COMMISSION ON ELECTIONS FORM

May 9, 2022
National and Local Elections 1
Statement of Contributions and Expenditures SOCE

PART A: PERSONAL INFORMATION OF THE CANDIDATE

A.1. NAME OF CANDIDATE:
(SURNAME) (FIRST NAME) (MIDDLE NAME)
GENDER:
(EXTENSION)

A.2. CANDIDATE TYPE: INDEPENDENT CANDIDATE (Indicate "N/A" for Part A.3.)
(Use "X" in appropriate box) CANDIDATE WITH SUPPORT OF A POLITICAL PARTY

A.3. NAME of POLITICAL PARTY:

(COMPLETE NAME OF THE PARTY) (ACRONYM)

ELECTIVE POSITION:
A.4. (Skip Part A.5. if national position)
A.5. CONSTITUENCY OF THE ELECTIVE POSITION:

(DISTRICT) Indicate "LONE" if only 1 (CITY/MUNICIPALITY) (PROVINCE/REGION)

CONTACT DETAILS: MOBILE/PHONE NOS.:

A.6.
E-MAIL ADDRESS:

A.7. PERMANENT ADDRESS:

(HOUSE NO./UNIT) (NAME OF BUILDING/SUBDIVISION) (STREET NAME)

(BARANGAY) (DISTRICT/AREA) (CITY/MUNICIPALITY) (PROVINCE)

PART B: CONTRIBUTIONS RECEIVED (Itemized entries in the schedule of contributions, indicate "0.00" if none received)
B.1. CASH CONTRIBUTIONS RECEIVED FROM OTHER SOURCES: ₱0.00
B.2. IN-KIND CONTRIBUTIONS RECEIVED FROM OTHER SOURCES: ₱0.00
B.3. CASH CONTRIBUTIONS RECEIVED FROM POLITICAL PARTY: (for candidates with parties only) ₱0.00
B.4. IN-KIND CONTRIBUTIONS RECEIVED FROM POLITICAL PARTY: (for candidates with parties only) ₱0.00
TOTAL CONTRIBUTIONS RECEIVED ₱0.00

PART C: EXPENDITURES INCURRED (Itemized entries in the schedule of expenditures, indicate "0.00" if none received)
C.1. EXPENDITURES PAID OUT OF PERSONAL FUNDS / RESOURCES:
C.2. EXPENDITURES PAID OUT OF CASH CONTRIBUTIONS:
C.3. EXPENDITURES INCURRED USING IN-KIND CONTRIBUTIONS:
TOTAL EXPENDITURES INCURRED ₱0.00

PART D: CERTIFICATION & ACKNOWLEDGMENT

The undersigned candidate, after being duly sworn to, hereby depose and state that:
(1) This disclosure and its attachments, are supported by receipts, vouchers, and other documents reflecting the full, true, accurate, and
complete contributions received and expenditures incurred by the undersigned candidate and his/her duly authorized representative;
(2) The expenditures incurred are for lawful purposes and the contributions were not received from persons or entities prohibited by law
to give contributions.
(3) The undersigned consents on the general use and sharing of information obtained in this disclosure and its attachments for legitimate
purposes.
IN WITNESS WHEREOF, the undersigned hereunto affix his/her signature on [date signed].

AFFIX SIGNATURE HERE


NAME AND SIGNATURE

SUBSCRIBED AND SWORN TO before me on date notarized , affiant exhibiting his/her

issued by expiring on [date of expiry].
(Type of identification document) (ID Number) (Government Agency issuing the ID)

Doc. No.:
Page No.:
Book No.:
Series of (Place Notarial Seal & Signature here)

THISform
Indicate "✓" beside SECTION IS FOR COMELEC
code/document
name if submitted, DO
not.
☐ SCR (Sched of Contributions Rcvd)
☐ SOE (Sched of Expenditures)
☐ SUO (Sched of Unpaid Obligations)
☐ SLE (Sum. Report of Lawful Exp.)
☐ Others: pls. specify:
USE ONLY "-✗
" ifNOT ENCODE / WRITING ANYTHING BEYOND THIS LINE
☐ Contribution Receipts
☐ Expenditure Receipts
☐ Obligations Payable
NO. OF PAGES: _________
(This space is for the receiving date/time stamp of the receiving office)
 FORM
COMMISSION ON ELECTIONS
May 9, 2022
Schedule of Contributions Received
2
National and Local Elections

SCR

Type of Contribution
NAME OF CANDIDATE:
(SURNAME) (FIRST NAME)

DATE RECEIPT FULL NAME OF DESCRIPTION

ADDRESS OF CONTRIBUTOR AMOUNT/VALUE OF CONTRIBUTION
RECEIVED NUMBER CONTRIBUTOR (for in-kind contributions)

(Cash or In-kind)

TOTAL CONTRIBUTIONS RECEIVED ₱0.00

CERTIFICATION ACKNOWLEDGMENT
I hereby certify that:(1) the contributions listed above were made to me as a candidate; (2) all SUBSCRIBED AND SWORN TO BEFORE ME this
entries specified above are true & correct; (3) they are supported by the official receipts affiant exhibiting his/her
issued by me upon acceptance; (4) the contributions are from sources not prohibited by the issued by the [issuing office] [date of expiry].
Omnibus Election Code and other pertinent laws.
DATA PRIVACY ACT
The undersigned consents on the general use and sharing of information obtained in this disclosure
and its attachments for legitimate purposes.
Doc. No. ________;
Page No. ________;
Book No. ________;
NAME AND SIGNATURE DATE SIGNED Series of ________. NOTARY PUBLIC
 COMMISSION ON ELECTION FORM
May 9, 2022
National and Local Elections 3
Schedule of Expenditures SCE

NAME OF CANDIDATE:
(SURNAME) (FIRST NAME) (MIDDLE NAME) (EXT)

DATE RECEIPT/ INVOICE FULL NAME OF BUSINESS FIRM ADDRESS OF BUSINESS FIRM TIN OF CONTRACTOR or BUSINESS Exp Type AMOUNT/VALUE OF
DESCRIPTION OF EXPENSE
INCURRED NUMBER OR CONTRACTOR OR CONTRACTOR FIRM (A-K) EXPENDITURE

TOTAL EXPENDITURES INCURRED ₱0.00

CERTIFICATION ACKNOWLEDGMENT
I hereby certify that: (1) the expenses listed above were incurred by me as a candidate or by my duly SUBSCRIBED AND SWORN TO BEFORE ME this [date of oath]
authorized representative/s; (2) all entries specified above are true and correct; (3) they are supported by affiant exhibiting his/her
the official receipts, invoices or other similar documents; (4) the expenses comply with Section 102 of the issued by the [issuing office] expiring on [date of expiry].
Omnibus Election Code.
DATA PRIVACY ACT
The undersigned consents on the general use and sharing of information obtained in this disclosure and its
attachments for legitimate purposes.
Doc. No. ________;
Page No. ________;
Book No. ________;
Series of ________.
NAME AND SIGNATURE DATE SIGNED NOTARY PUBLIC
 COMMISSION ON ELECTIONS FORM
May 9, 2022

National and Local Elections

4
SLE
Summary Report of Lawful Expenditures
PART A: PERSONAL INFORMATION OF THE CANDIDATE
A.1. NAME OF CANDIDATE: 0 0 0
(SURNAME) (FIRST NAME) (MIDDLE NAME)
GENDER:
(EXTENSION)

A.2. INDEPENDENT CANDIDATE (Indicate "N/A" for Part A.3.)

CANDIDATE TYPE:
(Use "X" in appropriate box) CANDIDATE WITH POLITICAL PARTY

A.3. NAME of POLITICAL PARTY: 0 0

(COMPLETE NAME OF THE PARTY) (ACRONYM)

A.4. ELECTIVE POSITION: 0 (Skip Part A.5. if national position)

A.5. CONSTITUENCY OF THE ELECTIVE POSITION:

0 0 0
(DISTRICT) Indicate "LONE" if only 1 (CITY/MUNICIPALITY) (PROVINCE/REGION)

PART B: SUBTOTAL OF LAWFUL EXPENDITURES PER EXPENSE TYPE/CATEGORY

Travel expenses of candidate and campaign personnel during the campaign and incidental personal expenses
A ₱0.00
Compensation of campaigners, clerks, stenographers, messengers, and other persons employed in the
B campaign ₱0.00
Telephone, mobile phone usage fees, prepaid phone load, internet access, postages, freight and courier
C charges ₱0.00

Stationery, printing and distribution of printed materials relative to candidacy;

D ₱0.00

Employment of watchers at the polls

E ₱0.00

Rent, maintenance and furnishing of campaign headquarters, office or place of meetings

F ₱0.00
Political meetings and rallies & the use of sound systems, lights and decorations during said meetings and
G rallies ₱0.00
Newspaper, radio, TV and other advertisements to promote the candidacy, including website/internet ad
H placements ₱0.00
SUBTOTAL ₱0.00

PART C: EXPENDITURES INCURRED (Itemized entries in Schedule of Expenditures)

Employment of counsel
I ₱0.00
Copying and classifying lists of voters, investigating and challenging the right to vote of persons registered in
J the lists ₱0.00

Printing of sample ballots in such color, size and maximum number as may be authorized by the Commission
K ₱0.00
TOTAL EXPENDITURES INCURRED ₱0.00

PART D: CERTIFICATION & ACKNOWLEDGMENT

The undersigned candidate, after being duly sworn to, hereby depose and state that:
(1) This disclosure and its attachments, are supported by receipts, vouchers, and other documents reflecting the full, true, accurate, and complete

contributions received and expenditures incurred by the undersigned candidate and his/her duly authorized representative;
(2) The expenditures incurred are for lawful purposes and the contributions were not received from persons or entities prohibited by law to give
contributions.
(3) The undersigned consents on the general use and sharing of information obtained in this disclosure and its attachments for legitimate purposes.

IN WITNESS WHEREOF, the undersigned hereunto affix his/her signature on [date signed].

AFFIX SIGNATURE HERE


000

SUBSCRIBED AND SWORN TO before me on date notarized , affiant exhibiting his/her

issued by expiring on [date of expiry].
(Type of identification document) (ID Number) (Government Agency issuing the ID)

Doc. No.:
Page No.:
Book No.:
Series of (Place Notarial Seal & Signature here)
 COMMISSION ON ELECTIONS FORM
May 9, 2022
National and Local Elections 5
Schedule of Unpaid Obligations SUO

NAME OF CANDIDATE:
DESCRIPTION OF THE
(SURNAME) (FIRST NAME) (MIDDLE NAME) (EXT)
OBLIGATION

REMAINING
PURPOSE
DATE CONTRACT / LOAN ADDRESS OF OBLIGATION AMOUNT/VALUE OF
NAME OF CREDITOR (for incurring
INCURRED NO. CREDITOR (Partial Payments were OBLIGATION
obligation)
made)

(i.e. loan, etc.)

TOTAL UNPAID OBLIGATIONS ₱0.00

CERTIFICATION ACKNOWLEDGMENT
SUBSCRIBED AND SWORN TO BEFORE ME this [date of oath]
I hereby certify that: (1) the obligations listed above were incurred by me as a
candidate or with my authority by my duly authorized representative; (2) all entries affiant exhibiting his/her
specified above are true & correct ; (3) they are supported by contracts, issued by the [issuing office] expiring on [date of expiry].
promissory notes & other similar documents.
DATA PRIVACY ACT
The undersigned consents on the general use and sharing of information obtained in this
disclosure and its attachments for legitimate purposes.
Doc. No. ________;
Page No. ________;
Book No. ________;
NAME AND SIGNATURE DATE SIGNED Series of ________. NOTARY PUBLIC