COMMISSION ON ELECTIONS

October 30, 2023

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

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

Office Address:

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)

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