Republic of the Phlllppiues

COMMISSION ON ELECTIONS
IHauila

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(Read well before
INSTI1UCTIQNS: filling up this forrn.)
1. . File thls 111 FIVE (5) LEGJljLE copies.
2. File this cernncate or candlclacy wll.ll tile Law uepertment, CO~1ELEC f"lain Offlce.: jntramuros, Hailila, starting November' 20, :Z009L1p to
mlrjnlght or November 3D, 2009.
3. Attacl1 to tllis certmcete the Certlflcate op.Pmty f'!ominatlull unless you ale an independent canotuate. Arter nlldllight of November 30, lU09, no
t',;,rlificate of nomination shall be accepted. . .
'I. Titlt:s such as 'Dr., AUy., Don, Glnoo, Senor, Datu, tladJI, Sultan, Btll, senora, Kapitan or stmnarttttes are expressly prullibitecl.
S. This certlrlcate sltall be sworn before a notary public or any official authortzed to aclmlnlster ceth. COI'lELEC officials are not authorized to
---.--- ..~~ administer
..
oath.
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[£I t"ial~ DFemale. .,,;1.0. .

5. f'1Y DATE Or- BiRTI-I IS :

Lt. NY POST OFfICE ADDHESS ron ELECTION PURPOSESJ!; : (couro be tile s~Jne as No.9)
..... ~.\J.R.QK... 1-,.. I{J\.J;.,.vVl:>JLG. hJ:i-' r.1!:\~l\X}?h 1AY C.J;l'.Y J J?Qlq: lJJ:J9l'J _.
13. IVI¥'PERIOD OF RESIDENCE 11'1 TIlE PI-HURPINES BEFORE FlAY 10 2010 IS:
I r ---";"-~--: - :--.-- -j- -- - ~ .'

:t .. _.:i.... !! No. or t'lontl15

.
! 56 1!
L __. .'
No. of 'rears
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J,.4. I Af"l A NATURAL BORN FIUPTIIJO CITIZEN.
15. [Afv1 NOT ;'\ PERfVlANENT HESJDENT OF, OR IfY1HIGRANT TO, A FOREIGN
COUNTRY.
:l6.1 AfvlEUGl BLE FOR Tt-lE OFFICE I SEEI, TO BE ELECTED TO.-
17. I WILL SUPPORT AND DEFEI'JD THE COI'JSTITUTION Or- THE REPUBLIC OF THE
PI-llLIPPINES AND WILL HAINTAIN TRljE FAITH AND ALLEGIANCE THERETO. I
WILL 08E'( :THE LAWS, LEGAL ORDEI<-S AI'JD DECREES PR.01"lULGATED BY THE
DULY CQN511TUTED AUTHORITIES. I Ifv1POSE THIS OBLIGATION UPON t"lYSELF
VOLUNTAP,(LY, wrruorrr fvlENTAL RESERVATION OR PURPOS OF EVASION.

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I hereby certify that the Iacts stated ilereill are ~&Ie ld' 'r-l,;.-n,!ft-Y' 1'(' own personal. knowletlqe.
TEdFIS II G" GUINGONA III

. QATI·i < . ("<'T~"i(f,,

_. .. SUBSCRIBEr.) I\NDSWOHN to before l1le.\I'\~--'l,J) r1m\l'@[,Nove.mber, 2009, at!~UEZaN_w~ affiant exiribil:l1ig to me Ills/I.lel'
CIC/ldelltrflcatloI1CanINo.~02347474 _\1~5uedbyT)3RGX~ALWANGAIDn: J~~Nu}u,-Y 6, 2009 .
Doc. No. . q<. . MALAYBALAY CITY, BUKIDNON

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~~~1L=-':":~ (Orncer Autnortzed to Adrnutlster Oatil)
Series of 2001

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