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COMMISSION ON ELECTIONS Form AIE

AUTHORITY TO INCUR ELECTION EXPENDITURES


Date filed: For the 09 May 2016 National and Local Elections
The undersigned candidate/party treasurer hereby grants the authority to incur election expenses to
his/her agent
, .
(Surname) (First Name) (Middle Name)
Said person is authorized to incur expenses for/on behalf of the candidate or party for the upcoming
2016 NLE elections. He/she is only authorized to incur expenses with a maximum limit of:
().
(Amount in words) (Amount in figures)

AFFIX SIGNATURE HERE


Before printing, encode name here [NAME OF CANDIDATE OR PARTY TREASURER]
Date signed:
PARTY INFORMATION: Accomplish this part only if you are the party treasurer
NAME of PARTY
TREASURER: (SURNAME) (FIRST NAME) (MIDDLE NAME)
NAME OF
PARTY: (COMPLETE NAME OF PARTY) (ACRONYM)
PARTY Political Party Contact information:
TYPE: Party-List Group (Phone no. & e-mail address)
CANDIDATE INFORMATION: Accomplish this part only if you are a candidate)
NAME OF
CANDIDATE: (SURNAME) (FIRST NAME) (MIDDLE NAME)
Elective District,
office Municipality/city/province
sought: of elective office:
Name of Contact information:
party: (Phone no. & e-mail address)

AGENT INFORMATION: (Person authorized to incur expenditures, whose name appears in main body)
Home/Office
Address:
Telephone &
E-mail Address:
Mobile No.:

ACKNOWLEDGMENT
REPUBLIC OF THE PHILIPPINES )
City/Municipality of __________________)

BEFORE ME, on and in , personally appeared the following


persons with competent evidence of their identity:
Name Doc. Type ID No. Expiry Date Issuing Authority

Said persons acknowledged under oath to me under penalty of law, that the whole contents of this
document are true and the same are their free and voluntary acts and deeds.

WITNESS MY HAND AND NOTARIAL SEAL.

Doc. No.: NOTARY PUBLIC


Page No.:
Book No.:
Series of

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