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Republic of the Philippines

COMMISSION ON ELECTIONS
. Manila

CERTIFICATE OF ~r
SENAl
INSTRUCTIONS:(Readwellbeforefilling up this form.) L1
1. Filethis in FIVE(5) LEGIBLE copies. TIME: --:::-:;,-_:-:-L-;:::""!'-
2. File this ce-nncare of candidacy with the La.w.Department,. CO~Ttto>'-"'","UW""-'''''''''..!ll!!£'!.!'.!!!~-!:!:~
midnight 0: Nove.mber 30, 2009.. ~
3. Attach to this certificate the Certificate of Party Nomination unless you are an independent candidate. After midnight of November 30, 2009, no
certirocate<>f
nominationshallbe accepted.
.4. Titles such as 'Dr., At~., Don, Ginoo, Senor, Datu, Hadjl, Sultan, Bait Seiiora, Kapitan or similar titles are expressty prohibited.
5. This certificate 'shall be sworn before a notary' publlc or 'any ofilelal authorized to administer oath. COMELECofficials are not authorized to
administer oath.

1.1 Lastf'l<Ime
f~;~ ;~rN::~H[.:T"",,""
:t-t:e:ilHty:
: T:.[·.:[: '.[.:T ·t:.:r• I.:·~"·:[·:.:l.:.:[·:·:1:•• .:];.:.~
.....
5. MY DATE OF BIRTH IS :
.. '.-
1.2 First Name
I 1- 11- j q 53
1.3 Middle Name- (~\t~·:·~·':A·:~./:E·::N·:T\j·~·i'AJ
. ~. ~ -
: .... : ...,. - .' . .
"
.'..
Month

6. MV PLACE OF BIRTH IS :
2. I A~' GENERALLY OR POPULARLY KNOWN BY THE NICKNAME OR STAGENAME
(Indkate. only one nickname or stacename)
Oty/Mun .c:A.i!A jA..GA.~
:~i:~ ~N"':'r;:':.j""'"'''' , ·.-··c· Province .l?A-ffl-Nc.?AS
:rr:,..: :,,: 1: ,
~-------'~'-'~"~'~"-'-~-~"-"~'-'~~:~'-'~"~'~'-"~'-'~~--.~.,-.~
..~,--.~~.-.~,-
..~~~~~.-.~,- ..~,~.-
..~.-.~,.-·~·-··-·~·-··~·-·~·-t8.MYCIVILSTATUSlS:
7. I AM OFFICIALLY NOMINATED BY: (Attleh Certificateof Nomination)
................ p. D.P:-: .I.-A.t?AN : , _ _ .
o Single D Widow!er

Political Pa [Z] 'Married 0 LegallySeparated

o ~nnulled I Divorced

Full Nameof Spouse,If. married


'1.'lJP.N.N.I.f .. M·..~L!NAN .
10. MY PROFESSION OR

:,:5':" '~'5::j':''~iO:e:Ei~":s:r
9.1 House No.f sm..t! Subdwlslon
:fi.ji:ij+f": ..~-.~.
.:...;...:...;...:...;..;..:..: f¥.!~!~~.~./.~.q4Nr
OCCUPATION IS :
...
11. MY POST OFFICE ADDRESS fOR ELECTION PURPOSES IS: (Couldbethe sameas No.9) 12. IAM'A REGISTERED VOTER OF

~'7S
.......
$.J. iOIOSL- OJ.,. ..CALA
--
TAGA;.) I eATAt~GAS . .
Precinct ...t.-:~ _ .
, '" ,

Bgy r
f'06LACION -
13. MY PERIOD OF RESIDENCE IN THE PHIUPPI/iES BEFORE MAY ,,0, 2010 IS:
'.·q.\.iA.T~~~"{~·
.
: .. ~.. "
No. of Month~ ~6:~.~ No. of Years
Oty/Mun

Province eATANGAS

14. I AM A NATURAL BORN FIUPINO CITIZEN.


15. I AM NOT A PER!"1ANENT RESIDENT OF, OR IMMIGRANT TO, A FOREIGN
COUNTRY. .
16. I AM EUGI6lE FOR THE OfFICE I SEEK TO BE ELECTED TO.·
17, I WILL SUPPORT AND DEFEND THE CONSTITUTION OF THE REPUBLIC OF THE
PHILIPPINES AND WILL MAINTAIN TRUE FAITH AND ALLEGIANCE THERETO. I
WILL OB~Y THE LAWS, LEGAL ORDERS AND DECREES PROMlJLGATED BY THE
DULY CONSTITUTED AUTHORITIES. I IMP.OSE THIS OBLIGATION UPON. MYSELF
VOLUNTARILY, WITHOlJf MENTAL RESERVATION ORPURPOSE OF EVASION. .

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