COMMISSION ON ELECTIONS

October 30, 2023

Barangay and Sangguniang Kabataan Elections SER
Statement of Expenses on Public Rally

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

ELECTIVE POSITION: CONSTITUENCY:

BARANGAY CITY/MUNICIPALITY PROVINCE REGION

DATE OF RALLY: Venue:

PART B: CONTRIBUTIONS RECEIVED BY CANDIDATE FOR THE PUBLIC RALLY

DATE OF RECEIPT OF RECEIPT CONTRIBUTION TYPE
CONTRIBUTIONS
NAME OF CONTRIBUTOR ADDRESS OF CONTRIBUTOR AMOUNT / VALUE
NUMBER (Cash/In-Kind)

N/A N/A N/A N/A N/A

TOTAL CONTRIBUTIONS (IN CASH & IN-KIND) RECEIVED FOR THE PUBLIC RALLY ₱ -
(Use separate sheet if necessary)
PART C: EXPENSES INCURRED BY THE CANDIDATE FOR THE PUBLIC RALLY
DATE EXPENSE WAS RECEIPT
NAME OF BUSINESS FIRM OR CONTRACTOR ADDRESS OF BUSINESS FIRM OR CONTRACTOR DESCRIPTION OF EXPENSE AMOUNT
INCURRED NUMBER

TOTAL EXPENSES INCURRED FOR THE PUBLIC RALLY ₱ -

(Use separate sheet if necessary)
PART D: CERTIFICATION, CONSENT AND ACKNOWLEDGMENT
SUBSCRIBED AND SWORN TO before me this
affiant exhibiting his/her expiring on
I hereby certify that: (1) the expenses listed in Part C were made by me as candidate or by my duly authorized representative; (2) the
contributions listed in Part B were received by me as candidate or by my duly authorized representative; (3) all entries specified above are (Gov't-Issued Identification) (ID Number)
true & correct; (4) both contributions and expenses are supported by receipts, invoices, and similar documents; (5) the expenses were
incurred in accordance with the Omnibus Election Code and other pertinent laws; and (6) the udersigned consents on the general use and , and issued by .
sharing of information obtained in this disclosure and its attachments for legitimate and authorized purposes. (Expiry Date of ID) (Issuing Government Agency)

AUTHORIZED PERSON TO ADMINISTER OATH

(SIGNATURE OVER PRINTED NAME) DATE SIGNED