Resolution No. 10924 Annex

REVISED CEF - 1
Ropublic of thc Philippines

ANNEX "A"
CONI]\TISSION ON ELECTIONS
Insh uction : Fill-in completel] rnd legibll the appropriatc sprces and check eppropliate choice/s in ovals.
Q nerltcnrtoN FoR REGISTRATIoN (Accomptish personat lnrormstion ar rhe back)
Note: (For Appli66nt/s with existing Reglstration Records)
t, Filipino, born on , a duly registered

voter in Precinct No. of Barangay City/tvunicipality of
Province of do HEREBY APPLY FOR: (Check appropriate box/es)
O meucmoN FoR TRANSFER oF REGtsrRATtoN REcoRD
O with jn the same City/Mun jcipaljty/District Ofrom another City,/Municipatity/Districl (Accomp,ish Persone hrormaJon anhe back).
My New Residence is:

House No. & Street
Baranga C ity/l\,lu n i cipa lity_P rovin ce
I have resided in my new residence for _ years and for _ months.
APPLICATION FOR REACTIVATION OF REGISTRATION RECORD

Reason for Deactivation:
1 . Sentenced by final judgment to suffer imprisonment for not less than one (1) year;
2. Convicted by final judgment of a crime involving disloyalty to the duty constituted
govemment, etci.
3. Declared by competenl authority to be insane or incompetent;
4. Failed to vote in two (2) successive preceding regular electionsi
5. Loss of Filiplno citizenship; or
6. Exclusion by a court orde..
7. Failure to Validate
That said ground no longer exists, as evidenced by the attached certificalion/order ol the coud (in cases of 1,2,3,5, and 6)
C APPLICATION FOR CHANGE OF NAME DUE TO MARRIAGE OR COURT ORDER/CORRECTION OF ENTRIES

IN THE VOTERS' REGISTRATION RECORD
(Att6ch required supporting documehts such as Certitied Copy or Certlficate of Couri Order or Certiflcate of Live Birth, and others)
Present Data/lnformation
NeWCorrected Data/lnformation:
APPLICATION FOR INCLUSION OF RECORDS IN THE BOOK OF VOTERS REINSTATEMENT OF NAME IN

THE LIST OF VOTERS '
lnclusion of VRR in Reinstatement of the name of the registered voter which
the precinct book of voters has been omitted in the list of voters
I do hereby request that my. name which has been omitted in the list of voters/my registration record which has not been
included in the precinct book of volers of Precinct No be reinstated/included therein. The said reinstatement of
name/inclusion of registration record is necessary and valid.
lN WTNESS WHEREOF, I hereunto affix my signature this _ day of _ ,2o_al

Province of _, Philippines.
Signature above printed name
SUBSCRIBED AND swoRN to before me on the above date
EO/Administering Offi cer
-,
ication No. Precinct No.
nstructlo ns: ( 1) Acc c it'l p I i sh s a rat e I i n t h ae e cop e5 (2

)
pfl nt e8 o
I I a nd ( J h c i( the a priate box.
il:
Part 1 PERSONAL INFORM ATION ( To be f, ed out by Applicont)
NAME Disabllty
it
Last
lt!i JI
II
Firrt
iI sted byi
{Pr€s. rll'op suppkmenr.l Dda F.m/asrtstor r

oarh)
iI
sESIDENCE/ADORESS
lr sEx
City/Municipality Bate i.-jtutate l-1r"."t"

llliiil DATE OF AIRTH
i::i":l t":i_l*I"l
House No. / Street Month Day
ti PLACE OF BIRTH
CITIZENSHIP By Birth Naturali2ed Reacquked City/ Mun
| [ Mtutoll,.d/t ocquit d, no'? dote oJ o^.t cenificor. Nutub.r ot @tuo]lrotbh/ado oJ oprtotot oS .eocquisnion)
^otutdtirorionLocquBttlo^
Date of Naturalization/ vonth Da Certificate No. /Order ofApproval
Reacquisition CIVIL STATUS
f'*1lsin8le
PERIOD OF RESIDENCE I
No, of Years No. of Months i-. jMarried
r:il ln the Philippines
!._.-_.i_.-i Name ofSpouse, f Married
PROFESSTON / OCCUPATTON
nN l*T*l--l t*T-i-l i"Tl l

PART 2 OATH ROLLED THUMAPRINTS / SPECIMEN SIGNATURES
rsrnnrrou n
flnre Irnnnrsre
I do solemnly swear that the above statements regardjng my person aae true and
correct: that I oossets all the oual;fication! and none of the oiloualificetions of a loter and
that I d-rLJnot regislereo ir any preciact or LJ registered i. a precinc! of dnolhe
City/Municipality/Oistrict in the Philippines. Further, I give consent to the processing of
the lnformation stated herein by the Commlssion on Elections for registration, election
and oth€r purposes as may be provided by law ln.ludlnS B.P. Blg. 881, R.A. No. 8189, R.A.
No. 10367 and R.A. 10173 ako known as the Oata PrivacyAct of 2012. Left Thumb RiEht Th!mb
uarei:iiii
Month Day 1
SiSnature ofApplicant
Above Printed N.he 2
EOlAdministering Officer 3
(5ignature above Printed N!me)
Part 3 ACTION BYTHE ELECTION REGISTRATION BOARD

Month Day
Approved With Precind Assignment No ttt
tti
Disapproved OATE Rcason for disapproval
chairman of the Board

lsiSnature above Prlnted N.me) (Sisnarure above Prinied Name) (slgnature above Printed Name)
Part 4 VOTER'S IDENTIFICATION NUMBER /Io be filled out by Election Officer)

Part lll
ti- i:t_t f l--l

Type of Appllcation ACKNOWLEDGEMENT RECEIPT ication No.
O Re8istration O Transfer with Reactivatioh
O rransfer O chan8e of Name/correction of Entry Th s is to acknowled8e /eceipt of your
O Reactivation O Reinstatement/lnclusion .ppllc.rlon. Your appllcaiion a5 tlbject lor

Apprdal/Ol5.pproval by the oectio. R.Bisl.ation Board
Ap lication for stration
{ERB). You need not appear an the ERa h.arlng lnles3
reqli.ed rhrou8h a Mftren nori.e
€Ol lnteru ewer Signature above Prinred Name

Annex "B"
SUPPLEMENTARY DATA
(Persons with disabilities/Senior Citizens with disabilities/ lndigenous People/lndigenous Cultural Communities)
PERSONAL INFORMATION PWD

TYPE OT OISABITITY
T.A5T NAME:
r
FIRST NAME: Hard ol sea ngloe.i
u
MIDDIE NAMEI
tr
PRECINCT NO.:
L
BARANGAYI
tr
CITY/MUNICIPATITY:
PROVINCI
Multiple Oisabilities
[tr
ryPEIS] OF ASSIsIANCE NEEDED ON ELECTION DAY
INDI6ENOUS PEOPTE
f
Are you a member of any lndigenous Pmple (lP)or
Com!nication Assistan.€ I-_
II
r
lndiSenous Cultural Communitie5 {lcC)?
tl E
Yes No
lfyes, please lndicate the Nameof lPllCC community
tr
PWDISENTOR CtTtZEN
ct!
It!
Are you willint to
vote in accessible
tr
E
o
Naire of lPllCC CommLrnity polling pla.e?
tr
z PWD/SC Pre.in.t No._
o (ro be filled up by Eo)
F
L,l
ul
tu
IIJ
F
d, Date:
o
t! Appli.anlsLeftlhumbmark ApplicrnlsiighrThunbmari
IL
o
I
cERTtFtCAT|ON/ATTESTATTON BY ASSTSTOR
(For llliterates/Persons with Disability/lndigenous People IlPl /lndigenoui Cultural Communities (lCC])
t, , a resident of
whose name and signature appear below, hereby bind myse f and declare
u nder oath
L That I assisted the herein applicant for registration:

2 That I filled out hls application in aacordance with the ihformation given to mej
3 That the applj€ant was pleced under oath;
4 That the Election Officer/hterviewer read to the appllcant his accomplished applicalion; and
5 That the applicant affirmed the truth of the information stated in the aacomplished application for
registratioh by affixinB his thumbmark and/or customary mark on has applicatioh in the presence
olthe Election Officer/lnterviewer.
flY WTINESS WHEREOF, I have here u nto aflixed my slgnatu re th is _ day of _,20_at
Province of
SiBnature over printed name of Assistor
asri*o., tefr rhumhm.r,( a<rkto.! Right Thumbma.k
SUaSCRIBED AND SWORN to before me this at
Philippines.
Election officer
Sipnatureover Printed Name
ANNEX,,C"
CERTIFICATION
This is to certify that , born on

, single/wid ow/erllegally sepa rated/ma rried to
a resident of
person a lly appeared in this
office to apply for transfer of registration record. However, his name is not
included in the LocalVoter's Registration Database (LVRD) or in the Printed
Lists of Voters (PLVs)/ Printed Lists of Deactivated Voters (PLDVs) per verification
con ducted by the undersigned.
Hence, pursuant to the Rules and Regulations on the Resumption of

the System of Continuing Registration of Voters and providing for the use
of Voters Registration Machines (VRM5) Nationwide, above-named
applicant is hereby advised to apply for original registration.
This certification is issued for whatever legal purpose it may serve

Done this day of in the City/Mun icipaiity
of Province of Region
Election Officer
{Signature over Printed Name)
CERTIFICATION
This is to certify that born on
single/widow/er/lega lly separated/ma rried to
a resident of
personally appeared in this
office to apply for transfer of registration record. However, his name is not
included in the Local Voter's Registration Database (LVRD) or in the Printed
Lists of Voters (PLVs)/ Printed Lists of Deactivated Voters (PLDVs) per verification
con ducted by the undersigned.
Hence, pursuant to the Rules and Regulations on the Resumption of

the System of Continuing Registration of Voters and providing for the use
of Voters ReBistration Machines (VRMs) Nationwide, above-named
applicant is hereby advised to apply for original registration.
This certification is lssued for whatever legal purpose it may serve.

Done this _day of in the CitylMunicipality
of _, Province of Region
Election Officer
(Signature over Printed Name)
Annex "U'
AFFIDAVIT OI IDENTIFICATION
(FOR APPUCANT WITH NO tDENTIF|CATION CARD)
of legal age, Filipino, and a resident of

under oath, declare:
't. That I personally know applicant

{tullname of applicant)
2. fhal to my knowledge, he/she was bom on t
and presently residing at
3- That to my knowledge, the applicant has atl the qualifications and none of the
disqualif cations of a voter;
4. That I am:
a. A registered voter of Preclnct No. of Barangay

City/Municipality of _, Province of
_b. A relative of the applicant within the fourth civil degree of

mnsanguinity/affinity, being his/her:
_i. Parent _ix. Great grandchildren

_ii. Son/Daughter _x. Father-in-law/Mother-in-law
_iii. Grandparent _xi. Brother-in-laWSister-in-law
_iv. Brother/Sister _xii. Nephews/Nieces from siblings
v. Uncle/Aunt
_vi- First cousin
_vii. Grandchildren
_viii. Great grandparents
ln WTNESS WHEREOF, I have hereunto affixed my signature this

day of 20- al Province of
, Philippines.
-
(Signature above printed name)
SUBSCRIBED AND SWORN to before me, on the above date and place'
the affiant exhibiting to me his/her , issued by
on
ELECTION OFFICER/
ADMINISTERING OFFICER
NOTE: lndicate the type of ldentification Card presented by the affiant'

lD Presented / lssued by: No. Valid until
v
APPLICATION FOR TRANSFER OVF No. 1B
From POST to PHILIPPINE
@ D
E
M UNtCTDA:-rw/C:TYlDtSTRtCT
To the same municipality/city/district

To another municipalitv/citv/district
Application No.
IIIIIIIl
(To be filled by the 0t0V)
PART I. PERSONAL INFORMATION
NAMI OF APPI.ICANT
III IITI IIIIIII IIIII ! rttiterare D Perlon wirh

Di3ab'l,rv
rrrIIr
LAsT
FIRST
MIDDLE
IIIIIIrrIT IIII
IIII IIIII IIIII lrt III
Er"diE.".,' Es€n.o' crizen
(Pleasefllup Suppleme^tar Data

ro.m/As5istors oath)
By Birth
CITIZENSHIP: [ ^.""0r*o sEX: EMALE E FEMALE
Itl notutot .d,/..rqub.d cin .Bhic, ot d.te o! n.ru.otbotj@ h@.qoiit n ol @rqdtj,oti6 an r c.nti.ot Nuab.. ol
ilil Il
,tot!ft,rdiaqtM.t ol AppMl ol neo.quisition o! Atu Bhb) OATE OF SIRTH
tuk 4 Notutotbs.b./s@Lb c.nttic.re No-/o.dlt .t

^,,.ovd
STATUS AgROAD: CIVIL sTATUs: O Single EMarried
E orw 0 lmmierant Name of Spouse (lf Married):
E s."f".". E ourtLtir"r' E othe.t
POST/COUNTRY PREVIOUSLY REGIsTEREO: PASSPORT/tD TNFORMATTON

atTYl(TATF._ PASSPORT/lO NO.: _
POSTAL CODE:
COUNTRY: ISSUED ON:

TIIIII
POST: ISSUEO AT:
REsIDENCE ABROAD:
NEW RESIDENCE:
COMPLETE MAILING ADDRESS:

Residence ln the Philippines where Applicant lntends to vote:
Barangay:
City/Municipality:
RESIDENCE IN THE PHILIPPINES BEFORE LEAVING AEROAD: Province:
Earangay:
CONTACT DETAII.S
City/Municipality:
TELEPHONE NO:
Province:
MOEILE NO:
EMAIL ADDRESs:
.-,,'
PARTII- OATH '' . ROLtEO.tHUMBPRINTS/SPECIMEN SIGNATURES
I r*rr ti.t tA..b@e s.rt6.nB... tru...d

ouallite0oni .nd none ol tnp dBauzlltlc:tlon3 ol: votec ttEl I ierlby:pply f.. t..ilte. froh
Pon b PhillpDane muntloality/cityldlrt ict i and th.t I gir€ con!€nt to tte proce$hg ol th.
r.rdm.ron n.red her.ir W th. cohdklon o. El4tion! for r4istBtion, llecrion .nd orh.r
purpos ,s m.y b. p.drd.d by l.w i.cludln€ a.P.aE. aa:a R.a- No. 31a9, R.A No. 989, i.a-
L .lo hM .t Lt
IIlr
10590, No. 1036, .^d i-q- uo. 10173 thE D.t: P.V.cy ol 2012-
r rI 1.
(Si8nature of appll(ant Above Printed Name)
2.
3.
Eo / AdministerlnE offlcer
(Signature Above Printed Name)
' Application o.
ACXNOWLEDGMENT RECEIPT
aoDlicetbn Ior Tiansre. Lom Post to Phil. MunicipalltY/dtY/Dlnti.t
rrrlIIlII II to actnowl€dge recelPt ot Your

Thls ls for lr'nifer from Posl
IT .pplication is subject to the

'pPlication
to Phillpplne municlpality,f'cttvldistrlct Your
approval of the OFOV and the OEO wh€re Y@ intod to vole
a Notice of APP.oval/Denial, vou need to rpp€ar belore th€ oEO
o^'e You rec''ve
where You
trr
-
rt rrtr
Eo/hi.n.-n. sic .tu.. ,6*.
ffi Reoublic of the PhiliPPines
CbMMISSION ON ELECTIONS
Intramuros, Manila
I-nstructions; Fill in completely and ldgibly the applopriate spaces and check choices,
APPLICATION FOR TRANSF'ER OF REGISTRATION RECORD FROM POST TO PHILIPPIITE

MUMCIPALTTY/CITY/DISTRICT
(_, From Post to the same municipality/cityldistrict
From Post to Philippine Municipality/City/Distdct Other than the VoteR'

Residence as Indicated in OVF No. I or the National List ofRegistered Voters
(NLRv)
My new residence is:
House No. & Street

Barangay
City/Municipality
Province
I have resided in my new residence for _ years and for _ months.
IN WITNESS WHEREOF, I have hereunto affix my signature this _

day of _,20-qt ,
Philippines.
Printed Name and Signature ofApplicant
SUBSCRIBED AND SWORN to before me on the above date.
P nted Name and Sigrature of

EO/Administering OfEcer
!r
ilE
t_.
RPI]BIIC OF THE PHILIPPINES

COMMISSION ON ELECTIONS
rntramros, Manila 21A2 -C g 6
ELECTION AND BARANGAY AFFAIRS OEPARTMENT
?recincts andn oting Centers Diyision
MEIVIORANDUM
TO aLl EtEcTtoN oFF|CERSIACI|NG ELECTTON OFFTCERS
THRU ALL RTGIONAT EIECflON DIRICTORS/

ACTING REGIONAL ELECTION DIRECTORS
ALr pROVtNCIAI ETECnON SUPERVISOBS/

ACTI'{G PROVINCIAL ETECTION SUPERVISORS
FRONN T}IE DIRECTOR IV
SUBJECI 6uidelines in the Preparation or Updatlng of Sarangay precinct

Maps Re Approved Transfer/Change/Correction of
Names/Addresges/Locations o, Voting Centers
DATE February 4, 2021
ln compliance with Section 4 of R.A No. 8189r, please find herein below, guidelines for the
preparation of updatea,Barangay Precinct Maps (BPMS) relative to approved Request for
Transfer/Change/Correction of Names/Addresses/Locations ofVoting Centers:
1. Secure a Barangay Map from the concerned Local Government Unit (LGU) through the
Municipal/City Planning Development Office/Council or the Municipal/City Engineering
Office;
2. Using the Barangay Map as reference, prepare the Barangay Precinct Map as follows
a Oelineate the precinct territories of all original/mother precinctr using natural or

man-made boundaries {road5,/streets, alleys, trails, rivers, creeks, or itrigation
canals);
b- Reflect in the territory of mother precincts their spin-off/ daughte. precincts;
c Plot the voting center/s in their proper location/s, indicating their name/s. For other
schools not being used voting center^, no need to indicate their names in the
BPM; "s
d. For barangays using voting center^ located in another barangay, indicate anywhere
in th€ BPM the nama of the voting center^, its exact location/s or address/es, and
the distance of the voting center from the residences of the voters of the barangay.
ln this case the EO need not submit the BPM of the barangay where the voting
center is located unless said barangay is also included in the request;
1
"The.e sh6ll b€ a pen.neht list of voteE p€r preclnct ln ea.h city or munklpality conskting of all reristered vote.s .esidio8 withi^ the
t..dto.ial jurisdictioo ot ev.ry preclnct indlGtecl by precinct m.pi. r r t."
e Put legends to show different landmarks such as churches, chapels, schools,
lnarkets, culverts, bridges, arches and the like; and
f. The Eo shall afFlx his/her signature in the BPM, certifying its correctness and
aacuracy.
For reference, please see attached Annex A {sample BPM where the voting center is located
within the barangay) and Annex B (sample BPM where the voting center is located in another
barangay).
Please take note that this Memorandum effectively amends our November 29, 2oL9
Memorandum referring to the same subiect matter.
For guidance and strict compliance.
w
d
L'.: OED
ADF"DO
CoNftIJF ']'lat-rrY N o'|lcE: AII autlniL',{ tcciyienls al nry p,J,:m"l natu it{ontunon, Pi:u.tc}c't nhr'tuutat rukl $tt9tft Nt:"ddt
.u;rirr* ei in &rfwiN Tui t Ih( Dnta ldonry Art o! :u12 (R'A t\:r d:': t::
Litctittts in <o,,yhantt zrzrl' tmds a,r,t , ANs, ,1u1?
,ui:tt s"ia tii,, -,1"t .,a ,;gulntuf,s. nlan q n' ,tat Ptioo.y, ..at it!, k,'1.!atiatit!, f Ma nd)tqtihititl'
"2ctid
m
}qflsNEx tr
REPI,BLIC (jT THE PIULIPPINES
COMMISSION ON ELECTTONS I -.i
Intra$uros, Manila
ELECTION AND BARANGAY AT'FAIRS DEPARTMENT
Precincts and Voting Centers Division
MEMORANDUlltr
TO ALL ELECTION OFTICERS/ACTING ELECTION OTFICERS
THRU ALL PROVII{CIAL ELDCTION SUPERVISORS /

ACTING PROVINCIAL ELECTION SUPERVISORS
ALL REGIONA' ELECTION DIRECTORS,/

ASSISTANT REGIONAL ELECTION DIRECTORS
rROM THE DIRECTOR IV
SUBJECT Posting Requirement re Request for Transfer of Voting

Center/Correction/ Change of Name/Address of Voting Center
DATE September 9, 2020
In order to avoid complaints subsequent to the approval of any request for transfer of
voting center/change/correction of name/address of voting center and also to give the public
llre opportunity to verify the authenticity of the document/s annexed to such request, the
undersigned rvould like to request all OEOS to comply with the following guidelines crn posting
ruqr.lirements, lo urit:
A. POSTING REQUIREMENT
Upon the submission of any request, the POP Regional ln-charge of EBAD shall make
the necessary evaluation thereof totether with all its supporting documents, Therezrfter,
a formal communication shall be sent to the EO informing him/her of the rcsult of thc
evaluation. If the requirements are already complete, a written notice/ instruc tion for
the posting of the iequest on thc bulletin board of the OEO, city/municipal hall and in
barangay hall/ s of the affected barangay/ s shall be made.
The posting shall be:
Composed of all supporting documents attached to the .equest, which shall be

certilied as true copies of the EO. In this regard, before transmitting the request
to the EBAD, the EO rnust leave duplicate copies thereof in his/her for purposes
of postingi
1t Made within two (2) days frorn receipt of the written notice/ instructiot from the
EBAD; and
iii. For at lcast ,ive (5) working days

Any complaint or opposition relati!/e to the request shall be {rled in rvriting with the
() EO
I], PROCEDURE AFTER POSTING
A certification to attest to the posting made shall be submitted to EBAD upon the
expiration of five {5) days. Photos showing compliance with the posting require,nent 1[
tilgshall be attached to the ccrtilication. All complaints / opposition s filed with rtic'
-OEO reTative to the posted request shall be forwarded to EBAD together with the EO's
comments/ recom mendations.
c. SENDII{G OF COPIES OF THE REQUEST TO STAXET{OLDERS
Within the same period of posting mentioned in the immediately preceding section, the
EO shall also be requircd to furnished certified copies of the request and its supportiilg
docrtments to all duly registered local political parties, citizen's arrrrs, civic organizations
and other stakeholders and interested parties as he/she may determine.
Relative to the foregoing, all OPESs and OREDS are hereby requested to rnonitor the
r:ompliance of their respective personnel with this Memorandum.
For information, guidance and appropriate action
..../.-i_-.,
E AS, JR.
dv
Copv luftlshed.:
OlJice of the ExeattiDe Dteatar
OlJice of the Deputy Exeattiue Diector fo. Operations
CONttDEMlALrty NOfiCE: Al a tlrcrizq! recipicrts of aiy pe\oAl data i4o.lnatio[, prioilegcd it{on atior rnd sensitiw yr<rnl
,,:xlatious, relali,q lo data pfunc1l, sccwity, conffur,lialily, prctecliofi dnd accotulabilify.

', n
",1,f,,,1F:-Y _H-- '1911-21$
REPUBIIC OF THE PHITIPPINBS
Intranuros, Manila
Dlection arld Barangay Affairs DepartEent
Precincts and Voting Ccnters Division
MEMORANDUM
TO A'L ELECTION OFFICERS/ACTING ELECTION OFFICERS
THRU ALL REGIONAL ELECTIOI{ DIRECTORS/ACTING REGIONAT

ELECTION DIRECTORS
AI,L PROVINCIAL ELECTION SUPERVISORS/ACTING

PROVINCIAL ELECTION SUPER\/ISORS
F'ROM THE DIRECTOR IV
SUBJECT : Administrative transfer of voters/Assigrtment of voters in their

proper precinct
DATE November 21, ?O),9
Section 4 of Republic Act No. 81891 statcs that, 3L9Ie_Sb.SlLbe-apeUtA4e-]1LLis! pl.'

,oters er ti o all idi
lenitoriaL recinct ittdicated b nct
X-txxxx
Xxxxxx
'l'lrc precincl assienmetTt it1 tl Le erntartent lis'L of rolers sh(ILl no t he charwed or
alt e tretl t<) anotlTer Ltlecinct tuithout the exoress turi n conseru -9I 118 -t)aleJ:
Provided", fauteuer, Tlaf ttv uoter shall not utlreasonablg u;ilhhold szch c'onsent. Atrg violaliort
tle,reof shall constituta an election olfense tuhich sh.all be p.utlished in qccsrdanLce with ktnt."
tn cornplialce rrith the above provision of larv, and to ensure that the POPS arc
accurate, aU OEOS are hereby requested to do the follou,ing;
1. Identify tt-re precincts affected by the wrong precinct assignment due to

non- use of barangay precinct maps during registration;
2. Verify the list of registered voters of the identfied
affected precincts by
conducting enumeration through house to house canvass;
3. Prepare the list ol vcrters who should be administratively transferred to
their proper precincts;
4. Require tlre affected voters to file Applications for Ttansfer of

Registration Record within the same city/municipalitv Pursuant to
Section i3? of Republic Act Ng. 8189;
',N ACT PROVTDTNG FOR A GENZRAL REGTSTRATION OF VOTERS, ADOPTING A SYSfEt' OF

CONTINUING REGTSTRA'ION, PRESCRIAZNG THE PROCED'JRES THEREOF AND AUTHORIZING THE
APPROPR'ATION OF FUNDS THEREFOR.
5. Subnit the list of voters for administrative transfcr, together with thrc
corresponding Application Forms, as mentioned above, to ERB hearings
upon the rcsumption of the contiluing registration of voters, rvith noticcs
to be posted in conspicuous places in the territory of the affected
precincts, Oflice of the Election Officer, and in the barangay hall;
6. Provide copies of the notice to representatives of registered political

parties, citizens' arms, cMc orgaoizations and otler stakeholders;
7. After ERB approval, efl'ect the administrative transfcr by including the

VRRs and the names of the conceraed voters in the Book of Voters and
ttre list of voters to their proper precincts;
8. Submit to thc ITD the updated list of voters, and to the BBAD the QPRs
and POPs, together with the list of voters administratively tral]sferred, and
ttre Minutes of IJRB proceedings;
9. As far as practicable and if necessary, only daughter/ spin-off precincts

shall be created to accommodate the voters for administrative transfer;
and
10. Update the Barangay Precinct Map of the affected barangays and post
copies thereof in conspicuous places within said barangays, on the
bulletin boards of the OEO and municipal/city halls.
Firrally, please be reminded that all requests {or transfcr of voting ccnters, regardless of
the mode of transfer availed of (signatures by majority of voters per precinct or agreement of
political parties or petition to the Commission DtL Banc under Section 154 of the Omnibus
Election Code3), which sha-Il require arl.ministrative transfer of voters, shall first comply ['ith
the foregoing before t-l:is Department shall act on the same.
o LNAs, J1./
{
Copy furnisled:
ODEDO
OED
Con ti.te n ti e I ity N otice :
"All aut:hofizecl reclpionts of any per-.tonai (tata, pegonat inlorfi:E,ttan, prlvitegad ihfoanlation ai'd scnsltive pe6onal informaiion
cantahed li this dacuDlent, inctudirg other pettircnL docuncnts ittached herelo that are shared by tha Coln,niistoi on Electidns in
conpltance with the existing taws'and rutes, and in coiltormtty with Utc Data P!.tvacy Act of 2Or2 (RA No. 10173) and kg
implenle ting Rules anc, Regulation. as well as the pcrtioent Ctrcula\ 6f lhe Natlonal Prlvts.y Commlssion, arc siqliletly b.o!|1d to
co;pty wlth'the said lzws, ;)les anc! regulations rctaihg to data ptivacy. securlty, .anicientlalilY, ProtecLion .nd ac.outltabilitY.-
' Sec. 13. Ch.rnge oJ Address ln the Same CYly ot llu.Llclpdllt!: - An!) xoter iho ho^s clotx'!,led itis addtess
,r l,re s.rrre citg or nutnicip.llil.V sholl int ediatelV notifg the Slection OLllcer tn wrltb g. lI -t!tc.-S!1,4!r!tP tI-!lU.tS-:
tt]!)el.es-s]d\tge in rLreg!:4 .lhp-P,:sr!_Str-"!!J!_a:usJ_ea"!:t!s Ic41,1ra!"iA!L-j-cs9t(l !!t -Ua,.2r99i!]rt t n. k lJ -at.l r s-!i -bia.J'.( !'
. -e"
prcctlts! atr"C,49-LiI! tl!-9."p-o19lJt-A91ea-p,re!.t!"tc1 All chanocs ,!i od,rr.,ss sntll D. 'epo4ad ,a tht olltn: of it.. ptottitlcial clcctton
etpctuisorord rhe Cohthissio,r a lrr{,ila.
Jt>r pollirtg ptae. - r x x x t No desbnation oJ potli'Llt pkacs sholl hc clnnled

' S€ctloE 154. R*luiremettts cxee?t nPnn
tritte^ petitio,t ofihr. ,,i tn" ,ii".s of the prc.:in.t or ds,ei,n"nr "Ji,it L1{, Poli!rcat Potues o" bv tu sotutut oJ o1a
(onY?tssi/,t upou f,ior"r",i"atl
notice und h4,iqg.
Annex "l"
C.E. Form No. A5
Republic of the Philippines

COMMISSION ON f,LECTIONS
BARANGAY AND SANGGUNIANG KABATAAN ELf,CTIONS
APPOINTMENT OF ELECTORAL BOARD CHAIRPERSON/POLL CLERK/THIRI)

MEMBERJSIJPPORT STAFF
Instructions: Prepare in three (3) copies: Th. original and secoad copies shall be retained by the City/Municipal Election Officer,
(one copy shall be for his/her file and the other shall be attached to th€ payroll for payment ofhonorarium of the Elecroral Board)
and lhe lhird cop! shall be issued to the chairperson, members and support staff of lhe Electoral Board concerned
N,-"'
Address:
(House No., Street, Barangay, C ity/M unicipality and Province)
Sir/Madam:
You are herebv APPOINTED as of the Electoral Board (EB) in

(Chairperson/Poll Clerk/Third Member/Support Staff)
Precinct No/s with polling place located at_
in Barangay_, C ity/M un icipality oi
, District_ Province of , Region_
You may immediately assume office upon taking your oath as required by law- However, this
appointment will be automatically cancelled and considered null and void if you are related to any candidate
or to any member ofthe Electoral Board of the said precinct/s within the fourth civil degree ofconsanguinity
or affinity. In such case, you shall not assume the duties of the office and shall immediately return this
appointment to the Election Officer. Assumption to office notwithstanding this prohibition is punishable
under the law.
BY AUTHORITY OF THE COMMISSION:
Election Officer as representative of the

Commission on E lecl ions
(Signature over Printed Name)
An nex "l-1"
C.E. Form Nr-r. A5-A

BARANGAY AND SANGGUNIANG KABATAAN ELECTIONS
OATH OF ELECTORAL BOAR-D CHAIRPERSON/POLL CLERX,/THIRD MEMBER/SI]PPORT

STAFF
(City/Municipality, District, Province, Region)
I, solemnly swear that I will faithfully perform the duties of

of the Electoral Board in Precinct No/s
(Chairperson?oll Clerk/Third Member/Support Stalr)
in Barangay of the above stated city/municipality, district, province and region to the best of my
knowledge and ability, without favoring any person, candidate, political party or group: that I will obey the laws and
legal orders promulgated by the duly constituted authorities, and that I voluntarily impose upon myself this obligation
without mental reservation or purpose ofevasion. SO HELP ME GOD!
(Signature Over Printed Name)
(Date)
SUBSCRIBED AND SWORN to before me this day of , 20_, at above

stated place.
Administering Officer
EB Chairperson/Co-Member
E Registered Voter ofthe Precinct
Insttuctions: prepare in three (3) copies: The originat aad second copies shall be retained by the City/Municipal Elecrion officer
(onc copy shall b; for his/her file and th€ other s;all be altached to the payroll for payment of honorarium of the Elecloral Board)
and the third cop! shall be issued to the chairperson, members and supporl slaff of the Elecloral Board concerned
Alnex 'J"
STATEMENT OF CANCELLATION
I Q"lame of candidate), of legal age

Fiiipino, and a resident of
after having
been duly sworn to in accordance with law, state as follows
1 On I filed my Certificate of Candidacy for the position

of before the Office of the Election Officer of
2. Also. on _ I filed my Certificate of Candidacy for the

position of before the Office of the Election Officer of
3 I am herebv cancellins
Jil":;f ::11'ff ; :;XTtriJ"#;":ii"rr'j:ilT :i
IN WITNESS WHEREOF, I hereunto affix my signature this _ day of

ln, Philippines.
(Name and Signature of Candidate)
(Date)
SUBSCRIBED AND SWORN to before me this _day of at

-
a-ffiant exhibiting to me an Identification document/card which
contains a photograph and signature bearing No. issued by
on
(Officer Authorized to Administer Oath)
Doc. No. :
PaSe No. :
Book No. _______j
Series
-.
NOTICE/DIrLAIMER: All authorized rccipients of any personal data, personal informatiot privileged information and s€nsitive
personal information contained in this document, induding other pertinent documents attached thereto that are shated by the
Corunission on Elections in compliance with existing laws and rules, and in conformity with the Data P vacy Act of 2012 (R.A. No.
10173) and its lmplementing Rules and Regulations, as well as ihe pertinent Circulars of the National hvacy Commission, are
similarly bound to comply with said laws, rules and regulations, relatinS to data privacy, security, conJidentiality, protection and
accountability.
Arnex 'J-1"
AUTHORITYTO SUBMIT
STATEMENT OF CANCELLATION
L (name of candidale), of legal

age, Filipino, and a resident of
hereby
authorize also of legal age,
Filipino, and a resident ot to
submit my Statement of Cancellation.
IN WITNESS WI{EREOF, I hereunto #fix my signature this _ day ol

ln- Philippines
(Date)
(Name and Signature of Agent)
(Date)
SUBSCRIBED AND SWORN to before me this of at

-daydocument/card which
affiant exhibiting to me an Identification
contains a photograph and signature bearing No. issued by
on

No.
Doc. ;
No.
Pase ;
BookNo. :
-.
Series
-.
inJormation and sensitrve

NoTICE/DITLAIMERi A]I authorized redPients of any Pe$onal data, Personal information, PrivileSed that are shared by the
p.r*J'i"for uu"" contained in ,n" a*i^..1 -ai.a:rrg 9*,g pejnent docume.s attached thereto
commission on Electio* in co^p[-." *,i-tt tu*, ,ia .,rt"r,'and in conJormity r4ith lhe.?ara Plv^acy Act:f ri1111 i-o^
"ri"ting are
iorrc) aI1J i" Implementing Rules and Regu.latiors, as well as the_ pertinmt cLculars of the National Privacy comBussro&
confidentiality, and
siuLilarly bound to comply with said 1",^,r, iJ*-""J t"grl"tioru, reliting to data privacy. secuity, Protection
accountability.
Annl-x "K"
Affix Latest
CERTIFICATE OF CANDIDACY FOR Photo Here
PUNONG BARANGAY Passport Size
NSTRUCTIONS: (Please read well before Rlling'out the COC form.)

. Fill-out th€ items completely. Write N/A if an item is not applicable.
. Print the COC Form on BOTH SIDES (front and back) of a FOLIo (8.5T 13") or LEGAL (8.5"xr4") size copy pap€r.
. Tltles such as Dr., Atty., Oon, Ginoo, Seior, Datu, Sultan, Bai, Se6ora, Kapatan or othei similai tides are cxpressly prohibited.
. This certificate shall be sworn b€fore e notary public or any ofticial authorlzed to admlnister oath. The Election Officer may adhinlster the oath on the COCa
filed within their area ofiurisdiction, free ofdtarge.
5 . F,le this in THREE (3) LEGIBLE Eoples with the COI4ELEC Or,lce concerned, on any day from August 28, 2023 (Monday) to September 2, 2023 (Saturday), ftoB
8:00 Al{ to S:00 PM Ol{LY.
6 . No tiling fe€ shallbe imposed,
I hereby announce my .indidacy to. the posi lion oJ PUNO C AARA GATot SA|UNGAY City/Municipality of
Province of , in the october 30, 2.023 Banngay and sangguniant Kabata.n (SK) Ele€tions; and after having been swom to in
accordance with law, I hereby state the following:
1. NAME:
|ltl
14. SEX: 15. AGE ON ELECTION DAY:
1.1 Last Name
!
TT-[I]
llttt
Mal€
Must be at least eighteen
1.2 First Name
1.3 lliddle Name

TTIN ! (18) years old on election
day
-
I TTTT_T 16. DATE OF BIRTH:

2. NICKNAME OR STAGENAME: (Indicate only one nickname or stage name)
I l -I 14onth
tl Dav
17. PLACE OF BIRTH

3. RESIDENCE/ADDRESS:
3.1 Province
t Ttl I
City/Mun
I
3.2 City/t"lunicipality 3.3 Barangay
1.4 House No./ Sreet / Subdivision

tl-tl-rTtl Province
18. CIVIL STATUS:
t I
T
TT I
i[ -1
l-l .re"
! maniea
!wrao*r"'
4. ADORESS FOR ELECTIOI{ PURPOSES: (could be ihe same as No.3) Full Name of Spo!*, if mamed
19. PROFESSION OR OCCUPATION:
5. PERIOD OF RESIOENCE IN THE PHILIPPINES UP TO THE DAY BEFORE OCT.30, 2023:
5.1 In the Philippines: tto. of vears

y*r.
[-T-l
fT_l
No. of Months
trl
tIl
20. I AM A REGISTERED VOTER OF
Precinct
5.2 In the above-staled Barangay tto. of No. of Months
Barangay
City/14un.
6. I A[1 A F1LIPINO CITIZEN, Province
I EXECLITED A SWORN RENUNCIATION OF FOREIGN CMZENSHIP. OF APPLICAELE, ATTACH A COPY)
a. I AI\4 NoT A PERMANENT RESIDEI,IT OF, OR AN ll4l4lGRANT To, A FoREIGN COUNTRY. 2I. OFFICIAL E-MAIL ADDRESS:
9. I AIV EUGIBLE FOR THE OFRCE I SEEK TO 8E ELECTED TO. (For notice and election purposes)
10 I WILL FILE, WITH THE OFFICEs OF THE COI4MISSION, WITHIN THIRTY (30) DAYS AFTER ELECNON DAY, MY FULL,
TRUE AND ITEMIZEO STATEMEMT OF CONTRIBUTTONS AND EXPENOTTURES (SOCE) IN CONNECTION W1TH THE
ELECNON.
11 I WILL SUPPORT AND DEFEND THE CONSTITUTION OF THE REPUBLIC OF TH€ PHIUPPINES AND WILL MAINTAIN 22.Have you ever been found liable for an
offense which carries with it the accessory
TRUE FAITH AND ALTTGIANCE THERETO, I WILL OEEY THE LAWS, LEGAL ORDERS, AND DECRE€S PROMULGATED BY
I
THE DULY CONSTITUTEO AUTHORTTIES, IMPOSE THIS OBTIGATTON UPON MYSELF VOLUNTARITY, WITHOUT
penalty of perpetual disqualification to
I.4ENTAL RESERVATION OR PURPOSE OF EVASION, hold public offlce, which has become final
12. I SHALL NOT AOVOCATE VIOLENCE OR UNLAWFUL I,IEANS TO ACHIEVE MY GOALS. and executory?
I GIVE CONSENT TO THE COI4MISSION ON ELECTIONS TO COLLECI, DISCLOSE OR SHARE. AND PROCESS THE
13.
PERSONAL DATA I PROVIDED HEREIN FOR ELECTION AND OIHER LAWFUL PURPOsES IN ACCORDANCE WITH THE
tr Yes
(Please provide details at the back)
PRIVACY NOTICE AT THE BACK OF THIS FORI14. AND AS MAY BE AUTHORIZED BY EXISTING TAWs.
n No
I hereby certify that the facts stated herein are true and correct to tie best of my knowledge.
Signature of Candidate over Printed Name
OATH
SUBSCRIBED AND SWORN to before me this day of 2023, at afflant exhibitinq to me an
Identiflcation documenvcard which contains a photograph and signature bearing No. issued by
-
Doc. No. ___________j
Page No. _; (afux P30.00 d*ome.t .v stsP)
(Offlcer Authorized to Administer Oath)
Book No, _;
Series of 2023.
THIS fORM C!.'.i B€ PHOTOCOPIEO OR REPRODT]CED ANO IS AVNTAALE AT THE CO}!EL[T OFRCES FREE OF CHA'GE
OR MAY B€ OOWNLOADED FRO THE CO}!EIfC OFFICIAT WEBSrIE (ww cdd*.6d.oh)
Case Docket Case Title Date Filed Status
Name of the Substitute Spouse, if applicable

(in case ofdeath ofcandidao
The colleded personal data will be encoded in the information slstem developed by the Commissaon ofl Elections (COMELEC). The personal
data inputted in the information system will be used by the COl4EtfC in the preparanory posting and/or publication of the lin of candidates
aM other electionrelated dooments or forms.
For l€gitimate r€s€arch needs and inquiries, and only for the purposes specified in the request, the COIIIELEC may disclose and share your COC
and/or its conlents. lYor€over, the COI'4ELEC may us€ and disclose your COC and/or its mntents in any proceeding or investigation in which
your COC and/or iL! contents is/ar€ in issue or may find relevance.
Onty authorized personnel are allow€d to access and process your personal data. Immediately after tlre election period or upon th€ oeiration
of the storage period set in existinq COI\4ELEC rules and policies, and laws and .egulations, whichever applies, the physical and digital copies of
your p€Gonaldata will be anonymized, deleted, and discarded following the disposition procedures of the COIVIELEC and the National Archives
You have the right to ask for a copy of your COC or aoy personal data it contains. Also, you may withdraw your candidacy in accordance with
the COITELEC rules and policies on the matter.
Ifyou have questions regarding Ulls Privacy Notice, please send an emailto dpo@@nelec.gov,ph.
Annex "K- l '
CERTIFICATE OF CANDIDACY FOR Affix Latest

Photo Here
MEMBER, SANGGUNIANG Passport Size
BARANGAY
Fill-out the items completev. Wrate N/A if an item is not applicable.
Print the COC Fom on BOTH SIoES (front and back) of a FOLIO (8.5'113") or LEGAL (8.5"x14") size copy paper.
Tiues such as Or,, Atty., Don, Ginoo, Seior, Datu, Sultan, Bai, Sefiora, K.pitan or other simil.r tiues are expressly prohibited,
This certiflcate shall be swom betore a notary public or eny official .uthorized to.dmlnister o.th. The Election Officer may .dnrinisler the oath on the CoCs
filed within th€ir area olJurlsdictlon, free of drarg€.
File this in rHREE (3) LEGIBLE coples with th€ COMELEC Office concerned, on any day from Augun 2a, 2023 (Mohday) to Septemb€r 2, 2023 (Saturday), froh
a:00 Alt{ to 5:O0 PM OILY.
No tiling fee sh.ll be imposed.
I
hereby announc€ my €andidacy for the position of MEMBE& SANGGUNIANG AARANGAY ol aARANGAT city/Municipality of
Prcvince oa in the october 30, 2023 Barangay and Sangguniang Kabatar, (sx) Elections; and after
having been sworn to in accordan(e with law, I hereby state the followingi
1, NAME:
1.1 Last Name
1.2 Farst Name

I llmr lt I trTltl
lll
14. SEX:
!,,"
15. AGE ON ELECTION DAYI
Must b€ at least eighteen

(18) years old on election
lIlll||ll
I
day
1.3 Middle Name
I 16, DATE OF BIRTH:
L
I
-T-[[tTTTTTTTT_II
2. NICKNAME OR STAGENAME: (lndicate only one nickname or stage name)
ul DaY
l
3. RESIDENCE/ADDRE$, 17. PLACE OF AIRTH:
r.r rro,,n."
City/14un
MI rl-tftr
3.2 City/MunicjpaliW 3.3 Barangay
Province
T
I
18, CIVIL STATUS:

3.4 House No./ Street / S!bdivision
Single
l'larried
4. AODRESS FOR ELECTION PURPOSES: (could be the same as No.3) ful Name of Spoue, f marled
5, PERIOD OF RESIDENCE IN THE PHILIPPINES UP TO THE DAY BEFORE OCT. 30, 2023:
20. I AM A REGISTEREO VOTER OF:
5.1 In the Philippinesl v"a.s fTl
t,to. of No. of Months
t-E
5.2 ln the above-stated Barangay: no. of veao fI No, of l4onths [E Precinct
Earan9ay
City/Mun.
6. I AI4 A FIUPINO CMZEN, Province
7. I EXECUTED A SWORN RENUNCTATION OF FOREIGN CMZENSHIP. (IF APPLICABLE, ATTACH A COPY)
8. I AI.4 NOT A PERi,IANENT RESIDENT OF, OR AN IMMIGRANT TO, A FOREIGN COUNTRY. 21. OFFICIAL E.MAIL ADDRESS
9. I AI"I EUGIELE FOR THE OFFICE I SEEK TO 8E ETECTED TO. (For notice and election purposes)
10 I WILL FILE, WITH THE OFFICES OF THE COMI'|I5SION, WITHIN THIRTY (30) DAYS AFTER ELECNON DAY, I4Y FULI-
TRUE ANO ITEMIZED STATEMENT OE CONTRIBUTIONS AND EXPENDTTURES (SOCE) IN CONNECNON WITH THE
ELECTION,
22. Have you ever been found liable for an
11. I WILL SUPPORI AND DEFEND THE CONSIITUTION OF THE REPUBUC OF THE PHILIPPINES AND wlLL MAINTAIN offense which carries wrth t the acceslory
TRUE FATTH ANO ALLEGIANCE THERETO. I WIII OBEY THE LAWS, LEGAL ORDERS, AND DECREES PROI|UTGATED BY
THE DULY CONSTTTUTED AUTHORIIIES. I
IMPOSE THIS OETIGATION UPON T4YSELF VOLUNTARILY, WITHOUT
penalty of p€rpetual disqualification to
hold public office, which has become final
MENTAL RESERVATION OR PURPOSE OF EVASION.
and etecutory?
12. I SHALL NOT ADVOCJTE VIOLENCE OR UNLAWFUL MEANS TO ACHIEVE MY GOALS.
I GIVE CONSENT TO IIIE COMMISSION ON ELECNONS TO COLtfCt, DISCLOSE OR SHARE, AND PROCESS THE
13.
PERSONAL DATA I PROVIDED HEREIN FOR EECNON AND OTHER LAWFUL PURPOSES IN ACCORDANCE WTTH THE
PRIVACY NOTICE AT THE BAC( OFTHIS FORII, AND A5 MAY BE AUTHORIZED 8Y E(IfiNG TAWS.
tr (Please provide details at the back)
tr No
I hereby certlfy that the facts stated herein are Eue and correct to the best of my knowledge
Signature of Candidate over Printed Name
OATH
SUaSCRIBED AND SWORN to before me this day ol at affiant exhibiting to me an

Identification documenvcard which contains a photograph and signature bearing No' issued by
-
Doc. No. :
Page No. (Amx P3o.oo d@nstary nanP)
(Omcer Authorized to Administer Oath)
Book No. _; -,2023,
series of 2023.
THIS FORM CAN AE PI|oTOCOPIEO OR REPRODUCEO AND IS AVAII.ABTE AT THE COi'IETEC OFFICE5 FREE O' CHARGE
-;
OR MAY aE oomlLOAO€D fRofi THE COlttElEc oFFIcIAf WEaSITE lM..omdeod.nhr
Case Docket
D o Case Title Date
D Filedo Status

(in case of death of candidate)
The collected personal data will be encoded in the information system developed by the Commassion on Elections (COl4EtfC). The p€rsonal
data inputted in the information system will be used by the COIVIELEC in the preparation, posting and/or publication of the list ot candidates
and other election-related documenE or fo.ms.
For legitimate research needs and inquiries, and only for the purposes specjfr€d in the requesl the COI4ELEC may disclose and share your COC
andlor its contents. IYoreover, the COI'IELEC may use and disdose your COC and/o. its contents an any proceeding or investjgation in which
your COC and/or its clntents is/are in issue or may 6nd r€levanc€.
Only authorized personnel are allowed to access and process your personal data, Immediately after the election period or upon the expiration
ofthe storage period set i. existing COMELEC rules and policies, and laws and regulations/ whichever applies, the physicaland digitalcopies of
your personal data will be anonymized, deleted, and discarded following the dispositjon procedures ol the COIIELEC and the National Archives
of the Pbilppines.
You have the nght to ask for a copy of you. COC or any p€rsonal data it conrains. Also, you may withdraw your candidacy in accordance witlr
the COi4ELEC rules and policies on the matter.
Ifyou have questions regarding this Privacy Notice, please send an emajlto dpo@conelec.9ov.ph,
Annex "K-2"
CERTIFICATE OF CANDIDACY FOR Amx Latest
CHAIRPERSON t Photo Here
Passport Size
SANGGUNIANG KABATAAN
INSTRUCTIONS: (Please read well before frllinq,out the COC fo.m.)
Fill-out the items completely. Write N/A if Bn item is not ipplicable.
Print the COC Folm on SOTH SIoES (fiont and back) of a FOUO (8.5" x t3') or LEGAL (8.5' or L4') size copy paper.
Titles such as Dr., Atty., Don, Ginoo, Sefror, Datu, Sultan, gai, Sefiora, Kepitan or other similar tides are expressly prohibited.
This ce(ificate shall be sworn b€fore a notary public or any ofliclal .uthorized to admlnlster oath. The Eleation Officer may admihister th€ oath on the
COCS filed within their are. ofjurisdiction, free of charqe.
File this in IHREE (3) LEGISLE copi€s with the COMEL€C Office €oncerned, on any day ftom august 28, 2023 (Monday) to september 2, 2023 (Saturday), ,rom
a:OO AM to 5:OO PM O LY.
t. No filin
I hercby announce my Gndidacy for the
position of GHAIRPERSoT SaNG6UNIANG KABATAAN of BARANGAY
City/l;runicipality ot Province of . in the October 30, 2023 Barangay and Sangguniang Kabataan
(SK) Elections; and .fter havihg been sworn to in a.cordance with law, I h€reby state the followlng:
I. .T
l
NAME: 17. sEx: 18. AGE ON ELECTION DAY
T I
1.1 Lnst Name
14ale Years l4onth/s Dav/s
1.2 First Name
t t TT-[ Muc be .t Ean ejghtee. (18)
yeaE dd but .o{ .Me th.n
tw€ntv-foot (241 ve.rs old on
el&tio. d.y, (Bom o &t. 30,
1-3 Middle Name
l TT-IT 1999 lo G. 30, 2005 to pas dE
2. NICKNAME OR STAGENAME: (Indicate only one nickname or stage name) 19. DATE OT BIRTH:
rttttttttl
14onth DaY
3. RESIDENCE/ADDRESS;
3.1 Province 20. PLACE OF BIR,TH:
3. 2 City/I,lunicipality 3.3 Barangay City/lYun.
3.4 House No./ $eet / Subdivision

21. CIVIL STATUS:
1-[n-rT-frT TTITT_I Single
!waow/er
Married
4. ADDRESS FOR ELECTION PURPOSES: (Could be the same as No.3)
ful Nare of Spouse, maried
5. PERIOD OF RESIDENCE IN THE PHILIPPINES UP TO THE DAY BEFORE OCT. 30, 2023:
23. I AM A REGISTERED VOTER OF:
5.1 Philippines:
In the ttto. ofVears
I l No. oftvlonths l l Preclnct
5.2 In the above-stated Barangay: r,lo. otvears [ ] to. ofmong,s I I I Barangay
City/f4un.
6. I AI.4 A FILIPINO CINZEN.
7, IEXECUTED A SWORN RENUNCIATION OF FOREIGN CITIZENSHIP. (IFAPPUC'ALE, ATTACH A COPY)
a. I Al.4 NOT A PERI'IANEIVI RESIDENT OF. OR AN II4MIGRANT TO, a fOREIGN COUNTRY. 24. OFFICIAL E-MAIL ADDRESS
9. I AM A QUALINED VOTER OF THE &qIPUNAN NG KABATAAN OF THE ABOVE.SIATEO EARANGAY. (For notice and election purposes)
10 ] AM NOT RFIATED WTTHIN THE 2IO CIVII DEGREE OF CONSANGUINITY OR AFFINII'Y TO ANY INCI]I4BENT ELECTED
NANONAL OFFICIAL OR TO ANY INCUMBENT ELECIED REGIONAL, PROVINCIAL, CITY, MUNICIPAI, OR BARANGAY OTFICIA! IN
THE LOCALITY WHERE I SEEK TO BE ELECTEO TO.
11, I SAVE NOT BEEN CON\'IfiED SY FINAL ]UOGMENT OF ANY CRIME INVOTVING MO&qL TURPI'TUDE.
t2. I AM EUGIBLE FOR THE OFRCE I SEEK TO 8E ELECTEO TO. 25. Have you ever been found laable for an
13. I WITL FILE, w1TH THE OFFICES OT THE COMMISSION, VYIIHIN IHIRTY (30) OAYS AFTER ELECTION DAY, MY FULI- TRUE AND offense which carries with it [he
ITEMIZED STATEMENI OF CONTRIBUIIONS AND EXPENDITURES (sOCE) IN CONNECTION WIIH THE ELECTION. accessory penalty of perpetual
I wlLL SUPPORT AND DEFENO THE CONSTITUIION Of THE REPUBLTC OF THE PHIUPPINES AND WlLt I'4AINTAIN TRUE FArTH
I
AND ALLEGIANCE THERETO. WILL OBEY TH€ LAWS, TEGAL ORDERS, AND DECREE PROI.4ULGATED BY THE OULY
disqualiflcation to hold public office,
CONSTITIITEO aUIHORnES. I IMPOSE THIS OBLIGcTION UPON I|YSELF VOLUNTARILY, WITHOUT |'4EI$IAL RESERVaTION OR which has become final and executory?
PURPOSE OF EVAsION.
15
16
I SHALL NOT ADVOCATE VIOLENCE OR UNLAWFUL MEANS
I
TO ACHIEVE I.4Y GOATs,
GryE CONSENT TO THE COII|MIssION ON ELECTIONS TO COLLECT, DISCLOSE OR SHARE, AND PROCESS THE PERSONA!
DATA I PROVIDED HEREIN FOR ETECTION AND OTHER LAWFUL PURPOSES IN ACCORDANCE WrIH THE PRIVACY NOTICE AT
tr Yes (Please provide details at the
back)
THE AAC( OF THIS FORI.4, AND A5 I.4AY BE AUTHORIZED BY EXISTING LAWs. No
I hereby certify that the facts stated herein are kue and correct to the best of my knowledge
slgnatlre olC..didat€ ov.r Priht.d N.me

OATH
SUBSCRIBED AND SWORN to before me dav of this 2023, at affiant exhibiting to me an
Identification documenvcard which contains a photograph and signature bearing No. issued bY on
Doc. No. _;
Paqe No. _; (Affx P30.0o d@lmot!ry st hp)
Eook No, _; (Officer Authorized to Administer Oath)
Series of 2023.
THIS FOR}4 CAN 8E P}IOTOCOPIED OR REPROOUCED AND IS AVAITABLf AT TIiE COIIEIIC OfNCES fREE Of CHARGE
oR MAY BE DowNtoADEo FRoL TlE COMELEC oFflcIAL WEBSITE (!444,!9d.!o4!h)
--
Case Docket
D 0 Case Title Date
D Filed0 Status

(in case ofdeath ofcandidaE)
The collect€d peGonal data will be encoded in the information slstem developed by the Commission on Electiorl! (COMELEC). The personal
data inpufted in the information s'ystem will be used by the COI4ELEC in the preparauon, postjng and/or publication of the list of candidates
and other election{elated documents or forms.
For legitimate research needs and inquines, and only for the purpos€s specifled in the reques! the COMELEC may disdos€ aod share your cOC
and/or its contents. Ivoreover, the COMELEC may use and disclose you. COC and/or its contents in any proceedang or investigation in which
your COC and/or its contents islare in issue or may find .€levance.
only authorized p€rsonnel are allowed to access and process your peEonal data. Immediately after rhe election period or upon the expiration
of the storage period sel in existing COI\4ELEC rules and policies, and latrs and regulations, whichever applies, th€ physical and digital copies of
your pe.sonal data will be anonymized, dehted, and discarded following the disposition procedures of the COMELEC and the National Archives
of the Philippines.
You have the right to ask for a copy of yow COC or any p€rsonal data it contains. Also, you may withdraw your candidacy in accordance with
the COl4EtfC rules and policles on $e matter.
lf you have questions regarding thas Privacy Notice, please s€nd an email to dpo@conelec,gouph.
t
Annex'K-3"
CERTIFICATE OF CANDIDACY FOR Afflx Latest
MEMBER, SANGGUNIANG Photo Here
Passport Size
KABATAAN
ITISTRUCTIONS: (Phase re.d wellbefore filling-out the COC fo.m.)
l. Fill'out the items completely. Write N/A if Bn item is not applicabb,
Z. Print the COC Fom on BOTH SIDES (front and back) of a FOUO (8.5" x r3') or LEGAL (8.5'or r.4') saze copy paper.
l. Tldes such .s Or., Atty., Don, Ginoo, Sefior, Datu, Sultan, B.i, S.lora, X.pitan or other similar ddes are exprercly prohlbited.
1. This ce.tifi.ate shall be swom b.fore a notary public or any ofilclal .utho.ized to admihister o.th. Tte Electioh Orlicer may .dmihister the oath on the
COC5 filed within their area ofiurisdiction, free ot charge.
t. Flle lhis in TttREE (3) LEGIBLE copies with the COi4ELEC Ofllce concerned, on any day ftom Augun 28, 2023 (Monday) to September 2, 2023 (Satu.day), from
S|OO AM to 5:OO PH OtlLY.
t. No filing fe€ shall be imposed.
I
hereby announce my candidacy for the posilion ot MEUBE& SAIIGGUNIANG KABAIAAN of BARANGAY City/Municipality of
Province of in the Oatober 30, 2023 Bahngay and Sangguniang Kabataan (S() Eledions; and
after having been swoh to in accordaoce with law, I hereby state the following:
1. NAME: 17. SEX: 18, AGE ON ELECTION DAY:

I I
T
1.1 Last Name
_I
_T --T-l Years Monh/s
l-2 First Name
TT tt
I
I Day/s
Must be at lead eightEn (13) ycars
.ld but not lwe th.n tw.ntyjour
1.3 Middle Name

LI
2. NICKNAME OR STAGENAME:- (lndicate only one nicknam€ or stage
It|||lllIl name)
(24) vears oh on electi@ day. (Born
on od, 30, 1999 ro ocr. 30, 2005 to
p!$ the age requnement)
19. DATE OF BIRTHi
ru I
l4onth Day
3. RESIDENCE/ADDRESS:
3.1 Province ttttt 20. PLACE OF AIRTI|:
t[uI
3.2 City/f4un cipaliW
n-n [I
3.3 Barangay
III
City/l'lun.
Province
lIt
3.4 House No./ Street / Subdivision
21, CIVIL STATUS:
I
rl-t]-t Single !waow/er

l,larried
4, ADDRESS FOR ELECTION PURPOSES: (could be the same as No.3)
Full Na@ ot Spoue, il maried
22, PROFESSION OR OCCUPATION:
5. PERIOO OF RESIDENCE IN THE PHILIPPINES UP TO THE DAY BEFORE OCT. 30, 2023:
23. I AM A REGISTERED VOTER OF:
5.1 In the Philippines: tto. of vea.s fI No. of Months
[r]
I
Precinct
5.2 In the above-stated BararEay m.orv"urs[f No, of l'"lonths Barangay
City/Mun.
I AM A FIIJPINO CITIZEN,
Province
6.
7. I EX€CUTED A SWORN RENUNCIAT1ON OF fOREIGN CTTIZENSHIP. (IF APPLICqBE, ATTACH A COPY)
a. I AI.4 NOTA PERMANENT RESIDENT Of, OR AN II'4I'IIGRANT TO, A FORE]GN COUNTRY.
9. I AM A QUAUFIED VOTER OF THE KATIPUNAN NG KA&ATAAN OF TH€ ABOVE-STATEO BARANGAY.
24. OFFICIAL E-MAIL ADDRESS:
t0 I AM NOT RELATED WITHIN THE 2*O CVIL OEGREE OF CONSANGUINIT'Y OR AfFINITY TO ANY INCUMBENT ELECTEO (For notice and election purposes)
NAIIONAL OFFICIAL OR TO ANY INCI'M8ENT ELECIEO REGIONAI, PROVINCIAL, CITY, MUNICIPAT, OR BARANGAY OFFICIAL IN
IHE LOCALIW WHERE I SEEK TO 8E ELECTED TO.
11_ I HAVE NOi AEEN CONV'CTED BY FINAT OF Airy CRIME IIWOIVING IVIORAI TURPITUDE.
11. 'UDGMENT
I AIq EUGIBLE FOR THE OFFICE I SEE( TO 8E ELECTED TO.
25. Have you ever been found liable for an
I WIL]- FILE, WITH THE OFACES OF THE COMMISSION, WTTHIN THIRTY (30) DAYS AfTER ELECIION OAY, I"IY FULI- IRUE ANO
offense which canies with it the
13.
ITEMIZED sIAtEIqEtlT OF COI'IRIBUnONS ANO E(PENOTTURES (socE) IN CONNECTION wml THE ELECTION.
14 I WILL SUPPORT ANO DEFEND THE CONSTTN,TION OT THE REPIJEUC Of THE PHIIJPPIII€S AND WILL MA]NIA,IN TRUE FATIH accessory Penalty of perpetual
ANO ALIEGIANCE THTRETO. 1 WILI OBEY THE LAWs, LEGAT ORDERS, AND DECREES PROMUTGATED BY THE DULY disqualificatton to hold public omce,
CONSTrIUTED AUTHORITIES. I IMPOSE IHIS OALIGATION UPON MYSEtr VOLUNTARILY, WTTHOW TEMTAL REsERVATION OR which has become final and executory?
PIIRPOSE OF EVASION.
15 I SHALL NOT ADVOCATE VIOLENCE OR UNLAWFUL MEANS TO ACHIEV€ I'1Y GOATs. Yes (Please provide details at the
16 I GIVE CONSENT TO THE COIIIIISSION ON ELECTIONS TO COLLEgT, DISCTOSE OR SHARE, ANO PROCESS THE PERSONIJ. back)
DATA I PROVIDED HEREIN FOR ETECIION ANO OTHER LAWFUL PI]RPOSEs IN ACCORDANCE WITH THE PRIVACY NOTICE AT
TI]E BACK OF THIS FORM, AND AS MAY BE AUTHORIZEO 8Y EXISIING LAWS.
I hereby certify that the facts stated herein are true and correct to the best of my knowledqe
Sig..tu.e of Ca.didate over Pnrt.d ame
OATH
SUBSCRIBED AND SWORN to before me this day of 2023, at affiant exhibiting to me an
issued by on
Identiflcation documenvcard which contains a photograph and signature bearing No.
-
Doc. No.
Paoe No. ; (Nnr P3o.oo d€urun6ryn'mP)
Book No, _; - -,
Series of 2023. -;
T}IIS FORM C{N OE PHOTOCOPIED OR RE'ROCUCEO AND TS AVAILABI"E AT THE COI1ELEC OFFICES FREE Of CHARGE
Ot MAY 8E DOW'i{tOAD€D FROH THE COI{ELEC OFFICIAL WEBSm (ww-dnele<.od,-oh)
Case Docket
D o Gase Title Date
D Filedo Status

(in case of death of candidaA
The collected p€rsonal data will be encoded in trle information system developed by the Commission on Elections (COIeIELEC). The personal
data inputt€d in the inrormation system will be used by the COMELEC in fle preparation, posting and/or prrblication of th€ list of candidates
and other eledion{elated documents or forms.
For legrtimate research ne€ds and inquiri€s, and only for the purposes specilled in ahe r€quesL the COIYELEC may disdose and share your CoC
and/or its contents. tYoreover, the COI'IELEC may use and disclose your COC and/or its contents in any proceeding ol anvestigation in which
your COC aM/or its contents is/ar€ in issue or may find releva.ce.
Only authorized personnel are allowed to arcess and process your personal data. Immedaately after the election period or upon the expration
ofthe storage p€riod set in existing COI,IELEC rules and policies, and laws and regulations, whichever applies, the physicalaod digital copies of
yoor personal data wall be anonymized, deleted, and discarded following the disposition procedures of the COMELEC and the Nalional Archives
of the Philippines.
You have s]e nqht to ask for a copy of your COC o. any personal data it contains. Also, you may wathdraw yorrr candidacy in a.cordanc€ with
the coMELEc rules and policies on the matt€r.
If you have quedions regarding lhis Privacy Noticg pleas€ send an e.nail to dpo@cone/&-goyph.
Annex "L"
AUTHORITY TO FILE CERTIFICATE OF CANDIDACY
I (name of candidate), ot legal

age, Filipino, and a resident of
hereby
authorize aiso of legal age,
Filipino, and a resident of to
file my Certificate of Candidacy for the position of of Barangay
CitylMunicipality of Province of
in the Barangay and Sangguniang Kabataan Elections.
IN WTTNESS WHEREOF, I hereunto affix my signature this day of

in Philippines. -
- (Date)
(Date)
SUBSCRIBED of
AND SWORN to before me this at
which
-daydocument/card by
affiant exhibiting to me an Identification
contains a PhotograPh and signature bearing No. issued
on

Doc.No. :
PageNo. ;
Book No.
Series
;
-.
-.
iniormation, Privileged info-ffutionand sensitive

NOTICE/DITLA.IMER: All authorized recipients of any peEonal data, Personal
inaidhg otha pertinort documants attacied thereto that are shared by the
personal'inloruration contained in *ti" a-oatl-"nl
conJormity with the Data Privacy Act of 20t 2 (R A No'
Commission on Elections in compliance n,itfr existing Ia*s ai'a r,les, and in
* *"u pertinent Circrnars of the National Privacy commission, are
ifl73);; t; i-plem"ntt,g n il"" ur,a R";;utioni, the.
"" reliting to data privacy, security, corilidentiaLity, Protection and
,i-Ufy t r-a ,6 iitf, *ia fu*., irf""-""J regulations,
accountabil ty.
""-pfy
Annex "M"
,}: Republic of the Philippines

&
h.
LIST OF ASPIRANTS IN THE QUEUINGA^/AITING AREA

WITH COMPLETELY FILLED OUT CERTIFICATE OF CANDIDACY
AT 4:45 PM ON
(Date)
NO. NAMEOFTHE POSITION TIMEOF NAME SIGNATURE OF COMELEC

ASPIRANT ASPIRED FOR LISTING PERS PERSONNEL IN-CHARGE
(Name and Signature of the Election Officer)
(Date)
NOTICWSCLAIMER: All authorized recipients of any personal data, personal information, privileged ifformation 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 of 2012 (R.A. No. 10173) 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.
Annex "M-1"

LIST OF ASPIRANTS INSIDE AND WITHIN 30 METERS

FROM THE QUEUING/WAITING AREA
WITH COMPLETELY FILLED OUT CERTIFICATE OF CANDIDACY
AT 5:CI PM ON
(Date)
NO. NAMEOFTHE POSITION TIME OF LISTING COMELEC SIGNATURE OF COMELEC

ASPIRANT ASPIREDIFOR -CHARGE PERSONNEL IN-CHARGE
(Date)
NO'flCF/DISCLAIMER: All authorized recipients of any personal data, personal information, privileged inlormation and sensitive personal information contained in this
do(ument, including other pertinent documents attached thereto that are shared by the Commission on Elections in compliance with existing laws and rules, and in conformity
similarly bound to comply with said laws, rules and regulations, relating to data privacy, security, confidentiality, protection and accountability.
REPORT ON NON-RECEIPT OF COC

Barangay and Sangguniang Kabataan Elections
NAME OTII{E POSITION ASPIRED FOR DATE PRESENTED FOR TIME PRESENTED FOR REASONFORNON.
ASPIRANT FILING FILING RECEIPT
(Date)
NOTICWSCLNMER: All authorized recipients of any personal data, personal informatiorL privileged information and sensitive personal information contained in this
document, including other pertinent documenb attached thereto that are shared by the Commission on Elections in compliance with existing laws and rules, and in conformity
sirnilarly bound to comply with said laws, rules and regulations, relating to data privacy, security, confidentiality, protection and accountability.
Annex "O"

LOG SHEET, BSKE
POSITION: PUNONG BARANGAY

BARANGAY:
PogrrloNr.,rl .NAME AND SIGNATURE OT
NAME OF TIIE NUMBEROF DATE FILED and. .,SIGNATURI OF THE ASPIRANT
ASPTRANT ASPIRED FOR. COCS FILED acrueitrMr:oF . oi NAME AND SIGNATURE OF THE RECEIVING OFFICER
......
AND RECEIVED RECEIPT] .:'. ., THE AUTHORIZED

REPRESENTATIVE OF TTIE
ASPIRANTIFNOT
PERSONALLY RLED
I
Annex "O-1"

LOG SHEET, BSKE
POSITION: MEMBER, SANGGUNIANG BARANGAY

BARANGAY:
NO. POSITION NUMBEROF DATE FILED and SIGNATURE OF THE ASPIRANT NAME AND SIGNATURE OF
ASPIRANT ASPIRED FOR COCS IILED ACTUALTIMEOT or NAME AND SIGNATLIRE OF THE RECEIVING OFFICER
ANDRECEIVED . RECEIPT THE AUTHORIZED
REPNESENTATWE OF TIIE.
ASPIRANT IF NOT
PERSONALLY FILED
I
Alnex "O-2"

LOG SHEET, BSKE
POSITION: CHAIRPERSON, SANGGUNIANG KABATAAN

BARANGAY:
NO. NAME OFTHE POSITION NUMBEROF DATE FILED and SIGNATURE OF THE NAME AND SIGNATURE OF
ASPIRANT ASPIRED FOR COCS FILED ACTUALTIMEOF ASPIRANT oT NAME AND THE RECEryING OFFICER
AND RECEIVED RECEIPT SIGNATTJRE OF THE
AUTHORIZED
REPRESENTATIVE OF THE
ASPIRANT IF NOT
PERSONALLY FILED
Annex "O-3"

LOG SHEET, BSKE
POSITION: MEMBER, SANGGUNIANG KABATAAN

BARANGAY:
NAMEOFTHE. POSTTION NUMBEROF.. DATE FILED aiid
ASPIRAhIT.,,'r ASPIREDIOR COCS TILEP ACTUALTIMEOF
ANDRECEIVED RECEIYT THEAUTHORIZED
REPRESENTATIVE OF TTIE
ASPIRANT IF NOT
PERSONALLY FILED
I
Annex "P"
ffi Republic of the Philippines

EO REPORT TO PES
Daily Report on the Number of Aspirants who Filed their Certificate of Candidacy per Elective Position
by Sex for the Barangay and Sangguniang Kabataan Elections
Dav No.
Province / City/Municipality/ Barangay Punong Bamngay Member, Sangguniang Barangay Chairperson, Sangguniang Kabalaan Member, Sangguniang Kabataan
TOTAI, MALE FEMALE TOTAL MALE FEMALE TOTAL MALE FEMALE TOTAL MALE !.EMALE
< Provioce Name>
[--T---
ffi
< CityMunicipslity Neme>
<Barangay Naine>
F
I tt tl I
<Barangay Name>
<Barangay Name>
<Bamngay Narne>
<Barangay Name>
<Barangay Name>
[--l =
I
Annex "P-1"
ffi Republic of the Philippines

PES REPORT TO REDO
Consolidated Daily Report on the Number of Aspirants who Filed their Certificate of Candidacy per Elective Position
by Sex for the Barangay and Sangguniang Kabataan Elections
Day No._
Province / City / Municipality Punong Barangay Member, Sangguniang Barangay Chairperson, Sangguniang Kabataan Member, Sangguniang Kabataan
TOl AL MALE FEMALE TOTAL MALE T'EMALE TOTAL MALE FEMALE TOTAL MAI-E FEMALE
< Province Nrme>

I
<City,Municipality Name>
<CityMunicipality Name>
<City/Municipality Name>
F
=
<City/Municipality Na$e>
<City/Ivlunicipality Name>
LL m t- I
I
Annex "P-2"
,ffi Republic of the Philippines

REDO REPORT TO ERSD
Consolidated Daily Report on the Number ofAspirants who Filed their Certificate ofCandidacy per Elective Position
bv Sex for the Barangay and Sangguniang Kabataan Elections
Day No.
Region / Province / City / Municipality Punong Barangay Member, Sangguniang Barangay Chairperson, Sangguniang Kabataan Member, Sangguniang Kabataan
TOTAL MALE FEMALE TOTAL MAI,E FEMAI,F, TOTAL MALE FEMALE TOTA I, MALE FEMALE
< Region Name>
< Province Name>
t--
<CitylMunicipality Name>
I
=
I
<City/Municipality Narne>
< Province Name>
[--T--- L
<C ity/\4un ic ipality Name>
I tl I I
Annex 'Q"
STATEMENT OF WITHDRAWAL
Q'Jame of candidate), ol legal age,

Filipino, and a resident of after having been
duly sworn to in accordance with law, state as follows:
1. On I filed my Certificate of Candidacy for the

position of before the Office of the Election Officer.
2. I am hereby withdrawing my candidacy for the position of
IN WITNESS WHEREOR I hereunto affix my signature tfus _ day of

ln Philippines.
(Date)

affiant exhibiting to me an Identi-fication document/card which
contains a photogaph and signature bearing No. issued bv
on
No.
Doc. ;
No.
Page ;
BookNo. ;
Series
NOTICE/DISCLAIMER: All authorized recipients of arry 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 existhg laws and rules, and in conformity with
the Data Privacy Act of 2012 (R.A. No. 10173) 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 arld accountability.
Annex 'R'
AUTHORITY T O FIL E STATEMENT OFWITHD RAWAL OF
CERTIFI CATE OFCAN DIDACY
I (name of candidate), of legal age,
Filipino, and a resident
of
hereby authorize
also of legal
age, Filipino and a resident of
to file my Swom
Statement of Withdrawl of Certitificate of Candidacy for the position
of
in the Barangay and
Sangguniang Kabataan Elections, for the reason that I -
_ tested positive for COVID1g;

was identified as a close contact with a person who was tested positive
- for COVID19 and on quarantine or isolation.
no other reason shall be allowed by the Commission.
-
IN WITNESS WHEREOF, I hereunto affix my signature this _ day of
.in Philippines.
(Active Cellphone Number and Email Address)
(Date)
(Date)

affiant exhibiting to me an Identification document/card which
contains a photograph and signature bearing No. issued bv
on -

Doc. No. :
Page No. :
Book No. :
Series
NOTICE/DISCLAIMEFIj All authorized recipients of any personal data, personal informatioru privileged infotuEtion and seraitive
perconal inJormation contained in this document, induding ottrer pertinettt doctments attached thereto that are shared by the
tommission on Elections in compliaace with existing laws and rules, and in conlormity wit} the Data Privacy Act of 2012 (R.A. No.
10173) and its Implementing Rules and Regulations, as well as the pertinent Ciculars of the National Privacy CoEmissim! are
similarly bound to comply with said laws, n es and rcgulations, relating to data privacy, secuiity, confidentiality, protection and
accountability.
Annex "T"
Instructions:
1 . Please fill in the following details and submit the same to the Law Department or Office of the Regional Election Director concemed
2. Additional Sheets may be used.
APPLICATION FOR REQUEST FOR AUTHORITY TO APPOINT OR HIRE

NEW EMPLOYEES
(For the Barangay and Sangguniang Kabataan Elections)
Name of Personnel
Position and Date of Cause of Vacancy, if Name of Requesting Authority,
Grade Appointment a licable Position and Name of Agency
I
CERTIFICATION
L of hereby CERTIFY as follows:
1) that the request is essential to the proper functioning of the office and shall not in any manner influence the conduct of the
Barangay and Sangguniang Kabataan Elections;
2) that the request shail not involve promotion or the giving of salary increases, remuneration or privileges during the prohibitive period before the
Barangay and Sangguniang Kabataan Electrons which is strictly prohibited without any exception whatsoever; and
3) that this authorization shall be prospective in application and without prejudice to the applicable Civil Service Law, rules and regulations on
personnel actions/ movements.-,
Prepared and Submitted by:
Position & Name of Agency

Date:
i1 1r)1 / 1r}'>'1,
Annex "U"
Instruc tions:
I . Please fill in the following detafu and submit the same to the Law Department or Office of the Regional Election Director concemed
APPLICATION FOR REQUEST FOR AUTHORITY TO CREATE OR

FILL NEW POSITIONS
Name of Personnel
Position and Date of Cause of Vacancy, if Name of Requesting Authority,
Salary Grade Appointment applicable Position and Name of g,e[c'
CERTIFICATION
1) that the request is essential to the proper functioning of the office and shall not in any manner inlluence the conduct of the
Barangay and Sangguniang Kabataan Elections;
2) that the request shall not involve promotion or the giving of salary increases, remuneration or privileges during the prohibitive period before the
Barangay and Sangguniang Kabataan Electtons which is sbictly prohibited without any exception whatsoever; and -
3) that this authorization shall be prospective in application and without preiudice to the applicable Civil Service Law, rules and regulations on
personnel actiors/ movements.-,

Date:
02/01/2023
Annex "V"
Instructions:
I . Please fill in the following details and submit the same to the law Department or Office of the Regional Election Director concemed
APPLICATION FOR REQUEST FOR AUTHORITY TO TRANSFER OR DETAIL

CIVI SERVICE OFFICERS OR EMPLOYEES
Name of Requesting
Transferred Date of Effectivity of
Name of Personnel Present Station fustification of Transfer Authority, Position and
Station Transfer
Name of n
CERTIFICATION
1) that the request is essential to the proper functioning of the office and shall not in any manner in-fluence the conduct of the _ Barangay
and. S an g guni an g Kab ataanElections;
2) that the request shall not involve promotion or the giving of salary increases, remuneration or privileges during the prohibitive period before the
Barangay a;rrd Sangganiang Kabataan Eleclions which is strictly prohibited without any exception whatsoever; and
3) that this authorization shall be prospective in application and without prejudice to the applicable Civil Service Law, rules and regulations on
personnel actions/ movements.-,
Prepared and Submitted by

Date:
02/01 / 202i
Annex "W"
Instructions:
1. Please fill in the following details and submit the same to the Law Department.
2. Attach herein the following:
I ) Certilied True Copy of the Formal Complaint executed under oath.
2) Certilied True Copy of the Decision or Resolution suspending the concerned elective local official
APPLICATION FOR REQUEST FOR AUTHORITY TO

SUSPEND ELECTIVE LOCAL OFFICIALS
Name of Personnel Position Nafure of Suspension Duration of

Name of Requesting Authority,
(Preventive or as a Suspension
Position and Name of Agency
Penalty)
CERTIFICATION
t, of , hereby CERTIFY as follows:
1) that the request shall not in any manner influence the conduct of the Barangay and Sangguniang Kabataan Electtons;
2) the case does not involve a violation of the Anti-Graft and Corntpt Practices Act
Prepared and Submitted by

Date:
0z/01/2023
Annex "X"
Instructions:
1. Pleasefill in the following details and submit the same to the Law Department.
2. Do not attach the individual request submitted by the Requesting Agency.
REGIONAL REPORT ON ACTIONS TAKEN ON THE

REQUESTS FOR AUTHORITY TO APPOINT NEW EMPLOYEES
AS RECEIVED BYTHE OFFICE OFTHE REGIONAL ELECTION DIRECTOR
Name of Personnel Position and Date of Name of Requesting Date of Action Taken Date of
Salary Appointment Authority, Position and Application for (Approved or Approval or
I Name of Agency Request for Disapproved) Disapproval of
Authority Request for
Authority
I
Regional Election Director, Region _

Date:
02/01 / 2023
Annex "X-1"
Instructions:
1. Please fili in the following details and submit the same to the Law Department
2. Do not attach the individual request submitted by the Requesting Agency.

REQUESTS FOR AUTHORITY TO TRANSFER OR DETAIL
CIVIL SERVICE OFFICER OR EMPLOYEE AS RECEIVED
BY THE OFFICE OF THE REGIONAL ELECTION DIRECTOR
Name of Personnel Present Station Transferred Name of Requesting Date of Action Taken Date of
I Station Authority, Position and Application for I
(Approved or Approval or I
I
Name of Agency Request for Disapproved) Disapproval of
Authority Request for
Authority

Date:
02/ 0-t / 2023

Annex "X-2"
Instructions
1. Pleasefill in the following details and submit the same to the Law Departrnent.
2. Do not attach the individual request submitted by the Regional Office of the Bureau of Local Govemment Finance (BLGF).
REGIONAL REPORT ON ACTIONS TAKEN ON ALL APPLICATIONS FOR

APPROVAL OF LEAVE OF ABSENCE OF LOCAL TREASURERS AS RECEIVED
BY THE OFFICE OF THE REGIONAL ELECTION DIRECTOR
(For the Barangay and. Sangguniang Kabataan Elections)
Requesting BLGF Name of Provincial, City Provincial, City or Reason for the Period of the Date of Approval or
or Municipal Treasurer Municipal Office Leave of Absence Requested Leave of Disapproval of the
Absence Request for Leave of
Absence

Date:
o? /fi /7021
Annex "Y"
Instructions:
.
I Please filt in the following details and submit the same to the Law Department or Office of the Regional Election Director concerned
APPLICATION FOR REQUEST FOR AUTHORITY TO TRANSFER OR DETAIL

OFFICERS OR EMPLOYEES OFTHE PHILIPPINE NATIONAL POLICE
(For the _ Barangay and Sangguniang Kabataan Elections)
Name of Requesting
Transferred Date of Effectivity of
Name of Personnel Present Station ]ustification of Transfer Authority, Position and
Station Transfer
Name of Agency
CERTIFICATION
l, of hereby CERTIFY as follows:
I ) that the request is essential to the proper functioning of the office and shall not in any manner in-fluence the conduct of the
Barangay arrd Sangguniang Kabataan Elections;
2) that the request shall not involve promotion or the giving of salary increases, remuneration or privilege during the prohibitive period immediately
preceding the December 5, 2022 Barangay and Sangguniang Kabataan Elections which is strictly prohibited without any exception whatsoever; and
3) that this authorization shall be prospective in application and without preiudice to the applicable Civil Service Law, ruies and regulations on
- Personnel actions/ movements.
-,

Date:
Annex "Y"
Instructions:
'1. Please fill in the following details and submit the same to the Law DePartment,
2 There is no need to attach herein the individual reports submitted by the Philippine National Police
3 Additional Sheets may be used.

REQUESTS FOR AUTHORITY TO TRANSFER OR DETAIL OFFICERS OR EMPLOYEES
OF THE PHILIPPINE NATIONAL POLICE
(For the December 5, 2022 Barangay ar.d Sangguniang Kabataan Elections)
Name of Present Station Transferred Name of Date of Action Taken Date of

Personnel Station Requesting Application (Approved or Approva/Disapproval
Authority, for Request Disapproved) of Request for
Position and for Authority Authority
Name of Agency
I
Position &Name of Agency

Date:
n) /n1 / )n)2
Annex "AA"
C.E. Form No. A30
Republrc ot rhe rnllippines

BARANGAY AND SANGGUNIANG KABATAAN ELECTIONS.
(M un ic ipality, Province) (Date & Time)
TEMPORARY APPOINTMENT OF CHAIRPERSON/POLL CLERX/THIRI)

MEMBER/SUPPORT STAFF OF THE COMMITTEE
lnslruclions: Prepare in three (3) copiesr Firs! copy to be retain€d by the Election Ofiic€r (EO) for his/her fil€; second copy to be
relained by the EO to be attached to the payroll for psyment of honorarium of Plcbiscite Committee snd third copy issued to thg
chairperson, members, support staff of the Committee
Name
Address
(House No., Street, Barangay, Municipality and Province)
Sir/Madam:
You are hereby TEMPORARI LY APPOINTED as
(Chairperson/Poll Clerk/Third Member/Support Staff)

of the Committee in Precinct No/s. with
pollingplace located at in Barangay
Municipality of Province of
You may immediately assume office upon taking your oath as required by law. However, this
appointment will be automatically cancelled and considered null and void as soon as the duly appointed
Chairperson/Poll Clerk/Third Member/Support Staff of the Plebiscite Committee for this/these precinct/s
shall appear/report for duty or the vacancy is filled, or you are related to any member of the Plebiscite
Committee of said precinct/s within the fourth civil degree of consanguinity or affinity. ln the latter cases,
you shall not assume the duties of the office and shall immediately return this appointment to the Election
Officer.
Assumption to office notwithstanding above prohibition is punishable under the law.
(Signature Over Printed name) (Signature Over Printed name)

Position as Committee Position as Committee
C.E. Form No. A3l
(Mun ici pality,Provinc e) (Date & Time)
OATH OF' TEMPORARY PLEBISCITE COMMITTEE

CHAIRPERSON/POLL CLERK/THIRD MEMBEWSUPPORT STAFF
I, solemnly swear that I will faithfully perform the duties of

of the Committee in Precinct No/s Barangay
in the above stated city and province to the best of knowledge and ability, without favoring any person
or group; that I will obey the laws and legal orders promulgated by the duly constituted authorities, and that I
volunwily impose upon myself this obligation without mental reservation or purpose of evasion. SO HELP ME GOD.
(Signatwe Over Printed Name)
SUBSCRIBED AND SWORN to before me this day of 2022, al above

stated place.
- (Signature Over Printed Name)
Administering Officer
_ Chairperson/Co-Member
F Registered Voter ofthe Precinct
Annex "BB"
C.E. Form No. A35

COMMTSSION ON ELECTIONS
BARANGAY AND SANGGUNIANG KABATAAN ELECTIONS.
CERTIFICATE OF CHALLENGE / PROTEST AND

DECISION OF TIIE ELECTORAL BOARI)
INSTRUCTIONS: PREPARE IN FOUR (4) COPIES. Fi.st (ls') copy: to the member of rhe _, Second (2"d)
copy: to the individual against whom the challenge or protest is made, Third (3'd) copy: to the vorer or watcher making
challenge or protest and the Fourth (4rh) copy: to be retained by the _Com.
Precinct No/s. Barangay:
Municipality: Province:
Region:
We hereby certify that on 2020,
(Name of Challenger / Protestant)
(Address)
MADE THE FOLLOWING CHALLENGE / PROTEST:
(State the natue or ground for challenge/ protest and name of individual against whom the
challenge/protest is made.)
The _Com after considering the evidence presented to it, DECIDED as follows:
IN WITNESS WHEREOF, we hereby sign this certificate this day of

2022.
Chairperson
(Signature Over Printed Name
Poll Clerk Third Member

(Signature Over Printed Name) (Signature Over Printed Name)
Annex "CC"
C.E. Form No. A39

(Municipality, Province)
BARANGAY AND SANGGTINIANG KABATAA]\I ELECTIONS.

Insfiuctions: Prepare in two (2) copies. Attach one (l) copy to the Minutes. of Voting and Counting of
Votes and one (l) copy to the challenged voter or afrant.
OATH OF VOTER CHALLENGED F'OR ILLEGAL ACTS

I, _, a resident of and a
registered voter of Precinct No. , Barangay
City/Municipality of _, Province of ,do
solemnly swear (or affirm) that I have neither received nor expected to receive, have not
paid, offered or promised to pay, nor have contributed, offered or promised to contribute
money or anything of value as consideration for my vote or for the vote of another; that I
have not made or received any promise to influence the giving or withholding of any
vote; and that I have neither made any bet nor am I directly or interested in any bet which
depends upon the result of the plebiscite.
IN WITNESS WHEREOF, I have hereunto set my hand this day of

2022 in the City/Municipality _, Province of
Region _, Philippines.
Affrant
(City/Municipality)
)S.S.
(Province)
SUBSCRIBED AND SWORN to before me this day of

2022 in the above stated place.
Chairperson/Member, _ Commitlee
(Signature Otter Printed Name)
Annex "DD"
C.E. Form No. A40

COMNfl SSION ON ELECTIONS
BARANGAY AND SANGGI]NIANG KABATAAN ELECTIONS.
Instructions: Prepare fieo (2) copies. Anach one (1) copy to the Minutes of Voting and Counting of
Votes intended for the ballot box. Give the other copy to the person making the challenge.
OATH TO IDENTIFY A CHALLENGED YOTER

I, a membq of the
Committee of Precinct No/s. Barangay
, City,Municipality of Province of
,do
solemnly swear that the voter registered under the name of
is personally known to me as the same person who now presents himself/herself to vote under
said name.
IN WITNESS WHEREOF, I have hereunto set my hand this day

of 2022 in the C ityl\,Iunicipal ity of _
Province of , Region Philippines.

Position as :
)
(City/\,Iunicipality)
)S.S
(Province)


Position as _:-_-
STEP
polling place:
LAY.OUT PLAN
1. Voter checks the following in tho PCVLS posted outsidethe
ihrl STIP I
Annex "E E"
lf polling place has two
.Precinct No. (2) doors
.Soquence No.
::. :::
oooooo
PCVt
ENTRANCE EXIT EXIT
STEP 2. Voter approach the Thi;d Member wto shall:
1. Ask he voter's name, age, precinct number and sequence number, I stt{' 7
2. Verry the nam6 of the voter in the PCVL-Barangay and/or PCVL- WATCHERS
sKi
2.1 Votels name not found in either PCVLS, he/she shall not vote
I
I
and requested to leave the polling place;
2.2 Votels name is found in tho PCVLs
lf
I 'I
I
2.2.1.1 shined, conclusive presumption that the voter has
akeady voter. Thereafter, requost the voter to leave
o
..l
,I
It ll i, !
i I
polling place. E J
(,
2.2.1.2 lI not stained, establish the identity of lire voter
o
2.2.'1.2.1 lf satislied with voter's identity, direct the voter to the =
t, o-
i, [, I, i
Chairporson .=
I IJJ I
lt
e
I
2.2.1.2.2 ln case of doubt, apply the provision of Sec. 42 F o
(Challenge against illegal voters) F I
tr o
The Electoral Board shall require lhe challonged votor proof
of registration, identity or qualifcation or the voter shall be idontified
(g
E
J
J I "J€t' l, i, t,il
\lll I
under oath by any (a) Eleotoral Board member, or (b) By another .E
j:f-.*{ o I
-l
registered voter of the same barangay. A barangay and/or SK voter
o
J r;,',', (9
z
can only be identified by anolher voter of the same barangay.
i, i,
S{EP 5
I
STEP 3. Voter goes to th6 Chairperson of the Electoral Board who I i

.Y j I
J
shall: o __l
1. Announce the votefs name, precinct number and ballovs serial 6 O

o i, l, t,
number/s while the Poll Clerk records the same in the EDCVL-
o l!\ I
Bamngay and/or EDCVL-SK; I I
o-
1.1 Auhenticato the balloUs by affixing signature at the back the.eof __l
1.2 Affix signature in the EDCVL

1.3 Fold the balloUs in such a manner that its face, except the
11
i, i, i, .h
portion where the SN appears is covered. ln case tho voter is I
entitled to vote in the barangay and SK elections, the ballots
{9c
shall be folded separately;
1.4 Ask the voter to affix his/her signature in the EDCVLs, and
1.5 Give the balloUs to the votor.
'1.5.1 In case voter refuses to accept any of the two (2) ballots, f
I
he Chairperson shall:
Explain that the voler shall hold on to the two ballots and
[] WA REA
acmmplish lhe ballot for the eloction said voter wishes to
{ )
participate
[]
Annex "GG"
C.E. Form No. A40

BARANGAY AND SANGGI]NIANG KABATAAN ELECTIONS.

Inslructions: Prepare in one (1) copy. To be presented and submitted by the DESO to the
Chairperson who shall place the same in an envelope which will be attached to the Minutes of yoting
and Counting of Votes.
IPP VOTER'S IDENTIFICATION
I' DESo of
(Name of Voting Center)
do declare that , is personally known to me as the same
person who now presents himself/trerself to vote under said name in the IPP of
(Name of Voting Center)
IN WITNESS WHEREOF, I have hereunto set my hand this duy

ol 2023 in the City^4unicipality of _
Province of . Region Philippines.

DESO
-,
L a registered voter of Precinct No/s.
Barangay , City/lfunicipality of
Province of and voting in the IPP of
, do solemnly swear that the voter registered under t}re name
Q.Jame of Voting Center)
of is personally kno\ n to me as the same person who now
presents himself,/herself to vote under said name.

ol 2022 ir the City/lvlunicipality of _
Province of , Region _, Philippines.

Registered Voter Voting in IPP
)
(City/Municipality)
) S.S
(Province)


DESO
Annex "HH"
C.E. Form No. A40

COMn/fl SSION ON ELECTIONS
BARANGAY AND SA}IGGI]NIANG KABATAAN ELf, CTIONS.
Instructions: Prepare in one (1) copy. To be presented and submitted by the DESO to the
Chairperson who shall place lhe same in an envelope which will be attached to the Minutes of Voting
and Counting of Votes.
IPP AUTHORIZATION FORM

I, , a registered voter of
Precinct No/s.
Barangay , City/Municipality of
Province of do declare that I
registered a temperatue of 37.5 degrees Celsius or higher, upon temperatue check at the
entrance of the voting center, hence, shall cast my vote in the IPP of
thereby waiving my rights to vote in the assigned
'
(Nrr" v"ttrrg c"rter)
"f
polling place and to sign in the EDCVL.

of 2022 in the City/Tvlunicipality of _
Province of , Region _, Phitippines.

Registered Voter Voting in IPP
)
(City/Municipality)
)S.S
(Province)

2022 i the above stated place.

DESO

Resolution No. 10924 Annex

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Resolution No. 10924 Annex

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REVISED CEF - 1

Ropublic of thc Philippines

Q nerltcnrtoN FoR REGISTRATIoN (Accomptish personat lnrormstion ar rhe back)

Note: (For Appli66nt/s with existing Reglstration Records)

t, Filipino, born on , a duly registered

O meucmoN FoR TRANSFER oF REGtsrRATtoN REcoRD

My New Residence is:

APPLICATION FOR REACTIVATION OF REGISTRATION RECORD

C APPLICATION FOR CHANGE OF NAME DUE TO MARRIAGE OR COURT ORDER/CORRECTION OF ENTRIES

APPLICATION FOR INCLUSION OF RECORDS IN THE BOOK OF VOTERS REINSTATEMENT OF NAME IN

lN WTNESS WHEREOF, I hereunto affix my signature this _ day of _ ,2o_al

Signature above printed name

SUBSCRIBED AND swoRN to before me on the above date

EO/Administering Offi cer

nstructlo ns: ( 1) Acc c it'l p I i sh s a rat e I i n t h ae e cop e5 (2

{Pr€s. rll'op suppkmenr.l Dda F.m/asrtstor r

City/Municipality Bate i.-jtutate l-1r"."t"

CITIZENSHIP By Birth Naturali2ed Reacquked City/ Mun

nN l*T*l--l t*T-i-l i"Tl l

Part 3 ACTION BYTHE ELECTION REGISTRATION BOARD

chairman of the Board

Part 4 VOTER'S IDENTIFICATION NUMBER /Io be filled out by Election Officer)

ti- i:t_t f l--l

O Reactivation O Reinstatement/lnclusion .ppllc.rlon. Your appllcaiion a5 tlbject lor

€Ol lnteru ewer Signature above Prinred Name

PERSONAL INFORMATION PWD

L That I assisted the herein applicant for registration:

SiBnature over printed name of Assistor

asri*o., tefr rhumhm.r,( a<rkto.! Right Thumbma.k

SUaSCRIBED AND SWORN to before me this at

This is to certify that , born on

Hence, pursuant to the Rules and Regulations on the Resumption of

This certification is issued for whatever legal purpose it may serve

Hence, pursuant to the Rules and Regulations on the Resumption of

This certification is lssued for whatever legal purpose it may serve.

of legal age, Filipino, and a resident of

't. That I personally know applicant

a. A registered voter of Preclnct No. of Barangay

_b. A relative of the applicant within the fourth civil degree of

_i. Parent _ix. Great grandchildren

ln WTNESS WHEREOF, I have hereunto affixed my signature this

(Signature above printed name)

NOTE: lndicate the type of ldentification Card presented by the affiant'

To the same municipality/city/district

PART I. PERSONAL INFORMATION

III IITI IIIIIII IIIII ! rttiterare D Perlon wirh

(Pleasefllup Suppleme^tar Data

tuk 4 Notutotbs.b./s@Lb c.nttic.re No-/o.dlt .t

POST/COUNTRY PREVIOUSLY REGIsTEREO: PASSPORT/tD TNFORMATTON

COUNTRY: ISSUED ON:

COMPLETE MAILING ADDRESS:

I r*rr ti.t tA..b@e s.rt6.nB... tru...d

rrrlIIlII II to actnowl€dge recelPt ot Your

IT .pplication is subject to the

APPLICATION FOR TRANSF'ER OF REGISTRATION RECORD FROM POST TO PHILIPPIITE

(_, From Post to the same municipality/cityldistrict

From Post to Philippine Municipality/City/Distdct Other than the VoteR'

My new residence is:

House No. & Street

I have resided in my new residence for _ years and for _ months.

IN WITNESS WHEREOF, I have hereunto affix my signature this _

Printed Name and Signature ofApplicant

SUBSCRIBED AND SWORN to before me on the above date.

P nted Name and Sigrature of

nN lTl--l t*T-i-l i"Tl l