October 30, 2023

BARANGAY AND SANGUNIANG KABATAAN ELECTIONS

Tuguegarao City, Cagayan
_______________________
(Date)
Name: _____________________________________________________________
Address: ___________________________________________________________
(House No., Street, Barangay, City/Municipality and Province)

SIR/MADAM:

You are hereby appointed as POLL WATCHER for and in my behalf in Precinct No, __________
with polling place located at ________________________________________________ of Barangay ,
Tuguegarao City, Province of Cagayan.

You may immediately assume duties upon taking your oath as required by law and upon presentment of this appointment to
proper authorities. This appointment will be automatically cancelled and considered null and void if you are related to any member
of the Electoral Board of said precinct/s within the fourth civil degree of consanguinity or affinity.

(Signature over Printed Name)

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Republic of the Philippines }

Tuguegarao City } S.s.

ACCEPTANCE AND OATH OF POLL WATCHER

I, _______________________________________, solemnly swear that I will faithfully perform the duties of a POLL
WATCHER in Precinct No. _________________ in Barangay of the above-stated city and province
TO THE BEST OF MY ABILITIES within the limits of Law. I hereby declare under oath that I am not related within the 4 th civil
degree of consanguinity or affinity to any member of the electoral board or the Barangay Board of Canvassers, that I possess all the
qualifications and none of the disqualifications specified by law as poll watcher and that I voluntarily impose upon myself ALL
obligation that I my bear as POLL WATCHER without mental reservation or purpose of evasion. SO HELP ME GOD!

_______________________________
(Signature over Printed Name)

SUBSCRIBED AND SWORN to before me this ____________ day of ______________________, 2023.