • Illiterate | _ J Disability
First Assisted by:.

(Please All-up Assistor's Oath)
Middle GENDER
I ,1 ,1 j Male J Female
RESIDENCE/ADDRESS Province rr T I
Height Weight
— . — _
T ~] [ ~ | — l — 1 —
TT
j i_
i i TT r ! j . r"T"!
J J
t__i i
J L
House No. / Street Year
~1 1 1 T"
Month Day
I ! !
I 1 I 1 I I J I L PLACE OF BIRTH
j By birth Naturalized Reacquired City/Mun

CITIZENSHIP
(If naturaiized/reacquired, state date of naturalization/reacquisition and Certificate Number of naturalization/order of approval of reacquisition) Province
Date of Naturalization/ Month Day Year Certificate No./Order of Approval C I V I L STATUS
P E R I O D OF
Reacquisition
RESIDENCE
1- U Single ^Jwidow/er
^Married ^Legally
Separated
In the City / Mun [ r~~iI in the Philippines r Tl Name of Spouse, if married
PROFESSION / OCCUPATION TIN rm-

NAME OF F A T H E R NAME O F MOTHER
j
" " T
i 1_I
Last Last
! ! 1 1 ]
J I L
First First
1 II f
i. X....~.l
M M
Middle!r Middlei
TI~

disqualifications of a voter; and that I have no pending application for registration
( | 1 f—r—I |—]—T—r
111-11 I'l I I L Signature of Applicant
Month Day Year Above Printed Name Left T h u m b Right T h u m b
2. 3.
PART 3 A C T I O N BY T H E ELECTION REGISTRATION BOARD

Day
M Approved ] IT] I With precinct assignment No.
| | Disapproved Date

PART 4 VOTER IDENTIFICATION N U M B E R (To be filled out by Election Officer)

CITY/MUN/
DISTRICT CODE NAME C O O E
P R E C I N C T NO. YEAR
DATE OF BIRTH
CEF-1D
Republic of the Philippines

APPLICATION FOR CHANGE / CORRECTION OF ENTRIES /
COMMISSION ON ELECTIONS INCLUSION OF RECORD IN THE BOOK OF VOTERS AND
REINSTATEMENT OF NAME IN THE LIST OF VOTERS.
• •
Change of name by reason of marriage Correction of wrong or misspelled Correction of any
or by virtue of a court order name in the list of voters other entry

City/Municipality of
Province of
Through: The Election Officer
Dear Sir/Madam:
a duly registered voter, do hereby request that my as recorded in the list
for Precinct No. _, with address at
be changed from to
That said change/correction is necessary and valid as evidenced by the attached certification/order of
the court.
t_ SUBSCRIBED AND SWORN to before me on the above date.

u
u.
u.
O
z EO/Chairman of the Election Registration Board
o (Signature above Printed Name)
u APPLICATION FOR INCLUSION OF RECORDS IN THE BOOK OF V O T E R S / REINSTATEMENT
•
OF NAME IN THE LIST OF V O T E R S
LU
Inclusion of VRR in the precinct book of' 1 Reinstatement
«' of registered voter whose
I I
R
I "ar has been omitted in the list of voters

voters name
H
r_
O
_- City/Municipality of
>- Province of
O
u Through: The Election Officer
Dear Sir/Madam:
I ., Filipino, born on
First name/Middle name/l ast name month/day/year
with address at ,
a duly registered voter, d o hereby request that my name which has been omitted in the list of voters/my
registration record which has not been included in the precinct book of voters of Precinct no.
be reinstated/included therein.
The said reinstatement of name/inclusion of registration record is necessary and valid.


Notice to the applicant: If your biometrics, i.e. photograph, signature and fingerprints had not been captured digitally, please accomplish
the form at the back.

.......
PART 1 PERSONAL INFORMATION (To be filled out by. Applicant)

NAME Disabled/ ,
i rI r I T I r r i 1 r T Illiterate I t^r^nt^V^
Last i l l •
i j. i J t i i i i J. .i
1 1
_.«Ja_.0~,
First I I ' l l
Assisted by:.
i I i I I I ! (Please fill-up Assistor's Oath)
GENDER
Middle i Tf1"
_ Male J Female
RESIDENCE/ADDRESS Province Height Weight

PLACE OF BIRTH
•
!
CITIZENSHIP • By Birth ^Naturalized Reacquired
(If n a t u r a l i z e d / r e a c q u i r e d , s t a t e d a t e o f n a t u r a l i z a t i o n / r e a c q u l s l t i o n a n d C e r t i f i c a t e N u m b e r o f n a t u r a l i z a t i o n / o r d e r o f a p p r o v a l o f r e a c q u i s i t i o n )
City/Mun
Province
Reacquisition j i j - • j i - j j j i j ^Single |]widow/er
PERIOD OF RESIDENCE ^Married Legally

• ' ] i Separated
In the City /Mun i i j In the Philippines
PROFESSION/OCCUPATION TIN
M NAME OF FATHER
' Last [ j | j i "
NAME OF MOTHER
Last
First i !
I I... -1 J-
First
r f -t V" ..........
Middle! Middle i

in any city/municipality; and that I am not registered in any precinct in the
Philippines.
DAI E
EO / Administering Officer 2. 3.
PART 3 A C T I O N BY T H E ELECTION REGISTRATION B O A R D
Approved With precinct assignment No.

I
Disapproved Date

PART 4 V O T E R IDENTIFICATION NUMBER (To be filled out by Election Officer)

CITY/MUN
DISTRICT C O D E
DATE O f BIRTH
ACKNOWLEDGEMENT RECEIPT Application No.

nHTTTTTT"
Last the Election Registration Board/(ERB). You need not appear
In the ERB hearing unless required throil_h a written notice.
Rrst
LZTIIITZD.1TZTI I i
Middle • i . ]
EO/Interyiewer Signature Above Printed Nan-
CEF-1D
'\&\ Republic of the Philippines A P P L I C A T I O N FOR C H A N G E / C O R R E C T I O N OF E N T R I E S /
COMMISSION ON ELECTIONS I N C L U S I O N OF R E C O R D IN T H E BOOK OF V O T E R S A N D
R E I N S T A T E M E N T OF N A M E IN T H E LIST OF V O T E R S .
• •
T Change of name by reason of marriage Correction of wrong or misspelled Correction of any
[ J or by virtue of a court order name in the list of voters other entry

Province of
Dear Sir/Madam:
I , Filipino, born on
a duly registered voter, do hereby request that my as recorded in the list
for Precinct No. , with address at

be changed from to
That said change/correction is necessary and valid as evidenced by the attached certification/order of
the court.


APPLICATION FOR INCLUSION OF RECORDS IN THE BOOK OF VOTERS / REINSTATEMENT
•
OF NAME IN THE LIST OF VOTERS
Inclusion of VRR in the precinct book of
voters

I 1" Reinstatement of registered voter whose
ame has been omitted in the list of voters
Province of
Dear Sir/Madam:
I, _, Filipino, born on
with address at ,
a duly registered voter, do hereby request that my name which has been omitted in the list of voters/my
registration record which has not been included in the precinct book of voters of Precinct no. ,
be reinstated/included therein.
The said reinstatement of name/inclusion of registration record is necessary and valid.


Notice to the applicant: If your biometrics, i.e. photograph, signature and fingerprints had not been captured digitally, please accomplish
the form at the back.
•
c n i ~ T T T
T
NAME
Person with '
[ | Illiterate
Last • Disability
First Assisted b y : .
(Please fill-up Asslstor's Oath)
Middle GENDER
L _ Male J Female
RESIDENCE/ADDRESS Province
Height Weight
I—I—r
.j... ; L.
II i
n1
i j
PLACE OF BIRTH
I l l
•
i
By birth Naturalized Reacquired City/Mun

CITIZENSHIP
(if naturalized/reacquired, state date of naturalization/reacquisib'on and Certificate Number of naturalization/order of approval of reacquisition) Province
Reacquisition Single ^Jwidow/er
i L_J I J i i._
PERIOD OF RESIDENCE ~J Married | Legally [

No. of Months No. of Years
No. of Years Separated
in the Philippines j
in the City / Mun I | j Name of Spouse, if married
"j—j
PROFESSION / OCCUPATION TIN
!
1 11 1
M i l
| I
Last ! Last
11
i
. . 1 . 1- 1 1
1
I l l . i L
i
J .1.1.
First i I I
j 1
L J
First
_ 1 1 1 1
t... • 1 i i.
i ... J
1 1 1 1 1
Middle Middle I j [ M i l | j
i. L L

disqualifications of a voter; and that I have no pending application for registration
Signature of Applicant
2. 3.
im i
Month Day Year
T—1—
_J Approved With precinct assignment No.
Disapproved Date


crry/MUN/
DISTRICT CODE NAME C O D E
PRECINCT NO. YEAR
DATE O F BIRTH
i

Resolution No 9853 PDF

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Resolution No 9853 PDF

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Republic of the Philippines APPLICATION FOR TRANSFER/

J within the same city/municipality/district to another city/municipality/district

That I have resided in my new residence for years and months.

(To be filled out by applicant applying for transfer with reactivation.)

<J I 3. Declaration of insanity or incompetence by a competent authority;

jE C 4. Failure to vote in two (2) successive preceding regular elections;

5. Loss of Filipino. Citizenship; or

(Signature above Printed Name)

SUBSCRIBED A N D S W O R N to before me on the above date.

EO/Chairman of the Election Registration Board

Application No. Precinct No.

PART 1 P E R S O N A L I N F O R M A T I O N (To be filled out by Applicant)

GENDER [^Male | [Female

RESIDENCE/ADDRESS Province Height Weight

City/Municipality Barangay DATE OF BIRTH

House No./ Street Month Day Year

Month Day Year CIVIL STATUS

First |f| First | | ]

PART 2 OATH ROLLED THUMBPRINTS / SPECIMEN SIGNATURES

Reason for disapproval

Member Chairman of the Board Member

PART 4 V O T E R IDENTIFICATION NUMBER (To be filled out by Election Officer)

Republic of the Philippines APPLICATION FOR TRANSFER/

J within the same city/municipality/district J to another city/municipality/district

That I have resided in my new residence for years and months.

(To be filled out by applicant applying for transfer with reactivation.)

4. Failure to vote in two (2) successive preceding regular elections;

5. Loss of Filipino Citizenship; or

IN WITNESS WHEREOF, I have hereunto affix my signature this day of , 20 at ,

(Signature above Printed Name)

SUBSCRIBED A N D S W O R N to before me on the above date.

EO/Chairman of the Election Registration Board

Application No. Precinct No.

PART 1 P E R S O N A L I N F O R M A T I O N (To be filled out by Applicant)

House No./ Street Month Day Year

v CITIZENSHIP ^ J B y Birth ~j Naturalized

(If naturallzed/reacquired, state date o f naturalization/ieacquisitlon a n d Certificate Number of naturalization/order of a p p r o v a l o f reacquisition)

r Date of Naturalization/ J_?... ,.J? L.,

PART 2 O A T H ROLLED THUMBPRINTS / SPECIMEN SIGNATURES

Member Chairman of the Board Member

PART 4 VOTER I D E N T I F I C A T I O N NUMBER (To be filled out by Election Officer)

PRECINCT NO. YEAR

Republic of the Philippines APPLICATION FOR TRANSFER/

APPLICATION FOR TRANSFER OF REGISTRATION RECORD

• within the same city/munidpality/district j to another city/municipality/district

That I have resided in my new residence for years and months.

(To be filled out by applicant applying for transfer with reactivation.)

• 4. Failure to vote in two (2) successive preceding regular elections;

t • 6. Exclusion by a court order.

IN WITNESS WHEREOF, I have hereunto affix my signature this day of , 20 at

(Signature above Printed Name)

SUBSCRIBED A N D S W O R N to before me on the above date.

EO/Chairman of the Election Registration Board

Application No. Precinct No.

PART 1 PERSONAL INFORMATION (To be filled out by Applicant)

RESIDENCE/ADDRESS Province i i Height Weight

City/Municipality Barangay DATE OF BIRTH

House No./ Street Month Day Year

CITIZENSHIP Birth ^Naturalized ^Reacquired City/Mun

Month Day Year Certificate No./Order of Approval CIVIL STATUS

N A M E O F FATHER NAME OF MOTHER

PART 2 OATH ROLLED THUMBPRINTS / SPECIMEN SIGNATURES