Republic of the Philippines

COMMISSION ON ELECTIONS
Manila

CERTIFICATE-

INSTRUCTIONS: (Read well before filling up this form.)

1. File this In FIVe (S}LEGIBLE copies.
2. File this certificate of candidacy with the Law Department, COMELEC Main Office, Intramuros, Manila, starting November 20, 2009 up to
midnight of November 30, 2009.
3. Attach to this certificate the Certificate of Party Nomination unless you are an independent candidate. After midnight of November 30, 2009, no
certificate of nomination shall be accepted.
4. TItles such as 'Dr., Atty., Don, Ginoo, Seiior, Datu, Hadji, Sultan, Bai, Senora, Kapitan or similar titles are expressly prohlbired.
5. This certificate shall be sworn before a notary public or any official authorized to administer oath. COMELEC offlclaleare not authori.ed to
admlnictt!r oath.'

1.1 Last Nome

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'

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1.2 Rrst Name

1.3 Middle Name

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Month
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DIY Year
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6. MY PLACE OF BIRTIl IS :
2. I AM GENERAllY OR POPULARLY KNOWN BY TIlE NICKNAME OR STAGENAME
IIndicate only one nickname or st!lgename) City/Mun SAN
... JUAN
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7. I AM OFFICIALLY NOMINATED BY: (Attach Certificate of Nomination)
.. : .... _... B~~~!3~-XA:N .. ~.. 1Te>l.u.nj:e.e.rE5. .f.q;r __a .. N~.W.. J?b,~.l.~pp.~Ile.?__....
0 Single 0 Widow/er

Po I a ~ Married 0 Legally Sepamted

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9. MY RESIDENCE! "
.
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ADDRESS IS :
9,1 ProVince . .
, ,. '" Annulled I Divorced
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9.2 OtyjMunlcipalily

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9.4 House No.1 street I Subdivision
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-e- • '.' • • Full Name of spouse, if married

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OCCUPATION JS :
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11. MY POST OFFICE ADDRESS FOR ELECTION PURPOSES JS : (Could be the same as No.9) 12. I AM A REGISTERED VOTER OF

#.0.5 () 5. -:-'A ..... _..... _

BID' IVe
-_ ..... ---_ .. -._--_ .. -----
13. MY PERIOD OF RESIDENCE IN THE PHILIPPINES BEFORE MAY 10, 2010 IS.:
CityfMun MARIKINA CITY
No. of Morrt!ls No. of Years
Province

14. I AM A NATURAL BORN FILIPINO CITIZEN. i D THUMBPRINT

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15. I AM NOT A PERMANENT RESIDENT OF, OR IMMIGRANT TO, A FOREIGN
COUNTRY. ~
16. tAM ELIGIBLE FOR THE OFFICE I SEEK TO BE ELECTED TO.
17. 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 TH-E
DULY CONSTITUTED AUTHORITIES. I IMPOS S OBLIGATION UPO YSELF
VOLUNTARILY, wrrnour MENTAL RESERVATION PURPO E OF EVA

Thumbprint

I hereby certify that the facts stated herein are true and
~
. FERNANDO

~OATH •
SUBSCRIBED AND SWORN to before me this In- day of r, 2009, at ~-l4ot1 Q~ffiantexhibiting to me hls/her
="'_"""" card No. 19 B 9. 952 issued by : MARlKINA ~T"'" JAN •- 13 , 2009

~~~~.tttI ;
Book No. .
KIMB~
(Of!i.cer AUth~~~inisterOath)
Series of 20(£) -~--. ~----tary stamlB<piring on December3f, 2010 -
- RolI#-5540a -\
PTR No. 5101033/01:.tl6;{l9lPasig City ,
IBP 768906/01,06,09JQuezon;City.:
93 Corumi St. Masambong
Quezon City