INSTRUCTIONS; (Read well before filling. up this form.

)
1. File this in AVE (5) LEGIBLE copies. . . .
2. File this certificate of candidacy with the Law Department, COMELEC ~lain Office; Intramuros, Manila, starting November 20, 2009 up to
midnight of November 30, 2009... .
3. Attach to this certificate the Certificate of Party Nominatiorl unless you are an independent candidate. After midnight of·November 30, 2009, no
certificate of nomination shall be accepted.
4 .. TItles such as 'Dr., Atly., Don, Ginoo, Senor, Datu, Hadji, Sultan, Bai, Senora, Kapitan or similar titles are expressly prohibited.
5. This certificate ·shail be sworn before a notary public or any offidal authorized to administer oath. COMELEC officials are not .authorized to
administer oath. . ..' .. _______ -1

3. MY GENDER IS : • 4. MY AGE IS :

51 Male DFema'e .. '1.0.., .

5. I'1Y DATE OFBIRTH IS :
:/~':fO"': fO"';Alfj"-:a>f::2:'Q,
!' •• ~"."P." __ ~
T:
: :-; '. tT·:~l :7Vi "".0>
1.. , ~ I. •• __ .1.

Month Day Year

6. MY PLACE OF BIRTH IS :
City/Mun GfefVj (J TO .
pro\1n~e ~P?:i:1A:t.!-A:r!?!!f!1!:~
7.IAGR7~r:t7hYN~~r/~r;clfc~ateofN£~inatiOn~
......................................................................
Political Pa
!f.. .. ~.t:i!1 c::l5J. AC'
t. - .-..

11. MY POST OfFICE ADDRESS FOR ELECTION PURPOS'ES IS : (Could be the same as No.9)

,..4H.·..lfV~.A.Q,) ~&A Y!.?-rA.-.~f!J?b-'-Y.(J.LQtl Q.C .

'" .W PERIOD Of RESIDENCE IN THE PHILIPPINES BEFORE MAY 10~ 2010 IS :

[Orb]
!. •. __' J
No. of Months [1:01
•••_._~ ••• _J
No. of Years

'14. I AM A NATURAL BORN FIUPINO CmZEN.

:. ~ 'ROLtED THUMBPR.INT- " ...
,', -' ' '
.15. I AM NOT A PERMANENT RESIDENT OF, OR IMMIGRANT TO, A 'FOREIGN
COUNTRY. .'
ie.lAM EUGIBLE FOR-THE OFFICE I SEEK TO BEELEffiO TO .
. 17. I WILL SUPPORT AND D~FEND THE CONSTITUTION OF .THE REPUBLIC OF THE .
.PHILIPPINES AND WILL MAINTAIN TRUE FAITH AND ALLEGIANCE THERETO. I
WILL OBEY THE LAyVS, LEGAL ORDERS AND ·DECREESPROMULGATED BY THE
DULY CONSTITUTED AUTHORITIES. I IMPOSE THIS OBUGATION UPON MYSEI-F
VOLUNTARILY, WITHOUT; MENTAL RESERVATION OR PURPOSE OF EVASION ..
Thumbprint

+-_-+-~_ , ~Iant exhibitiU,9. to me his!ner

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