COMMISSION ON ELECTIONS 14 MAY 2018 SYNCHRONIZED BARANGAY AND SANGGUNIANG KABATAAN ELECTIONS Form SAC

Date of Report: Summary of Advertising Contracts

NAME OF MEDIA ENTITY: STATION/OFFICE:

Name of Authorized JOB TITLE/POSITION:

(SURNAME) (FIRST NAME) (MIDDLE NAME)
Representative: TIN of MEDIA ENTITY:
Office Address:
E-mail Address: Telephone/Mobile No.:
CONTRACT CONTRACT RECEIPT NAME of PAYOR / CLIENT / NAME of CANDIDATE or CONTRACT PARTICULARS
AMOUNT / VALUE
DATE NUMBER NUMBER AD AGENCY (paid for ad) PARTY (pol ad beneficiary) (medium,period,frequency,duration,timeslot,etc)

CERTIFICATION AND ACKNOWLEDGMENT

The undersigned, being the duly authorized representative of 0 SUBSCRIBED & SWORN TO before me this
after being duly sworn, do hereby certify that: affiant exhibiting his/her expiring on
(1) the foregoing advertising contracts listed herein were made for the purpose of the elections; & (Gov't-Issued Identification) (ID Number)
(2) that all the information provided and stated in this report are true and correct. , and issued by .
(Expiry Date of ID) (Issuing Government Agency)
Doc. No.: ______
Page No.: ______
Book No.: ______
DATE SIGNED Series of 2016. NOTARY PUBLIC