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

22. PROFESSION OR OCCUPATION:

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

Name of the Substitute Spouse, if applicable

(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.