X41 COMELEC FORM A

COMMISSIION ON ELECTIONS INSTRUCTIONS:

COLLEGE STUDENT GOVERNMENT 1. PRINT ALL ENTRIES
SOUTH PHILIPPINE ADVENTIST COLLEGE 2. PLEASE WRITE CLEARLY
NATIONAL HIGHWAY, CAMANCHILES, MATANAO, DAVAO DEL SUR 3. PLACE AN X IN
THE APPROPRIATE BOX PROVIDED

CERTIFICATE OF CANDIDACY

Position Applied for:

[ ] President [ ] Vice President for Religious Affairs [ ]

Records Officer
[✓ ] Vice President for Finance [ ] Vice President for Social Affairs [ ]
Information Officer

NAME SEX CIVIL STATUS

TORRES________________________________________ARLY KURT
_____________________________B____________________[ ] Female [✓] Single
Last First M. I. [✓ ] Male [ ]
Married

COURSE:_______________BSA_____________________YEAR LEVEL: _________2ND______________AGE:

______20___________CITIZENSHIP:_____FILIPINO_________________

DATE OF BIRTH ____________AUG. 1, 2000___________PLACE OF BIRTH_____COTABATO, REGIONAL

HOSPITAL___________________________________________________

PRESENT ADDRESS (Please state if living outside SPAC campus)

________________________________________________
____________________________________________________________________________________________________
House No./ Blk Family Name of Residence Barangay Municipality
Province

HOME MAILING ADDRESS

__PUROK
1____________________________________POLONULING_________________________________TUPI___________________
______________SOUTH COTABATO_____
House No./ Blk Family Name of Residence Barangay Municipality
Province

PAST OFFICE/S OR POSITION/S HELD

Date: __NOVEMBER 6, 2020_____________________________ Position:

________PRESIDENT________________________________________

________________________________________________
___________________________________________________________

________________________________________________
___________________________________________________________

I promise to abide with the Election Code and hereby affix my signature this _____________27TH____________day of
_____MAY____________2021___________.

_____________________ ____________
______________________________________________
Signature of Applicant COMELEC CHAIRMAN
CLEARANCE TO RUN FOR CSG
OFFICE::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::

Mrs. Venus D. Escobidal, Registrar

Department Chairperson

Mr. Paul D. Cena, CSG Sponsor This is to certify that this copy is
original
Pastor. Jerson P. Arrelano VP for Student Services