Republic of the Philippines

Province of La Union
Municipality of Agoo

APPOINTMENT OF POLL WATCHER BY CANDIDATE ON THE BALLOT

To the Presiding BBOC:

The following person has been appointed to serve as a poll watcher on my behalf.
Name of Poll Watcher: ________________________________
Name of Candidate: __________________________________
Residence Address of Poll Watcher: ____________________________________________
Name and Date of Election: Barangay and SK Election, May 14, 2018
Voter Registration VUID Number of Poll Watcher: _______________________________
Precinct or other location Poll Watcher is to serve: ________________________________

_____________________________
Signature of Candidate
_____________________________
Title of Approving Authority
_____________________________
Signature of the Watcher

AFFIDAVIT OF POLL WATCHER

I, ___________________________________, a poll watcher for the above appointing authority,
do hereby swear or affirm that I do not have in my possession any type of mechanical or
electronic means of recording images or sound while serving as a watcher at this precinct or I
will disable or deactivate the device while serving as a watcher.

______________________________
S Signature of Poll Watcher

Sworn to and subscribed before me this ___ day of ___________________, ________.

____________________________
Signature of Board of Canvasser