Professional Documents
Culture Documents
FORM
October 30, 2023 Barangay and
Sangguniang Kabataan Elections 1
Statement of Contributions and Expenditures
THIS SECTION IS
Indicate "✓" beside form code/document FORifCOMELEC
name submitted,USE
" ✗" ONLY
if - DO NOT ENCODE / WRITING ANYTHING BEYOND THIS LINE
not.
☐ FORM 1 ☐ Contribution Receipts
☐ FORM 2 ☐ Expenditure Receipts
☐ FORM 3 ☐ Obligations Payable
☐ Others: pls. specify: NO. OF PAGES: _________
(This space is for the receiving date/time stamp of the receiving office)
Page 1 of 3
COMMISSION ON ELECTION FORM
October 30, 2023
Type of Contribution
Schedule of Contributions Received
DESCRIPTION
DATE RECEIVED RECEIPT NUMBER FULL NAME OF CONTRIBUTOR ADDRESS OF CONTRIBUTOR AMOUNT/VALUE OF CONTRIBUTION
(for in-kind contributions)
(Cash or In-kind)
NOT APPLICABLE
Schedule of Expenditures
RECEIPT/ INVOICE FULL NAME OF BUSINESS FIRM ADDRESS OF BUSINESS FIRM TIN OF CONTRACTOR or BUSINESS Exp Type AMOUNT/VALUE OF
DATE INCURRED DESCRIPTION OF EXPENSE
NUMBER OR CONTRACTOR OR CONTRACTOR FIRM (A-K) EXPENDITURE
NOT APPLICABLE
RAFONZEIL R. CECILIO
6/11/2023
NAME AND SIGNATURE DATE SIGNED
NOTE: Use additional sheet/s if necessary
COMMISSION ON ELECTIONS
October 30, 2023 FORM
Barangay and
Sangguniang Kabataan Elections 3
(7) All entries specified on my report on Election Contributions and Expenditures and supporting documents are true and correct.
IN WITNESS WHEREOF, the undersigned hereunto affix his/her signature on 6TH DAY of November, 2023
JURAT
TIN ID bearing No.____________________________ issued by BIR NAGA/RDO 065 expiring on [date of expiry].
(Type of identification document) (ID Number) (Government Agency issuing the ID)
Doc. No.:
Page No.:
Book No.:
Series of: (Place Notarial Seal & Signature here)