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F. Ramos Stieet, Cebu City

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&#,.121&3.# '2 &30/1/3&4 2', &'*0&1$',

INSTR0CTI0NS: (Reau well befoie fillip up this foim)
1. File this in .5,## 678 $#(19$# :;<=>? at the C0NELEC 0ffice, @AB=CD B>DAEFB ;GG=:> H;AB? 6IJKK 3- L; MJKK
+- '0$48, on any uay fiom NFCAFBO 7P L; 2>QBAFBO PRS RKPT.
2. This ceitificate shall be swoin befoie any C0NELEC official.
S. Attach to this ceitificate othei iequiiements as iequiieu by the C0NELEC.
I heieby announce my canuiuacy foi the position of !"#$!%&"' in the Naich S-4 2u14 Velez College-
Supreme Student Council ueneial Elections; anu aftei having been swoin to in accoiuance with the law, I heieby
state the following:
PRU $#0(.5 '2 ,#)1/#0&# 10
"#$#% &'$$#(#

0; ;G )>V>?L>B?
PU 03-#
1.1 Last Name

1.2 Fiist Name

1.S Niuule Name

P7U /3.# '2 91,.5
- -
N0NTB - BAY - YEAR
RU 01&W03-# (Inuicate only one nickname)

7U '221&13$$4 0'-103.#/ 94J
___________________________________________________________________
(Political Paity)
PTU (#0/#,

Nale
Female
PMU 3(#


____________
PXU +$3&# '2 91,.5
YYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYY
TU 03-#Z[',/) .' 3++#3, '0 .5# 93$$'.



(Last name, Fiist Name oi Nickname, Political Paity)
P\U &*,,#0. 3&3/#-1& $'3/

MU /#+3,.-#0.
College of Aits anu Sciences -Biology
College of Neuical Technology
College of Nuising
College of 0ccupational Theiapy
College of Physical Theiapy
PIU +,#)#0. ',(301%3.1'03$
3221$13.1'0)Z+')1.1'0

___________________________________
ROLLED THUMBPRINT
XU 4#3, $#"#$ 30/ 3&3/#-1& ).3.*) (Check two)
Fiist Yeai Regulai
Seconu Yeai Iiiegulai
Thiiu Yeai Tiansfeiee
Fouith Yeai
Fifth Yeai


7. THAT I AM ELIGIBLE TO RUN FOR THE SAID OFFICE,
8. I WILL ABIDE BY AND UPHOLD THE CONSTITUTION AND BY-LAWS OF THE VELEZ COLLEGE-
SUPREME STUDENT COUNCIL,
9. I WILL OBEY THE RULES AND REGULATIONS PROMULGATED BY THE CONSTITUTED
AUTHORITIES OF THE VC-SSC AND THE VELEZ COLLEGE ADMINISTRATION
10. I WILL FILE TO THE COMELEC, WITHIN THIRTY (30) DAYS AFTER ELECTION DAY, MY FULL,
TRUE AND ITEMIZED STATEMENT OF CONTRIBUTIONS AND EXPENDITURES IN CONNECTION
WITH THE ELECTION,
11. I WILL UPHOLD AT ALL TIMES THE LAWS OF THE LAND, THAT THIS OBLIGATION IMPOSED BY
MY OATH IS ASSUMED VOLUNTARILY AND WITHOUT ANY MENTAL RESERVATION OR
PURPOSE OF EVASION.
Theieby ceitify that the facts stateu heiein aie tiue anu coiiect to the best of my knowleuge.

______________________________________________________
Signatuie of Canuiuate 0vei Piinteu Name


S0BSCRIBEB ANB SW0RN to befoie me this _______ uay of _____________, 2u14, at ______________.
________________________ EBENEZER BARYL P. NANZAN0, RNT
C0NELEC 0FFICIAL vC-SSC ABvISER

(1x1 pictuie)