Anda di halaman 1dari 1

Form AIE

COMMISSION ON ELECTIONS

AUTHORITY TO INCUR ELECTION EXPENDITURES


For the 09 May 2016 National and Local Elections

Date filed:

The undersigned candidate/party treasurer hereby grants the authority to incur election expenses to

his/her agent

(Surname)

(First Name)

(Middle Name)

Said person is authorized to incur expenses for/on behalf of the candidate or party for the upcoming
2016 NLE elections. He/she is only authorized to incur expenses with a maximum limit of:

(
(Amount in words)

).

(Amount in figures)

AFFIX SIGNATURE HERE

[NAME OF CANDIDATE OR PARTY TREASURER]

Before printing, encode name here

Date signed:
PARTY INFORMATION: Accomplish this part only if you are the party treasurer
NAME of PARTY
TREASURER:
NAME OF
PARTY:

(SURNAME)

(FIRST NAME)

(COMPLETE NAME OF PARTY)

PARTY Political Party


TYPE: Party-List Group

(MIDDLE NAME)
(ACRONYM)

Contact information:
(Phone no. & e-mail address)

CANDIDATE INFORMATION: Accomplish this part only if you are a candidate)


NAME OF
CANDIDATE:
Elective
office
sought:
Name of
party:

(SURNAME)

(FIRST NAME)

(MIDDLE NAME)

District,
Municipality/city/province
of elective office:
Contact information:
(Phone no. & e-mail address)

AGENT INFORMATION: (Person authorized to incur expenditures, whose name appears in main body)
Home/Office
Address:
Telephone &
Mobile No.:

E-mail Address:

ACKNOWLEDGMENT
REPUBLIC OF THE PHILIPPINES
)
City/Municipality of __________________)
BEFORE ME, on (date)
and in (city/municipality)
persons with competent evidence of their identity:
Name
Doc. Type
ID No.

, personally appeared the following


Expiry Date

Issuing Authority

Said persons acknowledged under oath to me under penalty of law, that the whole contents of this
document are true and the same are their free and voluntary acts and deeds.
WITNESS MY HAND AND NOTARIAL SEAL.
Doc. No.:
Page No.:
Book No.:
Series of

NOTARY PUBLIC