Republic of' the Philippines !

U'
COMMISSION ON ELECLONS
Manila

IIISTRUcnOIlS: (Read woD before fining up Ihis li,"n)

1. Flle'lhis in FIVE (5) lEGIBLE copies.
2. file this certificate (,If candidacy wltn the law Department, ,COMELEC Nain Office, In tremuroa, ManHa, starting November 20, 2009 up to
midnight of November 30 ~2009.
3. Attach to this certificate the Certifica'te cf Party Nomination unless you are all independent candidate. Aft~r midnight of Ncvernber 30, 2.009, no
certificate of nomiaeticn shall be accepted.
4. Tides such as 'Dr., Atty.., Oon, Ginoo, Senor", Oa·tu, Hadji, Sultan, Bai, Senora, Kapitan or similar titles are expressly prohibited.
5. This certificate s-haJl be sworn befor-e a not~ry public ar anj- official authorized tojadrninls ter oath. CO~tElEC officials are not authcrtred to
adminism:r_oath.

f"-aTe . DFemaie
1.1 Lost llame
5. MY DATE OF SIRn! lS:
Name
1.2 Fir<t

1.3 ~liddl. Name

[~1-[{1·:-U[%£1~.
2. I AM GENERALLY OR POPULARLY
{Indicate only one nicknarre orstagename)

})jt ":8;;:1.)': i; l!/iFij)J;iiff':"

KNOWN BY THE NICKNAME ORSTAGENAME

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::u:LA~~. Province

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7.IAM OFFICIAUYNOMINATED BY: (Attach Ce;1ificall> of No ""tion)

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Single

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legally
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9. MY RESIPENCE/
ADDRESS IS : 9.1 Province
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o Annulled I Dtvcrced

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..: :.._~ : :.•..: : 10. MY PROFESSION OR

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9.4 House No.1 Street 15tJb1ivision
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11. MY POST OFFICE ADDRESS FOR·El.ECITON PURPoses IS ; (Could be the sarre as No.9) 12. I AM A. REGISTERED VOTER. OF

......_ _'._._<:F~~ ..f.J:~ ~P...'.9 _._.._.__. _.. .._. Precinct •••••• :r~.l(y..~ A .
llg, •••• A1,bLIIl. '!.It .
13. MY PERIOD OF RESIPEIICCE IN THE PHn.IPPINES

No.ofr>1onths
BEf'ORE MAY ID, 2010 IS:
.Clty{Mun
A.:onnce
•••••• a: .
14. I AMA NATURAl BORN FIUPINO crnzra
15. I AN NOT A PERI"1ANENTRESIDENT OF, OR IMI"IIGRANTTO, A FOREIGN
COUNTRY.
16. I AM EUGffiLE FOR lliE OffiCE I SEEK TO BE ELEC1EDTO.
17. I WILL SUPPORT AND DEFEND THE CONSTITUTION OF THE REPUBLIC OF THE
'-: ..
PHILIPPINES AND WIU MAINTAIN TRUE FAITH AND ALLEGIANCE THERETO. I
WILL OBEY THE LAWS, LEGAL ORDERS AND DECREES PROMULGATED BY THE
DULY CONSTITUTED AUTHORITIES. I IMPOSE THIS OBLIGATION UPON MYSELF
VOLUNTARILY,WITHOUT MENTAl RESERVATIONOR PURPOSE Of EVASIOrt.