Commission on Elections FORM

May 9, 2022
National and Local Elections AIE
Authority to Incur Expenditures
Date filed:

The undersigned candidate hereby grants the authority to incur election expenses to
his/her agent , .
(Surname) (First Name) (Middle Name)
Said person is authorized to incur expenses for/on behalf of the candidate for the upcoming May 9,
2022 National and Local Elections. He/she is only authorized to incur expenses with a maximum
limit of:
(₱).
(Amount in words) (Amount in figures)

AFFIX SIGNATURE HERE 

Before printing, encode name here  [NAME OF CANDIDATE]
Date signed:
ELECTORAL PARTY INFORMATION: Accomplish this part only if you are the party treasurer
NAME of PARTY
TREASURER: (SURNAME) (FIRST NAME) (MIDDLE NAME)
NAME OF
ELECTORAL
PARTY: (COMPLETE NAME OF PARTY) (ACRONYM)
PARTY  Political Party Contact information:
TYPE:  Party-List Group (Phone no. & e-mail address)
CANDIDATE INFORMATION: Accomplish this part only if you are a candidate)
NAME OF
CANDIDATE: (SURNAME) (FIRST NAME) (MIDDLE NAME)
District,
Elective office
Municipality/city/province
sought:
of elective office:
Contact information:
Name of party:
(Phone no. & e-mail address)

AGENT INFORMATION: (Person authorized to incur expenditures, whose name appears in main body)
Home/Office
Address:
Telephone &
E-mail Address:
Mobile No.:

ACKNOWLEDGMENT
REPUBLIC OF THE PHILIPPINES )
City/Municipality of __________________)

BEFORE ME, on (date) and in (city/municipality) , personally appeared the following persons with
competent evidence of their identity:
Name Doc. Type ID No. Expiry Date Issuing Authority

Said persons acknowledged under oath to me under penalty of law, that the whole contents of this document
are true and the same are their free and voluntary acts and deeds.

WITNESS MY HAND AND NOTARIAL SEAL.

Doc. No.: NOTARY PUBLIC

Page No.:
Book No.:
Series of