Annex "K-2"

CERTIFICATE OF CANDIDACY FOR Amx Latest

CHAIRPERSON, Photo Here

Passport Size
SANGGUNIANG KABATAAN I

INSTRUCTIO Si (Pl€ase read well before filling-out be COC form.)

l. Fill'out the items compl€tev, WriLe N/A if an item is not applicable.
Z. Print the COC Form on BOTH SIDES (front and back) of a F()UO (8.5" x l3') or LEGAL (8.5'or l4') size copy paper.
l. Tides such as Dr,, Atty., Don, Ginoo, Seffor, Datu, Sultan, Bai, Scior., Xapit n or other simalar tides are expressly p.ohibited.
1. This certificate shall be sworn before a notary public or ahy officlal .uthorized to admlnlster oath, The Eleclioh Officer may .dmininer the oath on the
COC5 filed within their area ofiurisdiction, fr€e of charge,
5. File this in TXREE (3) LEGIBLE copies with the COI4ELEC Offrce concerned, on any day ftom Augud 2a, 2023 (Monday) to September 2, 2023 (Saturday), from
a:OO Al'l to 5:OO Pll OI{LY.
3. No filillg fee shall be imposed.
I hereby announce my candidacy for the position ot CHAIRPERSOry SANGGUNANG KABATAAN of EARANGAY
City/Municipality of , Province of . in the October 30, 2023 Barangay and Sangguniang (abataan
(SK) El€ctions; end after heving been sworn to in ac.ordance with law, I hereby state the following:

1. NAME: 17. SEX: 18. AGE ON ELECTION DAY:

1.1 Last Name TTTTTTTT_II
l lT ltIu
t
Years t4onth/s Dav/s
1.2 First Name Mu{ b€.t han eignte€n (18)
yea6 old bln nc* M€ dla.

Ill|l
twnty-fd, (24) r!.rs old on
1.3 Middle Name

2. NICKNAME OR STAGENAME: (lndicate only one nickname or stage name

|llI ektio. day. (Som
1999 to O.t. ]o,
6 O(t. 10,
p4 the
2005 to

19. OATE OF BIRTH:

L
I L] ] I

l'.1onth Day
3. RESIDENCE/ADDRESS:
3.1 Province
T_ITTTTI 20. PLACE OF BIRTH
3.2 Clty/Nlunr( pa ity 3.3 Barangay City/14un

L] TTI T]
3.4 House No./ Street / Subdivision

tTIl_m
21. CIVIL STATUS
Single

!larried
4. ADDRESS FOR ELECTION PURPOSEST (Could be the same as No.3)
FullNare of Spolse, il turied

22. PROFESSION OR OCCUPATION:

5. PERIOD OF RESIDENCE IN THE PHILIPPINES UP TO THE DAY AEFORE OCT.30, 2023:

23. I AM A REGISTEREO VOTER OF:
5.1 ln the Philippines: No. of Years TI_l No. of l'lonths rT l Precinct

5.2 In the above-stated Earangay No. of Years flt No. of Months Trt Barangay

City/N1un.

6. I AI.,' A FILIPINO Provlnce

7, I EXECUTED ASWORN 'ITIZEN.
RENUNCIAT'ION OF FOREIGN CMZENSHIP. OFAPPLICABLE, ATTACH A COPY)
8. I At4 NOT A PERMANENT RESIDENT OF, OR AN IMI,4IGRANT TO, A FOREIGN COUNTRY. 24. OFFICIAL E-MAIL ADDRESS
I Ar,l A QUAIInED VOTER OF THE KAT]PUNAN NG KABATAAN OF THE ABOVE'STATED EARANGAY. (For notice and election purposes)
10, I AIY NOT RELATED WTTHIN THE 2TD CIVIL DEGREE OE CONSANGUINIIY OR AFFINITY TO ANY INCUMBENT ELECTED
NATIONAL OTFICIAL ORTOANY INCUMBENT ELECIED REGIONAL, PROVINCIAL, CIry, MUNIOPAT, OR EAf(ANGAY OFFICIAL IN
THE LOCILITY WHERE I SEEKIO BE ETECIED TO.
11. I HAVE NoT EEEN CONVICTEO BY FINAL IUDGIqENT OF T,NY CRI|,4E lNVOlvlNG I'4oR L TURPITUDE.
L2. I AII4 ELIGIELE FOR THE OfFICE I SEEX IO 8E ELECTED TO. 25. Have yoLr ever been found liable for an
13, I wIL! FILE, VWIH THE oFFlcEs oF THE col"ll'4I5SION, WIIHIN THIRTY (30) oAYS ArTER ELEfioN DAY, MY EULL, TRUE AND offense which carries with it the
rTEIIIZED STATTMENT OF COiITRISUTIONS Al,lD EPENDmJRES (SOCt) IN CONNECIION WTTH THE ELECTION. accessory penalty of perpetual
I WILL SUPPOR-T ANO OEFEND THE CONSITIUTION OF THE REPUBLIC OF THE PHIUPPINES AND WILL MAINTAJN TRUE FAITH
ANO AILEGIANCE THERETO. I WILL OBEY THE LAWS, LfGAT OROERs, ANO DECREES PROMUTGATED 8Y THE OULY
disqualificrtion to hold public office,
CONSIITUIED AUIHORITIES, I IMPOSE THIS OBUGAT1ON UPON IIYSELF VOLUNIARILY, WTTHOUT I"IENIAI RESERVATION OR which has become final and execllory?
PURPOSE OF EVASION,
15.
16.
I SHALL NOI ADVOCATE VIOLENCE OR UNLAWFUL MEANS TO ACHIEVE I'lY GOATs,
I GrvE coNSEr,lT TO THE COMI4ISSIoN oN ELECTIONS TO COLLECT, DISCLOSE OR SHARE, AND PRoCESS THE PERSONAI
OATA I PROVIDED HEREIN FOR ELECTION AND OTHER LAWFUL PURPOSES IN ACCORDATICE WrIH THE PRIVAC/ NOT1CE AT
n Yes (Phase provide details at the
back)
THE &qC( Or THIS FORH, ANO AS r"lAY 8E AUIHoRIZED BY EXISTING LAWS. No

I hereby certify that the facts stated herein are Uue and correct to the best of my knowledge.

Sigrature olC.ndid.t. ove. Print€d Name

OATH
SUBSCRIBED AND SWORN to before me this day of 2023, al affiant exhibiting to me an
Identification documenvcard which contains a photograph and signature bearing No, issued by
-
Doc. No.
Page No. (Afilx P30 0o dcumentary stamp)
Book No. _; (Officer Authorized to Administer Oath)
Series of -;
2023.
-;
THIS FORM c,AN 8E PHO-IOCOPIED oR REPROoUCED Al'lO Is AvAILABtf aT IHE CoMElEc oTFICES FREE of CH RGE
OR MAY BE DOWNLOAOEO MON THE COMELEC OFFICTAL WEESTTE (!AAA.!986:,S9!Ab)
 Case Docket Case Title Date Filed Status

Name of the Substitute Spouse, if applicable

(io case ofdeath ofcandidat,

The colle.ted personal data will be encoded in the informauon system developed by the Commission on Elections (COMELEC). The personal
data inputted in the infomaton system will be used by the COMELEC in th€ preparation, postrng and/or publication of the list of candidates
and other election{elated documents or forms.

for legitjmate
research needs and inquiries, and only for the purposes specified an the reque4 t'le COMLEC may disclose and share your COC
andlor its contents. Moreover, the COMELEC may use and disclose you. COC and/or its contents in any proceeding or investigatioo in which
your COC and/or its contents is/are in issue or may find relevance.

Ooly authorized p€rsonnel are allowed to access and procqss yoor personal data. Immediately after the ehction period or upon the expiration
ofthe storage period set in existing COM€LEC rules and policies, and laws and regulations, whichever applies, the physical and digitalcopies of
your personal data wlll be anonymized, deleted, and discarded fo owing the dispositon procedures of the COTYELEC and the Natlonal Archives
of the Philippines.

You have rhe right to ask for a copy of your COC or any pelsonal data it contains. Also, you may withdraw yoUI candidacy in accordance with
the COMELEC rules and policies on the matter.

Ifyou have questions regarding this Privacy Notice, please send an emailto dpo@comekc.gouph.