All information stated in this application are subject to resolution No.

2048-A and the Data Privacy Act of 2012 (R.A. No. 10173), and are deemed confidential and no access by the public is
authorized.

All authorized recipient of any personal data, personal information, privileged information and sensitives personal information contained in this document, including other pertinent
documents attached thereto that are shared by the commission on elections in compliance with existing laws and rules, and in conformity with the Data Privacy Act and its Implementing
Rules and Regulations, as well as the pertinent circular of the National Privacy Commission, are similarly bound to comply with said laws, rules and regulations, relating to data privacy,
security, confidentiality, protection and accountability.

CBFSP FORM NO. 2017-02 SA

(in 3 copies with CD attached)

Republic of the Philippines

COMMISSION ON ELECTIONS
Intramuros, Manila

COMMITTEE ON BAN ON FIREARMS AND SECURITY PERSONNEL

(CBFSP)

Barangay and Sangguniang Kabataan Elections

October 23, 2017

APPLICATION FOR AUTHORITY TO BEAR FIREARMS

with AFFIDAVIT OF UNDERTAKING

NAME OF AGENCY : GOLDLINK SECURITY & INVESTIGATIVE SERVICES, INC.

ADDRESS : _UNIT 301 3rd FLOOR, TGHC BUILDING, 125 K-1ST STREET, BRGY.
KAMUNING, QUEZON CITY.

I, CRISPIN G. DANTES of legal age, Filipino, after having been duly sworn to in accordance
with law, do hereby undertake that:

1) I am the President, of the above named security agency

(Position)

and I am authorized to apply for the issuance of a Certificate of Authority Security

agencies under COMELEC Resolution No. 10015. My certificate of Employment and
Authorization is attached hereto as Annex A.

2) Our Agency is duly licensed to operate by the Philippine National Police Attached hereto
as Annex B is a photocopy of our License to Operate

3) All the personnel in Form 17A-02 attached hereto and contained in the compact disc
(CD) submitted herewith, are in the plantilla of our agency, receiving regular
compensation for the services rendered there in and performing actual security or
protection services in their assigned stations;

4) The data, including the name/s and licenses of the security personnel with details of their
authorized firearms, in Form 17A-02, are real, true, and correct. particularly the
following;

5) Our security personnel, when in the possession of firearms, shall be:

a. In the agency-prescribed uniform with the agency-issued identification card

prominently and visible at all times, showing clearly the name and position;
b. In possession of a valid license to Exercise Security Profession (LESP) with Duty
Detail Order (DDO), and;
c. In the actual performance of duty at his specified place or area of duty.

6) The 4 x 5 colored picture with full description of the authorized uniform for the security
personnel is in Form 17B which is attached herein;

Page 1 of 2
Goldlink Security & Investigative Services, Inc.
All information stated in this application are subject to resolution No. 2048-A and the Data Privacy Act of 2012 (R.A. No. 10173), and are deemed confidential and no access by the public is
authorized.

All authorized recipient of any personal data, personal information, privileged information and sensitives personal information contained in this document, including other pertinent
documents attached thereto that are shared by the commission on elections in compliance with existing laws and rules, and in conformity with the Data Privacy Act and its Implementing
Rules and Regulations, as well as the pertinent circular of the National Privacy Commission, are similarly bound to comply with said laws, rules and regulations, relating to data privacy,
security, confidentiality, protection and accountability.

7) The actual place/area of duty of the security personnel are stated in the Monthly Disposition
Report (MDR) which is attached hereto as Annex c.
8) All the required license and permit are still valid, updated and will not expire during the
election period from September 23, 2017 (SATURDAY) to October 30, 2017
(MONDAY).

9) I have paid the amount of _____________________________ (Php __________) as evidence by

O.R. No. _____________________ dated ____________________.

10) I acknowledge that the filing fee is non-refundable, whether or not the application is
approved.

11) I understand that any misrepresentation or false statement in this Undertaking or its
attachments shall be a ground for the denial of the application or the revocation of an
approved certificate of Authority. This is without prejudice to the filing of the appropriate
criminal, civil, administrative, and or election offense charge/s.

12) The statements stated herein are all willingly, freely and voluntarily executed to attest to
the truth of the foregoing facts in connection with this application.

IN WITNESS WHEREOF, I have hereunto affixed my signature and seal of my office on this
____day of __________, 201__, in the City/Municipality of ___________, Philippines.

MR. CRISPIN G. DANTES

(Name and Signature)
HEAD OF AGENCY

Republic of the Philippines)

City of __________________ ) S.S.

SUBCRIBED AND SWORN TO BEFORE me this ____ day of ________________ 201__, in

the City/Municipality of __________________, Republic of the Philippines personally appeared to me
___________________________ with Identification No. ________ issued by _____________ on
_______________________ in _________________.

Notary Public/Administering Officer

Document No.: ___________

Page No. : ___________
Book No. : ___________
Series of 201__

N.B. Please attach Form 17A-02, Form 17B and Annexes

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Goldlink Security & Investigative Services, Inc.