RCilublic'oHhePhilippines

COMMISSION ON ELECTnaNS
Manila

CERTI FICATE OF
SENAtnrnr-r-H7~~~-
INSTRUCTIONS: (Read well before filling up this forni.)
1. Filethis In FM'(5) lEGIBLE copies.
2. File this certtrtcate of candidacy .with the u.aw Department. COMElEC Main Office, Intramu.ros, Manila, starting November 20, 2009
midnight 0' November 30, 2009.' .
3. Attach loth'ls certificate the Certificate of Pa rty Nomination unless you are an Independent candidate, After midnight of NO'/embor 30. 20';',.
certificate of nomination shall be accepted ..
4. Titles such as 'Dr " Atty'r Don, Ginoo, Senor, Datu, HaG~jl,Sultan, Bat, senora, Kapitan or Similar titles are expressly prohibited.
5. This certificate. shall: be' sworn before a not .•ry . public' or any official authorized to administer oath. COMELEC officia,ls are not authN"'" ;
administer oath, '

:......... ..,,',,"

1.1 last Nome

;e, ~:.~:,.: 1.;~. .,;T,:~<.
~.-- ",' . ' ... ~.. : ...
' .. . . . ... . . . . . 5. MY DATE OF BIRTH IS :
1.2 First Name ;J.;V.; 0&:-- 10 - I ':a S' '1
t·::,:::,:;;,:;:

1.3 MiddleName : L: A: 6\,: J : O:N; . . ....

...........
Month Day

2.JAMGENERAlLY OR POPULAR~Y KNOWN BYTHIE NICKNAME OR STAGENAME

(IMicate only one nickname or staqename)

7. 'r AM OFFICIALLY NOMINATE.D BY: (Attach Certilii:ate of Nomination)

,:-~ .... PA_~.T'~~Q._.N.ct ... MASA)N, .Ci.", .{'l,,",-LP.I.NO ... ,( .P..M.P.)..
Po'litical Pa

9. MY RESIDENCE!
ADDRESS IS: 9.1 Province : N: O:~:.'1 ;A.: .. : t;:C:-: .\.:u ,;A.
9.2 Oty/Munidpality
9:~.B?~~~~y.
:c. :,:\:8 :AN: A;T; U 1\"':(;.: \ : i'f; I-l; :C..:C ;tJ; c. e::p: (:.1 : 0: tof 10. MY PROFESSION OR

9.4 House. NO! s:r.ee~{5u~~;.sl.on OCCUPATION IS :

~----~~~~~~~-----~~--~~~~~--~~~--~~~~+---~-----
:S.:A:"''':O.s: :~:'l:e~
11. MY POST OFFICE ADDRESS FOR ELECTION PURPOSES IS : (Could be the same as No.9)
;'v'I;J;,;: ••..:A: e')! N ""t A ;su;tl:p.:LAWY~'t
12. I AM A REGISTERED VOTER OF
Precinct

Bgy .l'~l",ITA~ Pt:~E.

13. MY PERIOD DF RESiDENCE IN THE PHIUPI?INES B~FO;R~ .MAY 10, 2010 IS :
City/t~u~ ,~jiSP.N.AT\J~'>J (.;t T"i
No. t?f r40nths :s: :.2. : No.ofY.""
Province .N.•••..
£V_,. .. e.c..l.J ~

14. I AM A NATURAL BORN FILIPINO cmZEN.

""~ 1.5. I AM NOT A PERMANENT RESIPENT.Of, OR IM.MIGRANT TO, A fOREIGN
: COUNTRY. . !

.16. I AM ELIGIBLE FOR THE OFFICE I S(:EK TO BE ELECTED TO. I

17. I WILL SUPPORT AND DEfEND THE CONSTITUTION OF THE REPUBLIC OF THE
i.
PHILIPPINES AND WILL MAINTAIN TRUE fAITH AND ALLEGIANCE THERETO. I I i
WILL OBEY THE LAWS; LEGAL ORDERS
DULY CONSTITUTED AUTHORITIES:
AND DECREES PROMULGATED
I IMPOSE THIS OBLIGATION
BY THE
UPON MYSELF
,.
VOLUNTARILY, WITHOut MENTAL RESERVATION OR PURPOSE Of EVASION.

.,..: Thumbpnnt

I. hereby certify that the facts stated herein are true and correct of mYI/J~~"",~r.ii~~---

'Doc: No. -"S,-,S":::-' ~

Page No. R .' __~~~~~~U1~Je~~~~;A
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