COMMISSION ON ELECTIO

May 13, 2019

National and Local Elections
Statement of Contributions and E
PART A: PERSONAL INFORMATION OF TH
A.1. NAME OF CANDIDATE: Roquero
(SURNAME)

A.2. CANDIDATE TYPE:

(Use "X" in appropriate box)
X

A.3. NAME of POLITICAL PARTY: National Unity Party

(COMPLETE NAME OF THE PART

ELECTIVE POSITION:
A.4. City Council
A.5. CONSTITUENCY OF THE ELECTIVE POSITION:
2nd San Jose Del Monte
(DISTRICT) Indicate "LONE" if only 1 (CITY/MUNICIPALITY)

CONTACT DETAILS: MOBILE/PHONE NOS.:

A.6.
E-MAIL ADDRESS:

A.7. PERMANENT ADDRESS:

(HOUSE NO./UNIT)

(BARANGAY) (DISTRICT/AREA)

PART B: CONTRIBUTIONS RECEIVED (Itemized entries in the schedule

B.1. CASH CONTRIBUTIONS RECEIVED FROM OTHER SOURCES:
B.2. IN-KIND CONTRIBUTIONS RECEIVED FROM OTHER SOURCES:
B.3. CASH CONTRIBUTIONS RECEIVED FROM POLITICAL PARTY: (for candidates with parties
B.4. IN-KIND CONTRIBUTIONS RECEIVED FROM POLITICAL PARTY: (for candidates with part
TOTAL CONTRIBU

PART C: EXPENDITURES INCURRED (Itemized entries in the schedule

C.1. EXPENDITURES PAID OUT OF PERSONAL FUNDS / RESOURCES:
C.2. EXPENDITURES PAID OUT OF CASH CONTRIBUTIONS:
C.3. EXPENDITURES INCURRED USING IN-KIND CONTRIBUTIONS:
TOTAL EXPENDIT

PART D: CERTIFICATION & ACKNOW

The undersigned candidate, after being duly sworn to, hereby depose and state tha
(1) This disclosure and its attachments, are supported by receipts, vouchers, and oth
complete contributions received and expenditures incurred by the undersigned can
(2) The expenditures incurred are for lawful purposes and the contributions were n
to give contributions.
(3) The undersigned consents on the general use and sharing of information obtaine
and authorized purposes.
IN WITNESS WHEREOF, the undersigned hereunto affix

AFFIX SIGNATURE HERE

SUBSCRIBED AND SWORN TO before me on

(Type of identification document) (ID Number)

Doc. No.:
Page No.:
Book No.:
Series of

THIS SECTION IS FOR COMELEC USE ONLY - DO NOT ENCODE / WRIT

Indicate "✓" beside form code/document name if submitted, "✗" if
☐ SCR (Sched of Contributions Rcvd) ☐ Contribution Receipts
☐ SOE (Sched of Expenditures) ☐ Expenditure Receipts
☐ SUO (Sched of Unpaid Obligations) ☐ Obligations Payable
☐ SLE (Sum. Report of Lawful Exp.) NO. OF PAGES: _________
☐ Others: pls. specify:
OMMISSION ON ELECTIONS FORM

National and Local Elections 1

of Contributions and Expenditures SOCE

ONAL INFORMATION OF THE CANDIDATE

Vanessa Michelle
(FIRST NAME) (MIDDLE NAME)

INDEPENDENT CANDIDATE (Indicate "N/A" for Part A.3.)

CANDIDATE WITH SUPPORT OF A POLITICAL PARTY

National Unity Party NUP

(COMPLETE NAME OF THE PARTY) (ACRONYM)

City Council (Skip Part A.5. if national position)

N:

San Jose Del Monte Bulacan

(CITY/MUNICIPALITY) (PROVINCE/REGION)

(NAME OF BUILDING/SUBDIVISION) (STREET NAME)

(CITY/MUNICIPALITY) (PROVINCE)

EIVED (Itemized entries in the schedule of contributions, indicate "0.00" if none received)
SOURCES: ₱0.00
ER SOURCES: ₱0.00
CAL PARTY: (for candidates with parties only) ₱0.00
TICAL PARTY: (for candidates with parties only) ₱0.00
TOTAL CONTRIBUTIONS RECEIVED ₱0.00

RRED (Itemized entries in the schedule of expenditures, indicate "0.00" if none received)
NDS / RESOURCES: ₱229,364.68
BUTIONS: ₱0.00
ONTRIBUTIONS: ₱0.00
TOTAL EXPENDITURES INCURRED ₱229,364.68

ERTIFICATION & ACKNOWLEDGMENT

orn to, hereby depose and state that:
ported by receipts, vouchers, and other documents reflecting the full, true, accurate, and
res incurred by the undersigned candidate and his/her duly authorized representative;
rposes and the contributions were not received from persons or entities prohibited by law

e and sharing of information obtained in this disclosure and its attachments for legitimate

EOF, the undersigned hereunto affix his/her signature on [date signed].

Vanessa Michelle Roquero

, affiant exhibiting his/her

issued by expiring on [date of expiry].
(Government Agency issuing the ID)

(Place Notarial Seal & Signature here)

E ONLY - DO NOT ENCODE / WRITING ANYTHING BEYOND THIS LINE

(This space is for the receiving date/time stamp of the receiving office)