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Republic of the Philippines

Commission on Elections

ANNEX B 30 OCTOBER 2023 Synchronized Barangay and Sangguniang Kabataan Elections

STATEMENT OF EXPENDITURES

DATE NAME OF CONTRIBUTOR ADDRESS NATURE OF AMOUNT


RECEIVED CONTRIBUTION
(CASH/IN-KIND)

TOTAL CONTRIBUTION RECEIVED Php:


CERTIFICATION SUBSCRIBED AND SWORN to before me this _______ day of
I hereby certify that: (1) the contributions listed above were made to me as a ________________203, candidate exhibiting his/her _____________________with
candidate; (2) all entries specified above are true and correct; (3) they are supported by number ________________ issued by _____________________________with expiry
official receipts issued by me upon acceptance; and (4) the contributions are from sources date __________________________.
not prohibited by laws.
______________________________________
(Full Name & Signature)
ADMINISTERING OFFICER
______________________________
(Date Filed)

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