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COMMISSION ON ELECTIONS
A P P L I C A T I O N FOR T R A N S F E R OF R E G I S T R A T I O N R E C O R D
DUE T O C H A N G E OF R E S I D E N C E
to another city/municipality/district
, Filipino, born on
month/day/year
of
, Province of
Barangay
, single/widow/er/legally
. do hereby apply for the transfer of my registration
.
Barangay:
Province:
years and
months.
UJ
Further, I do hereby apply for the reactivation of my registration record which was deactivated due to (please
check appropriate box):
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1. Sentence by final judgment to suffer imprisonment for not less than one (1) year;
_;
[ ]
2. Conviction, by final judgment, of crime involving disloyalty to the duly constituted government, etc;
UJ
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jE
U.
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>.
L_J
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O
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That said ground no longer exists, as evidenced by the attached certification/order of the court (in case of
1,2,3, 5 and 6).
IN WITNESS WHEREOF, I have hereunto affix my signature this
day of
, 20
at
,
Province of
, Philippines.
Notice to the applicant: Please accomplish the form at the back and have your blometric data i.e., your photograph, signature and fingerprints
captured digitally if: l.) transfer is within the same city/municipality and you have not previously undergone validation procedure; or 2.) transfer is
to another city/munidpality.
Application No.
Precinct No.
Instructions : (1) Accomplish separately in three copies; (2) print legibly; (3) check the appropriate box.
PART 1
NAME
Last
First
i l l !
Disabled/
Assisted by
i l l !
GENDER
Middle j
RESIDENCE/ADDRESS
[^Male
Height
Province
City/Municipality
Barangay
I
Month
Birth
Naturalized
Month
Day
Year
Day
Year
PLACE OF BIRTH
Reacquired
City/Mun
Province
(If naturaiized/reacquired, state date of naturalization/reacquisltlon and Certificate Number of naturalization/order of approval of reacqulsltiuri)
Date of Naturalization/
Reacquisition
Weight
L_>
[Female
DATE OF BIRTH
I
CITIZENSHIP
CIVIL STATUS
^Single
jjwidow/er
PERIOD OF RESIDENCE
No. of Years
No. of Months
MamuiJ
No. of Years
In the Philippines j
PROFESSION/OCCUPATION
Separated
Name of Spouse, if married
TIN
N A M E O F FATHER
NAME O F M O T H E R
Last
Last
First
Legally
f
|f|
First
Middle;
Middle i
OATH
PART 2
I do solemnly swear that the above statements regarding my person are true and
correct; that I possess all the qualifications and none of the disqualifications of a voter;
that I have no pending application for registration in any city/municipality; and that I
am not registered in anyprecinct in the Philippines.
DATE
Month
Day
Signature of Applicant
Above Printed Name
Year
Left Thumb
Right Thumb
EO / Administering Officer
(Signature above Printed Name)
A C T I O N BY T H E E L E C T I O N R E G I S T R A T I O N B O A R D
PART 3
3.
Approved
[Disapproved
Member
Signature above Printed Name
PART 4
Member
Signature above Printed Name
PRECINCT N(
YEAR
DATE OF BIRTH
COMMISSION ON ELECTIONS
A P P L I C A T I O N FOR T R A N S F E R OF R E G I S T R A T I O N R E C O R D
DUE T O C H A N G E OF R E S I D E N C E
J to another city/municipality/district
I,
, Filipino, born on
First name Middle name/Last name
, Province of
Barangay
, single/widow/er/legally
, do hereby apply for the transfer of my registration
Barangay:
Province:
month/day/year
of
years and
months.
UJ
Further, I do hereby apply for the reactivation of my registration record which was deactivated due to (please
check appropriate box):
[ ]
2. Conviction, by final judgment, of crime involving disloyalty to the duly constituted government, etc;
UJ
m
UJ
1. Sentence by final judgment to suffer imprisonment for not less than one (1) year;
__
o
u
day of
, 20
at
Notice to the applicant: Please accomplish the form at the back and have your biometric data i.e., your photograph, signature and fingerprints
captured digitally if: 1.) transfer is within the same city/municipality and you have not previously undergone validation procedure; or 2.) transfer is
to another city/munidpality.
Application No.
Precinct No.
Instructions : (1) Accomplish separately In three copies; (2) print legibly; (3) check the appropriate box.
PART 1
Last
First
!..
City/Municipality
f
1
i
1 f
!
|
|
| |
Province
1
'
'
I i
Barangay
f
! i f
j | : |
1
!H_.VoA n
i
'
'
J_?...
,.J? L.,
a
.-
~j Naturalized
,- . .
Ye
ar
PERIOD OF RESIDENCE
No. of Years
In the City/Mun i
| I
^Reacquired
No. of Months
N A M E OF MOTHER
Last
First
First
Middle I
Married
. T I N i.
I I
^Jwidow/er
Legally
Separated
Name of Spouse, if married
No. of Years
In the Philippines
Year
CIVIL STATUS
^Single
Last
7 1 T
Day
Province
N A M E OF FATHER
I
Weight
City/Mun
PROFESSION/OCCUPATION
Fema|0
PLACE OF BIRTH
Date of Naturalization/
Reacquisition
j-|
j ^ i j l
^ J B y Birth
CITIZENSHIP
Ma|e
Height
DATE OF BIRTH
J....
Month
i
Oath)
I
I
<
( P l e a s e fill up A s s i s t o r ' s
GENDER
RESIDENCE/ADDRESS
Assisted by
1
Middle i
r-[Disabled/
ff&nnto>*>
Illiterate
PART 2
Middle
O A T H
I do solemnly swear that the above statements regarding my person are true and
correct; that I possess all the qualifications and none of the disqualifications of a voter,
that I have no pending application for registration in any city/municipality; and that I
am not registered in any precinct in the Philippines
DATE
Day
Month
Signature of Applicant
Above Printed Name
Year
Left Thumb
Right Thumb
EO / Administering Officer
(Signature above Printed Name)
3.
A C T I O N BY T H E E L E C T I O N R E G I S T R A T I O N B O A R D
PART 3
r
I
[Approved
Day
.
;
Date
[Disapproved
Member
Signature above Printed Name
PART 4
j.
Member
Signature above Printed Name
PRECINCT NO.
YEAR
DATE OF BIRTH
ACKNOWLEDGEMENT RECEIPT
Application No.
Application for Registration
Last
First
Middle |
[ [ i l l
L...L.
EO/Interviewer Signature Above Printed Name
CEF-1B
Republic of the Philippines
COMMISSION ON ELECTIONS
j to another city/municipality/district
, Filipino, born on
I,
month/day/year
of
, Province of
Barangay
, single/widow/er/legally
_, do hereby apply for the transfer of my registration
Barangay:
Province:
years and
months.
Further, I do hereby apply for the reactivation of my registration record which was deactivated due to (please
check appropriate box):
Q.
DC
1. Sentence by final judgment to suffer imprisonment for not less than one (1) year;
Q_]
2. Conviction, by final judgment, of crime involving disloyalty to the duly constituted government, etc;
PI
That said ground no longer exists, as evidenced by the attached certification/order of the court (in case of
1,2,3, 5 and 6).
IN WITNESS WHEREOF, I have hereunto affix my signature this
Province of
, Philippines.
day of
, 20
at
Notice to the applicant: Please accomplish the form at the back and have your blometric data i.e., your photograph, signature and fingerprints
captured digitally if: 1.) transfer is within the same city/municipality and you have not previously undergone validation procedure; or 2.) transfer is
to another city/munidpality.
Application No.
Precinct No.
Instructions : (1) A c c o m p l i s h separately in t h r e e copies; (2) print legibly; (3) c h e c k the a p p r o p r i a t e box.
PART 1
Last
1 11 1 1 j 11 j1 11 1 I1
First
i j
Middle I
j i ; i i | ] i j
RESIDENCE/ADDRESS
Province
11I 1 1
GENDER
Barangay
--I
f |"II
,.i 1 i I .
I J i L
^Naturalized
Birth
Month
Day
Year
^Reacquired
In the Philippines j
. TIN [
"jLegaliy
Separated
Name of Spouse, if married
I-i
NAME OF MOTHER
Last
Last
First
Middle j
First
Middle
OATH
PART 2
jjwidow/er
^Married
N A M E O F FATHER
j
Year
CIVIL STATUS
No. of Years
No. of Months
Day
Province
^Single
PROFESSION/OCCUPATION
Weight
City/Mun
PERIOD OF RESIDENCE
No. of Years
In the City /Mun i
i
I do solemnly swear that the above statements regarding my person are true and
correct; that I possess all the qualifications and none of the disqualifications of a voter,
that I have no pending application for registration in any city/municipality, and that I
am not registered in any precinct in the Philippines
DATE
Month
Day
Signature of Applicant
Above Printed Name
Year
Left Thumb
Right Thumb
EO / Administering Officer
(Signature above Printed Name)
PART 3
^Approved
^Disapproved
Member
Signature above Printed Name
PART 4
|Female
PLACE O F BIRTH
(If naturalized/reacqulred, state date o f naturalization/reacquisition and Certificate Number of naturalization/order of approval of reacquisition)
Month
DATE OF BIRTH
Date of Naturalization/
Reacquisition
^Male
Height
City/Municipality
CITIZENSHIP
[Disabled/
Assisted by:
|[""'I'""]jJ|
! | | j |
ill
illiterate
I I I I I I I
Member
Signature above Printed Name
YEAR
DATE OF BIRTH