COMMISSION ON ELECTIONS FORM

May 13, 2019

National and Local Elections 1
Statement of Contributions and Expenditures SOCE

PART A: PERSONAL INFORMATION OF THE CANDIDATE

A.1. NAME OF CANDIDATE:
(SURNAME) (FIRST NAME) (MIDDLE NAME)

A.2. CANDIDATE TYPE: INDEPENDENT CANDIDATE (Indicate "N/A" for Part A.3.)
(Use "X" in appropriate box)
CANDIDATE WITH SUPPORT OF A POLITICAL PARTY

A.3. NAME of POLITICAL PARTY:

(COMPLETE NAME OF THE PARTY) (ACRONYM)

ELECTIVE POSITION:
A.4. (Skip Part A.5. if national position)
A.5. CONSTITUENCY OF THE ELECTIVE POSITION:

(DISTRICT) Indicate "LONE" if only 1 (CITY/MUNICIPALITY) (PROVINCE/REGION)

CONTACT DETAILS: MOBILE/PHONE NOS.:

A.6.
E-MAIL ADDRESS:

A.7. PERMANENT ADDRESS:

(HOUSE NO./UNIT) (NAME OF BUILDING/SUBDIVISION) (STREET NAME)

(BARANGAY) (DISTRICT/AREA) (CITY/MUNICIPALITY) (PROVINCE)

PART B: CONTRIBUTIONS RECEIVED (Itemized entries in the schedule of contributions, indicate "0.00" if none received)
B.1. CASH CONTRIBUTIONS RECEIVED FROM OTHER SOURCES: ₱0.00
B.2. IN-KIND CONTRIBUTIONS RECEIVED FROM OTHER SOURCES: ₱0.00
B.3. CASH CONTRIBUTIONS RECEIVED FROM POLITICAL PARTY: (for candidates with parties only) ₱0.00
B.4. IN-KIND CONTRIBUTIONS RECEIVED FROM POLITICAL PARTY: (for candidates with parties only) ₱0.00
TOTAL CONTRIBUTIONS RECEIVED ₱0.00

PART C: EXPENDITURES INCURRED (Itemized entries in the schedule of expenditures, indicate "0.00" if none received)
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 EXPENDITURES INCURRED ₱0.00

PART D: CERTIFICATION & ACKNOWLEDGMENT

The undersigned candidate, after being duly sworn to, hereby depose and state that:
(1) This disclosure and its attachments, are supported by receipts, vouchers, and other documents reflecting the full, true, accurate,
and complete contributions received and expenditures incurred by the undersigned candidate and his/her duly authorized
representative;
(2) The expenditures incurred are for lawful purposes and the contributions were not received from persons or entities prohibited by
law to give contributions.
(3) The undersigned consents on the general use and sharing of information obtained in this disclosure and its attachments for
legitimate and authorized purposes.
IN WITNESS WHEREOF, the undersigned hereunto affix his/her signature on [date signed].

AFFIX SIGNATURE HERE

NAME AND SIGNATURE

SUBSCRIBED AND SWORN TO before me on date notarized , affiant exhibiting his/her

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

Doc. No.:
Page No.:
Book No.:
Series of (Place Notarial Seal & Signature here)

THIS SECTION IS FOR COMELEC USE ONLY - DO NOT ENCODE / WRITING ANYTHING BEYOND THIS LINE
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: (This space is for the receiving date/time stamp of the receiving office)