COMMISSION ON ELECTIONS Form SER-C

DATE OF ELECTIONS May 09, 2016 Statement of Expenses on Public Rally (Candidate)
PART A: PERSONAL INFORMATION OF THE CANDIDATE
NAME OF
CANDIDATE'S TIN:
CANDIDATE: (SURNAME) (FIRST NAME) (MIDDLE NAME)

Candidate Type: INDEPENDENT (no political party nomination) E-MAIL ADDRESS:

(Mark with "X") WITH POLITICAL PARTY NOMINATION (CONA) CONTACT NUMBER:
NAME OF PARTY:
(For candidates with CONA) (COMPLETE NAME OF PARTY) (ACRONYM)
District/City/Municipality/
ELECTIVE POSITION:
Province/Region :
Home/Office Address:
NUMBER STREET NAME BUILDING/SUBDIVISION BARANGAY CITY/MUNICIPALITY PROVINCE/REGION

DATE OF RALLY: Rally Venue & Address:

PART B: CONTRIBUTIONS RECEIVED BY CANDIDATE FOR THE PUBLIC RALLY

DATE of Receipt of CONTRIBUTOR'S Contribution Type
Receipt No. NAME OF CONTRIBUTOR ADDRESS OF CONTRIBUTOR AMOUNT / VALUE
CONTRIBUTIONS Taxpayer ID No. (TIN) (Cash/In-Kind)

TOTAL CONTRIBUTIONS (IN CASH & IN KIND) RECEIVED FOR THE PUBLIC RALLY ₱ -

PART C: EXPENSES INCURRED BY THE CANDIDATE FOR THE PUBLIC RALLY

DATE EXPENSE was RECEIPT BUSINESS FIRM/ NAME OF BUSINESS FIRM OR
ADDRESS OF BUSINESS FIRM OR CONTRACTOR DESCRIPTION OF EXPENSE AMOUNT
INCURRED NUMBER CONTRACTOR'S TIN CONTRACTOR

TOTAL EXPENSES INCURRED FOR THE PUBLIC RALLY ₱ -

PART D: CERTIFICATION & ACKNOWLEDGMENT

I hereby certify that: (1) the expenses listed in Part C were made by me as candidate or by my duly authorized SUBSCRIBED & SWORN TO before me this
representative; (2) the contributions listed in Part B were received by me as candidate or by my duly authorized affiant exhibiting his/her expiring on
representative; (3) all entries specified above are true & correct; (4) both contributions & expenses are supported by (Gov't-Issued Identification) (ID Number)
receipts, invoices, & similar documents; (5) the expenses were incurred in accordance with the Omnibus Election , and issued by .
Code & other pertinent laws. (Expiry Date of ID) (Issuing Government Agency)
Doc. No.: ______
Page No.: ______
Book No.: ______
DATE SIGNED Series of 2016. NOTARY PUBLIC
COMMISSION ON ELECTIONS Form SER-P
DATE OF ELECTIONS May 09, 2016 Statement of Expenses on Public Rally (Party)
PART A: PERSONAL INFORMATION OF THE PARTY TREASURER
Name of PARTY
TREASURER:
PARTY'S TIN:
(SURNAME) (FIRST NAME) (MIDDLE NAME)

PARTY TYPE: POLITICAL PARTY E-MAIL ADDRESS:

(Mark with "X") PARTY-LIST ORGANIZATION CONTACT NUMBER:
NAME OF PARTY:
(COMPLETE NAME OF PARTY) (ACRONYM)

Home/Office Address:
(OF THE PARTY) NUMBER STREET NAME BUILDING/SUBDIVISION BARANGAY CITY/MUNICIPALITY PROVINCE/REGION

DATE OF RALLY: Rally Venue & Address:

PART B: CONTRIBUTIONS RECEIVED BY THE PARTY FOR THE PUBLIC RALLY

DATE of Receipt of CONTRIBUTOR'S Contribution Type
Receipt No. NAME OF CONTRIBUTOR ADDRESS OF CONTRIBUTOR AMOUNT / VALUE
CONTRIBUTIONS Taxpayer ID No. (TIN) (Cash/In-Kind)

TOTAL CONTRIBUTIONS (IN CASH & IN KIND) RECEIVED FOR THE PUBLIC RALLY ₱ -

PART C: EXPENSES INCURRED BY THE PARTY FOR THE PUBLIC RALLY

DATE EXPENSE was RECEIPT BUSINESS FIRM/ NAME OF BUSINESS FIRM OR
ADDRESS OF BUSINESS FIRM OR CONTRACTOR DESCRIPTION OF EXPENSE AMOUNT
INCURRED NUMBER CONTRACTOR'S TIN CONTRACTOR

TOTAL EXPENSES INCURRED FOR THE PUBLIC RALLY ₱ -

PART D: CERTIFICATION & ACKNOWLEDGMENT

I hereby certify that: (1) the expenses listed in Part C were made by me as party treasurer or by my duly authorized SUBSCRIBED & SWORN TO before me this
representative; (2) the contributions listed in Part B were received by me as party treasurer or by my duly authorized affiant exhibiting his/her expiring on
representative; (3) all entries specified above are true & correct; (4) both contributions & expenses are supported by (Gov't-Issued Identification) (ID Number)
receipts, invoices, & similar documents; (5) the expenses were incurred in accordance with the Omnibus Election , and issued by .
Code & other pertinent laws. (Expiry Date of ID) (Issuing Government Agency)
Doc. No.: ______
Page No.: ______
Book No.: ______
DATE SIGNED Series of 2016. NOTARY PUBLIC