Transcript

Republic of the Philippines

COMMISSION ON ELECTIONS

Polomolok,
South
Cotabato

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CERTIFICATE OF CANDIDACY FOR
SANGGUNIANG KABATAAN CHAIRMAN
INSTRUCTIONS: (Read well before filling up this form.)
1.
File personally or through your duly authorized representative, in FIVE (5) LEGIBLE copies with the Ofce of the Election Ofcer in your
city/municipality, during regular working hours on February 07, 09 & 10, 2015 up to 5:00PM only. If fled through a representative, a written authority
under oath must be presented.
2.
Your certifcate of candidacy will not be accepted by the Election Ofcer if you are not a member of the Katipunan ng Kabataan in the barangay where you
seek to be elected.
3.
Title such as ‘Dr., Atty., Don, Ginoo, Senor, Datu, Hadji, Sultan, Bai, Senora, Kapitan or similar titles are expressly prohibited.
4.
This certificate shall be sworn before a notary public or any oficial authorized to administer oath.

I hereby announce my candidacy for the position of Sangguniang Kabataan Chairman of Barangay

, Municipality of
, Province of
on February 21, 2015 Sangguniang Kabataan Elections; and
after having been sworn to in accordance with law, hereby state the
3. MY GENDER
4. MY AGE IS:
following:
IS:

1. MY NAME IS :

Male

1.1 Last Name

Female

5. MY DATE OF BIRTH IS:

1.2 First Name
1.3 Middle Name

Month

City / Mun.
Province

7. MY CIVIL STATUS IS:

8.1 Province

8.2 City / Municipality
Barangay

Year

6. MY PLACE OF BIRTH IS:

2. I AM GENERALLY OR POPULARLY KNOWN BY THE NICKNAME OR
STAGENAME :
(Indicate only one nickname or stage name)
8. MY RESIDENCE/
ADDRESS IS:

Day

8.3

Single

Widow/er

Married

Legally Separated

Annulled / Divorced
Full Name of Spouse, If Married

8.4 House No./ Street / Subdivision

10. MY POST OFFICE ADDRESS FOR ELECTION PURPOSES IS: (Indicate if the same
as No. 8)

9. MY PROFESSION
OR OCCUPATION IS:

11. MY PERIOD OF RESIDENCE IN THE PHILIPPINES BEFORE FEBRUARY 21, 2015 IS:

12. I AM A MEMBER OF
KATIPUNAN NG KABATAAN OF:

No. of Months

No. of Years

Precinct

13. I AM A FILIPINO CITIZEN.
14. I AM A MEMBER OF THE KATIPUNAN NG KABATAAN IN THE BARANGAY WHERE I
SEEK TO BE ELECTED.
15. I AM A RESIDENT OF THE BARANGAY WHERE I SEEK TO BE ELECTED FOR AT
LEAST ONE YEAR BEFORE THE SANGGUNIANG KABATAAN ELECTION.
16. I AM NOT A PERMANENT RESIDENT OF, OR IMMIGRANT TO, A FOREIGN COUNTRY.
17. I POSSESS ALL THE QUALIFICATIONS AND NONE OF THE DISQUALIFICATIONS FOR THE
OFFICE I SEEK TO BE ELECTED.
18. I WILL SUPPORT AND DEFEND THE CONSTITUTION OF THE REPUBLIC OF THE
PHILIPPINES AND WILL 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 RESERVATION OR
PURPOSE OF EVASION.
19. I RECOGNIZE THE AUTHORITY OF THE ELECTION OFFICER OR HIS REPRESENTATIVE NOT
TO ACCEPT MY CERTIFICATE OF CANDIDACY IN CASE I AM NOT A MEMBER OF THE
KATIPUNAN NG KABATAAN IN THE BARANGAY.

Barangay
City / Mun.
Province

ROLLED THUMBPRINT

Right Thumbprint

I hereby certify that the facts stated herein are true and correct of my own personal knowledge.

Signature of Candidate Above Printed Name

OATH
SUBSCRIBED AND SWORN to before me this
his/her Identification Card No.
Issued by:

day of

, 2015 at
On:

(Afx documentary stamp)

, afant exhibiting to me
.

(Oficer Authorized to Administer Oath)

. _. Book No. _.Doc. No. _. Series of 2015. Page No.