Commission on Elections

October 30, 2023

Barangay and Sangguniang Kabataan Elections ARC
Authority to Receive Contribution
Date filed:

The undersigned candidate herein grants the authority to the agent,

, ,
(SURNAME) (FIRST NAME) (MIDDLE NAME) (EXT. )
To receive contributions and issue receipts for the same on behalf of the candidate and shall be responsible for the actions of the said agent.

SIGNATURE OVER PRINTED NAME OF CANDIDATE]

Date signed:

CANDIDATE INFORMATION: Accomplish this part only if you are a candidate.

NAME OF
CANDIDATE: (SURNAME) (FIRST NAME) (MIDDLE NAME) (EXT)

Elective
Barangay
Position

Contact information:
(Mobile no. and e-mail address)

AGENT INFORMATION: (Person authorized to receive contributions, whose name appears in main body)
Home/Office
Address:

Mobile No.: E-mail Address:

ACKNOWLEDGMENT
REPUBLIC OF THE PHILIPPINES )
City/Municipality of __________________)

BEFORE ME, on ___(date) and in (city/municipality) , personally appeared the following persons with competent evidence of their
identity:
Name I.D. Type Expiry Date Issuing Authority

aid persons acknowledged under oath to me under penalty of law, that the whole contents of this document are true and the same are their free
and voluntary acts and deeds.
AUTHORIZED PERSON TO ADMINISTER OATH