PART B: LIST OF ELECTION-RELATED BUSINESS TRANSACTIONS
DESCRIPTION OF SERVICES NAME OF DATE OF RECEIPT AMOUNT OF GOODS PURCHASED / RENDERED/GOODS CANDIDATE TRANSACTION NUMBER VALUE OF SERVICES RENDERED PURCHASED
PART D: CERTIFICATION, CONSENT AND ACKNOWLEDGMENT
The undersigned, after being duly sworn, do hereby certify that : (1)the foregoing transactions for goods/services were made for the purpose of the elections; (2)that all the information provided and stated in this report are true and correct; (3) the candidate complied with the duty to require every agent of a candidate to present written authority to incur electoral expenditures on behalf of such candidate as mandated by Section 112 of the Omnibus Election Code; and (6) consents on the general use and sharing of information obtained in this disclosure and its attachments for legitimate and authorized purposes.
(SIGNATURE OVER PRINTED NAME) (DATE SIGNED)
(Position of the Signatory)
SUBSCRIBED AND SWORN TO BEFORE ME this , affiant exhibiting his/her
issued by , with expiry date on [Identification (ID) Type] [Serial No. of ID] [Government Agency issuing the ID] . [Expiry date of ID]