COMMISSION ON ELECTIONS

October 30, 2023

SAC
Barangay and Sangguniang Kabataan Elections
Summary Report of Advertising Contracts
NAME OF MEDIA ENTITY: N/A STATION/OFFICE:

Name of Authorized
N/A N/A N/A
Representative: (SURNAME) (FIRST NAME) (MIDDLE NAME) (EXT) JOB TITLE/POSITION:

Office Address: N/A

E-mail Address: NAME of PAYOR / CLIENT / AD Telephone/Mobile No.:
AGENCY NAME of CANDIDATE

CONTRACT RECEIPT CONTRACT PARTICULARS AMOUNT /

CONTRACT DATE
NUMBER NUMBER (medium,period,frequency,duration,timeslot,etc) VALUE
(Political Ad
(Paid Beneficiary)
For Ad)

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

CERTIFICATION AND ACKNOWLEDGMENT

The undersigned, being the duly authorized representative of after being duly sworn, do hereby certify that:
SUBSCRIBED AND SWORN TO before me (Date of Oath)
(1) the foregoing advertising contracts listed herein were made for the purpose of the elections; (2) all the
information provided and stated in this report are true and correct; (3) the candidate complied with the duty to this affiant exhibiting his/her expiring on
require his/her agent/contributor to present written authority to incur election expenditures on behalf of such (Gov't-Issued Identification) (ID Number)
candidate as mandated by Section 112 of the Omnibus Election Code.
, and issued by .
(Expiry Date of ID) (Issuing Government Agency)

AUTHORIZED PERSON TO ADMINISTER OATH

(SIGNATURE OVER PRINTED NAME) DATE SIGNED