ANNEX A

Republic of the Philippines

COMMISSION ON ELECTIONS
Barangay and Sangguniang Kabataan Elections

October 30, 2023

DEED OF CONTRIBUTION
(for Individual Contributor)

KNOW ALL MEN BY THESE PRESENTS:

This Deed of Contribution, made and executed by into and between:

____(NAME OF CONTRIBUTOR)______, a Filipino citizen, of legal age, with residential address at

______________________, hereinafter called the CONTRIBUTOR,

- and -

Name of Candidate who is running for (POSITION) of (PLACE OF CONSTITUENCY), represented by

____________________________, with address at
_____________________________________________________________, hereinafter called the DONEE.

WITNESSETH

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That for and in consideration of a desire to support the electoral campaign of _________ for the 2023 Barangay
and Sangguniang Kabataan Elections, the CONTRIBUTOR has freely and voluntarily given, transferred and
conveyed by way of contribution to the DONEE,

Details of the Contribution Amount (for Cash Contribution)/Equivalent Fair

Market Value (for In-kind Contribution)
___________________________ _____________________________
___________________________ _____________________________

IN WITNESS WHEREOF, the CONTRIBUTOR has hereto subscribed this ____ day of ____________,
2023.

______________________________
CONTRIBUTOR
(Signature over Printed Name)

ACCEPTANCE

For and in behalf of the Candidate, the DONEE expresses his/her most sincere appreciation for the
generosity shown by the CONTRIBUTOR. The DONEE, hereby accepts and acknowledges the above
Contribution/s.

IN WITNESS WHEREOF, the DONEE has hereto subscribed this ____ day of ____________, 2023.

______________________________
DONEE
(Signature over Printed Name)

SIGNED IN THE PRESENCE OF:

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 ________________________ ________________________
(Signature over Printed Name) (Signature over Printed Name)

ACKNOWLEDGMENT

REPUBLIC OF THE PHILIPPINES)

________________________) s.s.

BEFORE ME this ________ (date) __________, personally appeared:

NAME Identification Card and No. Date of Issue or Validity

__________________ _______________________ _______________________
___________________ ________________________ _______________________

known to me to be the same persons who executed the foregoing instrument, and they acknowledged to me that the
same is free and voluntary act and deed, including that of the entities that they represent.

This instrument refers to a Deed of Contribution and Acceptance that consists of 2 pages, including this page
whereon this acknowledgement is written, and which is signed by the parties concerned on each and every page
thereof.

WITNESS MY HAND AND SEAL, this ___ day of ____________________ 2023 in the
____________________, Philippines.

AUTHORIZED PERSON TO
ADMINITER OATH

Doc. No. ______

Page No.______
Book No. _____
Series 2023.

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(Note: The Deed of Contribution involving personal property/ies amounting to less than Five Thousand Pesos must
be in writing but need not be notarized.)

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