All information stated is this application are subject to Resolution No.

2048-a and the Data Privacy Act of 2012 (R.A. No. 10173), and are
deemed confidential and no access by the public is authorizes.

All authorized recipients of any personal data, personal information, privileged information and sensitive personal information
contained in this document, including other pertinent documents attached thereto that are shared by the Commission on Elections in
compliance with existing laws and rules, and in conformity with the Data Privacy Act and its Implementing Rules and Regulations, as
well as the pertinent circulars of the National Privacy Commission, are similarly bound to comply with said laws, rules and regulations,
relating to data privacy, security, confidentiality, protection and accountability.

CBFSC FORM NO. 2022-05OQI

HRI under Section 22 (b)

Republic of the
Philippines
COMMISSION ON ELECTIONS
Intramuros, Manila

COMMITTEE ON THE BAN ON FIREARMS AND SECURITY CONCERNS

(CBFSC)

National and Local Elections

May 09, 2022
APPLICATION FOR AUTHORITY TO BEAR, CARRY,
OR TRANSPORT FIREARMS with AFFIDAVIT OF
UNDERTAKING

NAME : ___________________________________________________________
AGENCY (if applicable) :___________________________________________ Please attach latest
2x2 photo
I, _________________________________________________, of legal age, (taken within the last six
Filipino, after having been duly sworn to in accordance with law, do hereby months)
undertake that:

1. I am authorized to apply for the issuance of a Certificate of

Authority-High Risk Individual (CA-HRI) under COMELEC Resolution No. 10728;

2. (Select one, delete the others)

I am a former public official of the (name of agency/department); or

I am considered a High Risk Individual by reason of the nature of my official duties and
functions, profession, business or occupation as described in the attached annex; or

I am under the Witness Protection, Security and Benefit Program of the Department of Justice
or similar program of the government;

3. The firearms I will bear, carry or transport are described in CBFSC Form No. 2022A-05QI. The
data indicated therein are real, true and correct;

4. All the applicable and required permits and licenses attached in CBFSC Form No. 2022A-05QI
are valid, updated and will not expire during the election period from January 9, 2022 to June 8,
2022;

5. In addition, the following requirements set forth by Comelec Resolution No. 10728 are hereby
submitted, to wit:

Page 1 of 3
2022-05OQ1 HRI (b)
All information stated is this application are subject to Resolution No. 2048-a and the Data Privacy Act of 2012 (R.A. No. 10173), and are
deemed confidential and no access by the public is authorizes.

All authorized recipients of any personal data, personal information, privileged information and sensitive personal information
contained in this document, including other pertinent documents attached thereto that are shared by the Commission on Elections in
compliance with existing laws and rules, and in conformity with the Data Privacy Act and its Implementing Rules and Regulations, as
well as the pertinent circulars of the National Privacy Commission, are similarly bound to comply with said laws, rules and regulations,
relating to data privacy, security, confidentiality, protection and accountability.

A. For former public officials

i. Any proof of being a former public official;

ii. Copies of the (a) CFR or LCR with PAR/ARE/MR; (b) LTOPF; and (c) PTCFOR,
MO or LO;
iii. Threat Assessment issued and certified by the Directorate for Intelligence for the
national level or the Regional Director of the Police Regional Offices for the local
level; and
iv. Endorsement and/or Certification of the Chief, Philippine National Police, stating that
the Applicant is considered under High-Risk.

B. For other HRI:

i. If applicable, certification of the employment stating that he/she is currently employed

under the conditions stated in the application;

ii. Any proof that the nature of his/her official duties, profession, business or occupation puts
the applicant at high-risk;

iii. Company or office-issued identification card showing his/her photograph, designation,

and signature, if any;

iv. Copies of the (a) CFR or LCR with PAR/ARE/MR; (b) LTOPF; and (c) PTCFOR, MO
or LO;

v. Threat Assessment issued and certified by the Directorate for Intelligence for the national
level or the Regional Director of the Police Regional Offices for the local level; and

vi. Endorsement and/or Certification of the Chief, Philippine National Police, stating that the
Applicant is considered under High-Risk.

6. I will abide and comply with the conditions set forth in Section 22 (b) of COMELEC Resolution
No. 10728;

7. I acknowledge that payment of corresponding administrative fees is required and non-

refundable;

8. I understand that the CBFSC has the discretion to grant or deny this application;

9. I understand that any misrepresentation or false statement in this Undertaking or its

attachments, or any violation of the conditions in COMELEC Resolution No. 10728, shall be a
ground for the denial of the application or the revocation of an approved Certificate of Authority.
This is without prejudice to the filing of the appropriate criminal, civil, administrative, and/or
election offense charge/s; and

10. The statements stated herein are all willingly, freely and voluntarily executed to attest to the
truth of the foregoing facts in connection with this application.

Page 2 of 3
2022-05OQ1 HRI (b)
 All information stated is this application are subject to Resolution No. 2048-a and the Data Privacy Act of 2012 (R.A. No. 10173), and are
deemed confidential and no access by the public is authorizes.

All authorized recipients of any personal data, personal information, privileged information and sensitive personal information
contained in this document, including other pertinent documents attached thereto that are shared by the Commission on Elections in
compliance with existing laws and rules, and in conformity with the Data Privacy Act and its Implementing Rules and Regulations, as
well as the pertinent circulars of the National Privacy Commission, are similarly bound to comply with said laws, rules and regulations,
relating to data privacy, security, confidentiality, protection and accountability.

IN WITNESS WHEREOF, 1 have hereunto affixed my signature and seal of my office on this
_________ day of_______________, 20____, in the City of _________, Philippines.

Former Public Official/Other HRI

(Name and Signature)

Republic of the Philippines)

City of __________ )S.S.

SUBCRIBED AND SWORN TO BEFORE me this ____ day of__________202_ in the City/
Municipality of ___________ Republic of the Philippines personally appeared to me _____________
with Identification No. _________ issued by ___________ on ____________ in ________________ .

Notary Public/ Administering Officer

Document No. : ____________

Page No. : ____________
Book No. : ____________
Series of 202_

N.B. Please accomplish and submit CBFSC Form No. 2022A-05OQI including all attachments.

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2022-05OQ1 HRI (b)