COMMISSION ON ELECTIONS FORM

October 30, 2023 RCF

Barangay and Sangguniang Kabataan Elections
Report of Contractor and Business Firms
PART A: INFORMATION OF THE CONTRACTOR OR BUSINESS FIRM

NAME of CONTRACTOR
(Natural persons & sole
proprietors) (SURNAME) (FIRST NAME) (MIDDLE NAME) (EXT)

NAME of BUSINESS FIRM:

NAME of PRESIDENT,
OWNER OR GENERAL
MANAGER: (SURNAME) (FIRST NAME) (MIDDLE NAME) (EXT)

CONTACT DETAILS: Mobile/Phone Nos.:

E-Mail Address:
OFFICE / BUSINESS
ADDRESS:
(STREET NO.) (STREET NAME) (BUILDING/SUBDIVISION)

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

PART B: LIST OF ELECTION-RELATED BUSINESS TRANSACTIONS

DESCRIPTION OF SERVICES
NAME OF CLIENT 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 owner, contractor, president/general manager of the aforementioned company 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) that he/she complied with his/her duty to require every agent of a candidate to present
his/her written authority to incur electoral expenditures on behalf of such candidate as mandated by Section 112 of the Omnibus Election
Code; (6) the udersigned consents on the general use and sharing of information obtained in this disclosure and its attachments for legitimate
and authorized purposes.
AFFIX SIGNATURE
HERE 
Input complete name of signatory here ➔ (DATE SIGNED)
Input job title/position of signatory here ➔ [job title/position in the company]

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]

Document No.:
Page No.:
Book No.:
Series of 2023 .
NOTARY PUBLIC