Republic of the Philippines

COMMISION ON ELECTIONS
Manila
Instructions: Submit this form in five (5) legible copies to the Law Department,
Commission on Elections, Intramuros, Manila not later than March 31, 2001
pursuant to Sec. 8, R.A. No. 7941, in relation to COMELEC Resolution No.
3322.
CERTIFICATE OF NOMINATION
PURSUANT to the power and authority vested in me by the Constitution
and By-Laws of _____________________________, a political party/sectoral
party/organization/coalition duly accredited by the Commission to participate
in the May 14, 2001 elections under the party-list system, the following are
hereby nominated in the order stated as Party-List Representatives:
NAME
1.___________________________
2.___________________________
3.___________________________
4.___________________________
5.___________________________

ADDRESS
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________

I hereby certify that the above nominees have all the qualifications and
none of the disqualifications of party-list nominees; that they are not
candidates for any elective office nor have anyone of them lost his/her bid for
an elective office in the immediately preceding election.
IN WITNESS WHEREOF, I hereunto affix my signature this ____ day of
___________ 2001, in _______________________, Philippines.

__________________________________________
President/Chairman/Corporate Secretary

SUBSCRIBED AND SWORN to before me this _______day of __________,

2001, at ____________, Affiant exhibited to me his/her Community Tax
Certificate No. ____________ issued on ____________ at ____________________,
Philippines.

_________________________________
(Officer Authorized to Administer Oath)

Doc. No. _________;

Page No. _________;
Book No. _________;
Series of 2001.
(Affix documentary stamp)

ACCEPTANCE
1. _____________________________
2_______________________________
3. ______________________________
4. ______________________________
5. ______________________________

Republic of the Philippines

COMMISSION ON ELECTIONS
Manila
Instructions: Prepare this form in five (5) legible copies, attach them to the
Certificate of Nomination and submit to the Law Department, Comelec,
Intramuros, Manila not later than March 31, 2001.

NOMINEE NO. ___________________.

CERTIFICATE OF ACCEPTANCE
I,________________________, a bona fide member of ___________, hereby
accept the nomination as its party list representative in connection with the
May 14, 2001 elections, and after having sworn in accordance with law, depose
and state the following:
c

1. FULLNAME: ___________________________________________________
(Surname/FirstName/Maternal/Maiden Name)
2. PARTY/SECTORAL ORGANIZATION/COALITION: _____________________
3. DATE OF BIRTH: ______________ PLACE OF BIRTH: _________ SEX: ____
4. CIVIL STATUS: ______ IF MARRIED,
FULL NAME OF SPOUSE: ________________________
(Maternal/Maiden Name)
5. I AM A NATURAL BORN FILIPINO CITIZEN.
6. PROFESSION OR OCCUPATION:
_______________________________________________________
7. RESIDENCE (Complete/Exact Address):
_______________________________________________________

(House No./Street/Municipality/City/Province)
8. NO. OF YEARS RESIDENCE IN THE PHILIPPINES IMMEDIATELY
PRECEDING THE MAY 14, 2001 ELECTIONS:
______________________________________________
1. I AM A REGISTERED VOTER OF PRECINCT NO. __________
BARANGAY_____________________ CITY/MUNICIPALITYOF_________________,
PROVINCE
OF_________________________.
2. I AM ELIGIBLE for the office for which I am nominated. I will support
and defend the Constitution of the Philippines, and will maintain true faith and
allegiance thereto; that I will obey the laws, legal orders and decrees
promulgated by the duly constituted authorities of the Republic of the
Philippines; and that I impose this obligation upon myself voluntarily, without
mental reservation or purpose of evasion. I hereby certify that the facts stated
herein are true and correct of my own personal knowledge.
_____________________ 2001.

RIGHT HAND THUMBMARK ___________________________________

(Signature of Nominee)
SUBSCRIBED AND SWORN to before me this ____day of _______, 2001 at
_________, Affiant exhibiting his/her Community Tax Certificate No.
____________ issued on _______ at ___________________________, Philippines.

________________________________________
(Officer Authorized to Administer Oath)
Doc. No. ________;
Page No. ________;
Book No. ________;
Series of 2001.

(Affix documentary stamp)