INSTITUTE OF INTEGRATED ELECTRICAL

ENGINEERS OF THE PHILIPPINES, INC. (IIEE)

41 Monte de Piedad St., Cubao, Quezon City

ELECTION FORM A: APPLICATION FOR CERTIFICATE OF CANDIDACY

This is to certify that the undersigned whose name and signature, and personal data appears below hereby submit
and file this certificate to the Election Committee for the term-year of _.

Full Name: ALAN P. NEBRIDA Membership Grade: RME REE PEE

Age: 38 Date of Birth: March 6, 1983 Civil Status: Married _

Permanent Address: Purok 8, Banggot, Bambang, Nueva Vizcaya

Position:

Company: Nueva Vizcaya State University

Company Address: Heroes Boulevard, Bambang, Nueva Vizcaya

Company Tel. No:

Email Address: alan@nebrida.com

Cellphone No: 09954688187

October 19, 2021

Name and Signature Date

_
Nomination of Active Members

_ _ ___
Signature Above Printed Name Signature Above Printed Name Signature Above Printed Name
Type of License: Type of License: _ Type of License:
License No: License No: _ License No:

Membership Grade: Membership Grade: Membership Grade:

ELECTION COMMITTEE’S ACTION/APPROVAL

Approved for Candidacy
Denial of Candidacy for reasons of:

By:

Chairperson, Election Committee