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

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14. SEX:

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15. AGE ON ELECTION DAYI

Must b€ at least eighteen

(18) years old on election

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day
1.3 Middle Name
I 16, DATE OF BIRTH:

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2. NICKNAME OR STAGENAME: (lndicate only one nickname or stage name)
ul DaY
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3. RESIDENCE/ADDRE$, 17. PLACE OF AIRTH:
r.r rro,,n."
City/14un

MI rl-tftr
3.2 City/MunicjpaliW 3.3 Barangay
Province

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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

19. PROFESSION OR OCCUPATION:

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)

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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

Name of the Substitute Spouse, if applicable

(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,