Commission on Elections FORM

May 9, 2022
National and Local Elections AIE
Authority to Incur Expenditures
Date filed:

The undersigned party treasurer hereby grants the authority to incur election expenses to
his/her agent SAYSAY, ROBERT M.
(Surname) (First Name) (Middle Name)
Said person is authorized to incur expenses for/on behalf of the candidate or party for the upcoming
May 9, 2022 National and Local Elections. He/she is only authorized to incur expenses with a
maximum limit of:
(₱).
(Amount in words) (Amount in figures)

AFFIX SIGNATURE HERE  ROBERT M. SAYSAY

Before printing, encode name here  [PARTY TREASURER]
Date signed:
ELECTORAL PARTY INFORMATION: Accomplish this part only if you are the party treasurer
NAME of PARTY SAYSAY ROBERT M.
TREASURER: (SURNAME) (FIRST NAME) (MIDDLE NAME)
NAME OF
ELECTORAL
PDP-LABAN PDP-LABAN
PARTY: (COMPLETE NAME OF PARTY) (ACRONYM)
PARTY  Political Party Contact information:
TYPE:  Party-List Group (Phone no. & e-mail address)
CANDIDATE INFORMATION: Accomplish this part only if you are a candidate)
NAME OF BAGASBAS NENA B.
CANDIDATE: (SURNAME) (FIRST NAME) (MIDDLE NAME)
District,
Elective office
Municipality/city/province
sought:
MUN. MAYOR of elective office: 5TH BALATAN, CAMARINES SUR
Contact information:
Name of party:
TEAM ONE BARES (Phone no. & e-mail address) 09289773730
AGENT INFORMATION: (Person authorized to incur expenditures, whose name appears in main body)
Home/Office ZONE 6 DURAN BALATAN, CAMARINES SUR
Address:
Telephone &
E-mail Address:
Mobile No.: 09289773730
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 Doc. Type ID No. Expiry Date Issuing Authority

Said 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.

WITNESS MY HAND AND NOTARIAL SEAL.

Doc. No.: NOTARY PUBLIC

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