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MARC P. CAUBANAN
SIGNATURE OVER PRINTED NAME OF CANDIDATE]
Date signed:
Elective
Barangay
Position SANGGUNIANG KABATAAN
CHAIRPERSON 28
Contact information:
(Mobile no. and e-mail address)
AGENT INFORMATION: (Person authorized to receive contributions, whose name appears in main body)
Home/Office
Address:
ACKNOWLEDGMENT
REPUBLIC OF THE PHILIPPINES )
City/Municipality of __________________)
BEFORE ME, on ___(date) and in (city/municipality) , personally appeared the following persons with competent evidence of their
identity:
Name I.D. Type Expiry Date Issuing Authority
aid persons acknowledged under oath to me under penalty of law, that the whole contents of this document are true and the same are their free
and voluntary acts and deeds.
AUTHORIZED PERSON TO ADMINISTER OATH