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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.