COMMISSION ON ELECTIONS

NATIONAL ELECTIONS

REQUEST FOR CANCELLATION OF REGISTRATION RECORDS

NAME OF REQUESTOR:
PERSONAL INFORMATION OF OVERSEAS VOTER WHOSE REGISTRATION RECORDS ARE
REQUESTED TO BE CANCELLED
LAST NAME:
FIRST NAME:
MIDDLE NAME:
DATE OF BIRTH:
POST:
COUNTRY:
REASON/S FOR CANCELLATION SUPPORTING DOCUMENT/S SUBMITTED
Instruction: Kindly check the appropriate boxes.
Certificate of Loss of Filipino Citizenship
(Original/Certified True Copy)
Certificate of Foreign Naturalization/Foreign Citizenship
(Original/Certified True Copy)
Loss of Filipino Citizenship
Certified List of Overseas Voters who Lost Citizenship
issued by the Post
Other Proof of Loss of Citizenship (please
specify:_______________)
Certified List of Persons who died submitted by the Local
Civil Registrar, pursuant to Section 19 of RA No. 8189
Death Certificate (Original/Certified True Copy)
Death of Overseas Voter
Certification from Post or Report of Death of Overseas
Voter (Original/Certified True Copy)
Sworn Declaration of next of kin who has personal
knowledge of the death and identity of the deceased
I swear that the above information are true and correct for purposes of the cancellation of registration records of
the said overseas voter/s under Section 17 of the Overseas Voting Act of 2013 and in relation to the processing
of information under the Data Privacy Act of 2012.

Date Filed: _____________________________ _______________________________

Signature of Requestor

_______________________________
Administering Officer
ACTION OF THE RESIDENT ELECTION REGISTRATION BOARD (RERB)
Approved Date: ____________________________
Disapproved Reason for Disapproval: ____________________________________________

________________________ __________________________ _________________________

Signature above printed name Signature above printed name Signature above printed name
RERB MEMBER RERB CHAIRPERSON RERB MEMBER