COMMISSION ON ELECTIONS

May 9, 2022 National and Local Elections

Omnibus Report of Contributions
(For Domestic Corporations)

PART A: PERSONAL INFORMATION OF THE CONTRIBUTOR OR DONOR

NAME OF CORPORATION:
AUTHORIZED
REPRESENTATIVE:
(SURNAME) (FIRST NAME)
CONTACT DETAILS: Mobile/Phone Nos.:
E-Mail Address:
BUSINESS ADDRESS
(STREET NO.) (STREET NAME)

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

PART B: CONTRIBUTIONS OR DONATIONS MADE IN CASH

DATE WHEN CASH RECEIPT NUMBER (Receipt
NAME OF CANDIDATE OR ELECTORAL PARTY
CONTRIBUTION WAS issued by Candidate / Electoral
(For whose benefit the contribution was made)
MADE Party)

TOTAL CASH CONTRIBUTIONS OR DONATIONS MADE

PART C: CONTRIBUTIONS OR DONATIONS MADE IN KIND

NAME OF CANDIDATE OR
DATE WHEN IN-KIND
DESCRIPTION OF PARTY
CONTRIBUTION WAS
IN-KIND (For whose benefit the
MADE
contribution was made)

TOTAL IN-KIND CONTRIBUTIONS OR DONATIONS MADE

PART D: CERTIFICATION AND OATH

The undersigned contributor, after being duly sworn, do hereby certify that the foregoing contributions were made by him/her to the candidates or
party treasurers, or their duly authorized representatives; that
DATAall thePRIVACY
informationACT
provided and stated in this report are true and correct; and that
The udersigned consents on the general use and sharing of information obtained in this disclosure and its attachments for legitimate purposes

AFFIX SIGNATURE HERE 

NAME AND SIGNATURE

SUBSCRIBED AND SWORN TO BEFORE ME this

issued by
[Identification (ID) Type] [Serial No. of ID] [Government Agency issuing the ID]
.
[Expiry date of ID]

Document No.:
Page No.:

(NOTARY PUBLIC SEAL & SIGNATURE)

Book No.:
Series of .
(NOTARY PUBLIC SEAL & SIGNATURE)
 FORM
ROC

OR DONOR

(MIDDLE NAME) (EXT)

(BUILDING/SUBDIVISION)

(PROVINCE)

CASH

AMOUNT OF
CONTRIBUTION

₱ -

KIND

MARKET VALUE OF IN
KIND CONTRIBUTION

₱ -

re made by him/her to the candidates or

this report are true and correct; and that
ttachments for legitimate purposes

(DATE SIGNED)

, affiant exhibiting his/her

, with expiry date on

UBLIC SEAL & SIGNATURE)

UBLIC SEAL & SIGNATURE)