COMMISSION ON ELECTIONS

October 30, 2023 Barangay and Sangguniang Kabataan Elections ROC

Omnibus Report of Contributions
(For Individual Contributor)

PART A: PERSONAL INFORMATION OF THE CONTRIBUTOR

NAME OF THE
CONTRIBUTOR
NONE NONE NONE
(SURNAME) (FIRST NAME) (MIDDLE NAME) (EXT)

CONTACT DETAILS: Contact Number

E-Mail Address:

BUSINESS ADDRESS
(STREET NO.) (STREET NAME) (BUILDING/SUBDIVISION)

(BARANGAY) (DISTRICT/AREA) (CITY/MUNICIPALITY) (PROVINCE)

PART B: CASH CONTRIBUTIONS

DATE OF RECEIPT NUMBER NAME OF CANDIDATE

AMOUNT OF CONTRIBUTION
CONTRIBUTION (Receipt issued by Candidate) (For whose benefit the contribution was made)

N/A N/A N/A 0.00

TOTAL CASH CONTRIBUTIONS MADE 0.00

PART C: IN-KIND CONTRIBUTIONS

DATE OF NAME OF CANDIDATE EQUIVALENT FAIR MARKET
DESCRIPTION
CONTRIBUTION (For whose benefit the contribution was made) VALUE

N/A N/A N/A N/A 0.00

TOTAL IN-KIND CONTRIBUTIONS OR DONATIONS MADE 0.00

PART D: CERTIFICATION AND OATH

The undersigned authorized representative of the contributor, after being duly sworn, do hereby certify that: (1) the foregoing contributions were made by (Name of the Contributor)

to the candidates or their duly authorized representatives; (2) all the information provided and stated in this report are true and correct; and (3) the contributions were made in

accordance with the pertinent provisions of the Omnibus Election Code and other pertinent laws.
DATA PRIVACY ACT

The udersigned consents on the general use and sharing of information obtained in this disclosure and its attachments for legitimate purposes

SAN CHAI P. MANTE

11/20/2023
(SIGNATURE OVER PRINTED NAME) (DATE SIGNED)

SUBSCRIBED AND SWORN TO BEFORE ME this , affiant exhibiting his/her

VOTER'S CERTIFICATION issued by COMELEC , with expiry date on

[Identification (ID) Type] [Serial No. of ID] [Government Agency issuing the ID]
NOT APPLICABLE .
[Expiry date of ID]

AUTHORIZED PERSON TO ADMINISTER OATH