COMMISSION

May 13, 2019

National and
Statement of Contribu
PART A: PERSONAL INFORM
NAME OF CANDIDATE:
A.1.
(SURNAME)

A.2. TYPE CANDIDATE:

(Use "X" in appropriate box)

A.3. NAME of POLITICAL PARTY:

(COMPLETE

A.4. ELECTIVE POSITION:

A.5. CONSTITUENCY OF THE ELECTIVE POSITION:

(DISTRICT) Indicate "LONE" if only 1 (CITY/

A.6. CONTACT DETAILS: MOBILE/PHONE NOS.:

E-MAIL ADDRESS:

PERMANENT ADDRESS:
A.7.
(HOUSE NO./UNIT)

(BARANGAY) (DISTRICT/AREA)

PART B: CONTRIBUTIONS RECEIVED (Itemized e

B.1. CASH CONTRIBUTIONS RECEIVED FROM OTHER SOURCES:
B.2. IN-KIND CONTRIBUTIONS RECEIVED FROM OTHER SOURCES:
B.3. CASH CONTRIBUTIONS RECEIVED FROM POLITICAL PARTY: (for candida
B.4. IN-KIND CONTRIBUTIONS RECEIVED FROM POLITICAL PARTY: (for cand
TO

PART C: EXPENDITURES INCURRED (Itemized e

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:
T

PART D: CERTIFICATION
The undersigned candidate, after being duly sworn to, hereby depos
(1) This disclosure and its attachments, are supported by receipts, vo
contributions received and expenditures incurred by the undersigned
 (2) The expenditures incurred are for lawful purposes and the contri
contributions.
(3) The undersigned consents on the general use and sharing of inf
authorized purposes.
IN WITNESS WHEREOF, the undersig

AFFIX SIGNATURE HERE

SUBSCRIBED AND SWORN TO before me on

(Type of identification document) (ID Number)

Doc. No.:
Page No.:
Book No.:
Series of

THIS SECTION IS FOR COMELEC USE ONLY - DO NO

Indicate "✓" beside form code/document name if submitted, "✗" if not.
☐ 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:
 ON ELECTIONS
FORM
1
Local Elections
tions and Expenditures SOCE

ATION OF THE CANDIDATE

(FIRST NAME) (MIDDLE NAME)

INDEPENDENT CANDIDATE (Indicate "N/A" for Part A.3.)

CANDIDATE WITH POLITICAL PARTY

NAME OF THE PARTY) (ACRONYM)

(Skip Part A.5. if national position)

MUNICIPALITY) (PROVINCE/REGION)

(NAME OF BUILDING/SUBDIVISION) (STREET NAME)

(CITY/MUNICIPALITY) (PROVINCE)

ntries in the schedule of contributions, indicate "N/A" if none received)

tes with parties only)

idates with parties only)
TAL CONTRIBUTIONS RECEIVED

ntries in the schedule of expenditures, indicate "N/A" if none received)

OTAL EXPENDITURES INCURRED

AND ACKNOWLEDGMENT
e and state that:
uchers, and other documents reflecting the full, true, accurate, and
complete
and his/her duly authorized representative;
butions were not received from persons or entities prohibited by law to give

ormation obtained in this disclosure and its attachments for legitimate and

ned hereunto affix his/her signature on [date signed].

NAME AND SIGNATURE

date notarized , affiant exhibiting his/her

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

(Place Notarial Seal & Signature here)

T ENCODE / WRITING ANYTHING BEYOND THIS LINE

Remarks:

(This space is for the receiving date/time stamp of the receiving office)
 COMMISSION ON ELECTION
May 13, 2019

Schedule of Contributions Receive

NAME OF CANDIDATE:
(SURNAME) (FIRST NAME)

DATE RECEIPT FULL NAME OF

ADDRESS OF CONTRIBUTOR
RECEIVED NUMBER CONTRIBUTOR

TOTAL C
CERTIFICATION
I hereby certify that:(1) the contributions listed above were made to me as a candidate; (2) all SUBSCRIBED
entries specified above are true & correct; (3) they are supported by the official receipts issued by affiant exhibiting his/her
me upon acceptance; (4) the contributions are from sources not prohibited by the Omnibus issued by the
Election Code and other pertinent laws.
 DATA PRIVACY ACT
The undersigned consents on the general use and sharing of information obtained in this disclosure and
its attachments for legitimate and authorized purposes.

Doc. No. ;
Page No. ;

Book No. ;
NAME AND SIGNATURE DATE SIGNED Series of .
S FORM

National and Local Elections 2

d SCR

(MIDDLE NAME)

DESCRIPTION
AMOUNT/VALUE OF CONTRIBUTION
(for in-kind contributions)

ONTRIBUTIONS RECEIVED
ACKNOWLEDGMENT
AND SWORN TO BEFORE ME this
[issuing office] [date of expiry].

NOTARY PUBLIC
 COMMISS
May 13, 2019

Sched

NAME OF CANDIDATE:
(SURNAME)

RECEIPT/ FULL NAME OF

ADDRESS OF BUSINESS FIRM OR
DATE INCURRED INVOICE BUSINESS FIRM OR
CONTRACTOR
NUMBER CONTRACTOR
 CERTIFICATION
I hereby certify that: (1) the expenses listed above were incurred by me as a candidate or by my duly
authorized representative/s; (2) all entries specified above are true and correct; (3) they are supported
by the official receipts, invoices or other similar documents; (4) the expenses comply with Section 102
of the Omnibus Election Code.
DATA PRIVACY ACT
The undersigned consents on the general use and sharing of information obtained in this disclosure and its
attachments for legitimate and authorized purposes.

NAME AND SIGNATURE DATE SIGNED

 ION ON ELECTIONS

ule of Expenditures National and Local Elections

(FIRST NAME)

TIN OF CONTRACTOR or Exp Type

DESCRIPTION OF EXPENSE
BUSINESS FIRM (A-K)
 TOTAL EXPENDITURES INCURRED
ACKNOWLEDGMENT
SUBSCRIBED AND SWORN TO BEFORE ME this
affiant exhibiting his/her
issued by the [issuing office] expiring on

Doc. No. ;
Page No.
; Book No.
;
Series of .
NOTARY
 FORM

3
SCE

(MIDDLE NAME)

AMOUNT/VALUE OF EXPENDITURE
 ₱0.00

[date of oath]

[date of expiry].

PUBLIC
Report of Lawful Expenditures

PART A: PERSONAL INFORM

A.1. NAME OF CANDIDATE:

(SURNAME)

A.2.
CANDIDATE TYPE:
(Use "X" in appropriate box)
A.3. NAME of POLITICAL PARTY:
(COMPLET

A.4. ELECTIVE POSITION:

A.5. CONSTITUENCY OF THE ELECTIVE POSITION:

(DISTRICT) Indicate "LONE" if only 1 (CIT

PART B: SUBTOTAL OF LAWFUL EXPEND

Travel expenses of candidate and campaign personnel during the
A campai

Compensation of campaigners, clerks, stenographers, messengers, and ot

B
Telephone, mobile phone usage fees, prepaid phone load, internet
C access,

Stationery, printing and distribution of printed materials relative to candi

D
Employment of watchers at the polls
E
Rent, maintenance and furnishing of campaign headquarters, office or
F pl

Political meetings and rallies & the use of sound systems, lights and
G deco
Newspaper, radio, TV and other advertisements to promote the candidac
H placements
 PART C: EXPENDITURES INCURRED (
Employment of counsel
I
Copying and classifying lists of voters, investigating and challenging the
J lists
Printing of sample ballots in such color, size and maximum number as m
K
T

PART D: CERTIFICATION A
The undersigned candidate, after being duly sworn to, hereby depose
an
(1) This disclosure and its attachments, are supported by receipts, vou

contributions received and expenditures incurred by the undersigned can

(2) The expenditures incurred are for lawful purposes and the contribu
contributions.
(3) The undersigned consents on the general use and sharing of infor
authorized purposes.
IN WITNESS WHEREOF, the undersig

AFFIX SIGNATURE HERE

SUBSCRIBED AND SWORN TO before me on

(Type of identification document) (ID Number)

Doc. No.:
Page No.:
Book No.:
Series of
 National and Local Elections
FORM

Sum mary 4
SLE

ATION OF THE CANDIDATE

(FIRST NAME) (MIDDLE NAME)

INDEPENDENT CANDIDATE (Indicate "N/A" for Part A.3.)

CANDIDATE WITH POLITICAL PARTY

E NAME OF THE PARTY) (ACRONYM)

(Skip Part A.5. if national position)

Y/MUNICIPALITY) (PROVINCE/REGION)

ITURES PER EXPENSE TYPE/CATEGORY

gn and incidental personal expenses

her persons employed in the campaign

postages, freight and courier charges

dacy;

ce of meetings
a
rations during said meetings and rallies

y, including website/internet ad
 SUBTOTAL

temized entries in Schedule of Expenditures)

right to vote of persons registered in the

ay be authorized by the Commission

OTAL EXPENDITURES INCURRED

ND ACKNOWLEDGMENT
d state that:
chers, and other documents reflecting the full, true, accurate, and complete

didate and his/her duly authorized representative;

tions were not received from persons or entities prohibited by law to give

mation obtained in this disclosure and its attachments for legitimate and

ned hereunto affix his/her signature on [date signed].

NAME AND SIGNATURE

date notarized , affiant exhibiting his/her

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

(Place Notarial Seal & Signature here)

 COMMISSIO
May 13, 2019

Schedule of Un

NAME OF CANDIDATE:

(SURNAME) (FIRS

DATE CONTRACT / LOAN

NAME OF CREDITOR ADDRESS OF CREDITOR
INCURRED NO.
 CERTIFICATION
I hereby certify that: (1) the obligations listed above were incurred by me as a SUBSCRIBED A
affiant exhibiting his/her
candidate or with my authority by my duly authorized representative; (2) all entries
issued by the
specified above are true & correct ; (3) they are supported by contracts,
promissory notes & other similar documents.
DATA PRIVACY ACT
The undersigned consents on the general use and sharing of information obtained in this
disclosure and its attachments for legitimate and authorized purposes.

Doc. No. ;
Page No.
; Book No.
NAME AND SIGNATURE DATE SIGNED ;
Series of .
N ON ELECTIONS FORM

National and Local Election

5
SUO
paid Obligations

T NAME) (MIDDLE NAME)

AMOUNT/VALUE OF OBLIGATION

TOTAL UNPAID OBLIGATIONS

 ACKNOWLEDGMENT
ND SWORN TO BEFORE ME this [date of oath]

[issuing office] expiring on [date of expiry].

NOTARY PUBLIC