RESET FORM REVISED CEF - 1 Republic ofthe Philippines COMMISSION ON ELECTIONS. Instruction: Flin completely and legibly the appropriate spaces and check appropriate choice in ovals, © APPLICATION FOR REGISTRATION (Accomplish Personal Information at the back) ‘Note (For Appicans with eating Regisvaion Records) I, , Filipino, born on , a duly registered voter in Precinct No. of Barangay , City/Municipality of Province of do HEREBY APPLY FOR: (Check appropriate box/es) © APPLICATION FOR TRANSFER OF REGISTRATION RECORD ‘within the same city’Municipalty/Distict- from another CityiMunicipaly/District (Accomplish Personal infomation atthe boc My New Residence is: House No. & Street Barangay. CilyiMunieipallty Province. | have resided in my new residence for years and for ‘months, © APPLICATION FOR REACTIVATION OF REGISTRATION RECORD Reason for Devotion: © 1. Sentenced by final judgment to suffer imprisonment for not less than one (1) year; © 2. Convicted by final judgment of @ crime involving distoyalty to the duly constituted government, et: © 3. Declared by competent authority to be insane or incompetent; © 4- Failed to vote in two (2) successive preceding regular elections; QS. Loss of Filipino citzenship, or © 6.Exctusion by 2 court order. © 7-Falure to Validate ‘That said ground no longer exists, as evidenced by the attached certitication/order of the court (in cases of 1.2.3, and 6), © APPLICATION FOR CHANGE OF NAME DUE TO MARRIAGE OR COURT ORDERICORRECTION OF ENTRIES IN THE VOTERS’ REGISTRATION RECORD (Attach requied supporting decuments such as Certified Copy or Certificate of Court Order or Cerificate of Live Bith, and others) Present Data/Information NewiCorrected Datallnformation © APPLICATION FOR INCLUSION OF RECORDS IN THE BOOK OF VOTERS / REINSTATEMENT OF NAME IN THE LIST OF VOTERS © Inclusion of VRR in © Reinstatement of the name of the registered voter which the precinct book of voters, has been omitted in the list of voters | 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 reinstatediincluded therein, The said reinstatement of namelinclusion of registration record is necessary and valid IN WITNESS WHEREOF, | hereunto affix my signature this _day of, + 20___at Province of . Philippines. ‘Signature above prntedname SUBSCRIBED AND SWORN to before me on the above date. EOvAdministering OfficerApplication No. Precinct No. instructions: (1) Accomplish separately in three ci iby, and (3) check the appropriat fe box PERSONAL IN sd out by Applicant) POMao [_]reoistrarion []reansren NAME tmete Osan, i ern Fist assisted by: RESIDENCE/ADDRESS Province = Giy/Munsipality orang Male Female DATE OF BIRTH House No. / street oni Day Year PLACE OF BIRTH CITZENSHIP FILIPINO |v evaith Naturalized Rescquires ctw mun (fread sg ede of rutin aston ond Cite Naber ratralatorader apr of cen uu Date of Naturalization Month Day Year Certificate No. /Order of Approval Reacqustion ‘vit STATUS PERIOD OF RESIDENCE Single No.of Yeo No.of Months No.of ears, Masi Inthe Gyan Inthe Philppines me Name of Spouse, If Married PROFESSION / OCCUPATION TN Feed poses al the qualifications and none ofthe dsquafiations ofa voter and not repistered in any precinct or LT registered In a preci of ancther Ciy/taniipalty/Oseet the Phipines. Further, |v consent tothe processing of that | a the Information stated herein by the Comision on Elections fo regstation, election and ther purposes 3¢ may be provded by aw fecodng BP le, HE RA, No, #389, RA Left Thumb Worth “Bay” Year 1 Signature of Appian Stove mirada 2 £07 pain Oar 3 Er CGI an eae Right Thumb Ene Month Day Yer lApproved th Precinct Assignment No Disapproved Dae Reason or disapproval Moraber ‘Chairman ofthe Board Member (strtur above Printed Nar) (signature above Printed Navel (signntuce above ited Name) Type of Application "ACKNOWLEDGEMENT RECEIPT ‘Application No. Registration © Transfer O Reactivation ‘Application for Registration (Q Transfer with Reactivation change of Name/Comection of Entry ‘O Reinstatement/Inlusion (ER, You reed ot sea inthe ERD hen ws saasied wen