Republic of the PhilippinesCOMMISSION ON ELECTIONS Polomolok, South Cotabato Affix Latest Photo Here (1 – ½ x 1 – ½) CERTIFICATE OF CANDIDACY FOR SANGGUNIANG KABATAAN CHAIRMAN INSTRUCTIONS: (Read well before filling up this form.) 1. File personally or through your duly authorized representative, in FIVE (5) LEGIBLE copies with the Ofce of the Election Ofcer in your city/municipality, during regular working hours on February 07, 09 & 10, 2015 up to 5:00PM only. If fled through a representative, a written authority under oath must be presented. 2. Your certifcate of candidacy will not be accepted by the Election Ofcer if you are not a member of the Katipunan ng Kabataan in the barangay where you seek to be elected. 3. Title such as ‘Dr., Atty., Don, Ginoo, Senor, Datu, Hadji, Sultan, Bai, Senora, Kapitan or similar titles are expressly prohibited. 4. This certificate shall be sworn before a notary public or any oficial authorized to administer oath. I hereby announce my candidacy for the position of Sangguniang Kabataan Chairman of Barangay , Municipality of , Province of on February 21, 2015 Sangguniang Kabataan Elections; and after having been sworn to in accordance with law, hereby state the 3. MY GENDER 4. MY AGE IS: following: IS: 1. MY NAME IS : Male 1.1 Last Name Female 5. MY DATE OF BIRTH IS: 1.2 First Name 1.3 Middle Name Month City / Mun. Province 7. MY CIVIL STATUS IS: 8.1 Province 8.2 City / Municipality Barangay Year 6. MY PLACE OF BIRTH IS: 2. I AM GENERALLY OR POPULARLY KNOWN BY THE NICKNAME OR STAGENAME : (Indicate only one nickname or stage name) 8. MY RESIDENCE/ ADDRESS IS: Day 8.3 Single Widow/er Married Legally Separated Annulled / Divorced Full Name of Spouse, If Married 8.4 House No./ Street / Subdivision 10. MY POST OFFICE ADDRESS FOR ELECTION PURPOSES IS: (Indicate if the same as No. 8) 9. MY PROFESSION OR OCCUPATION IS: 11. MY PERIOD OF RESIDENCE IN THE PHILIPPINES BEFORE FEBRUARY 21, 2015 IS: 12. I AM A MEMBER OF KATIPUNAN NG KABATAAN OF: No. of Months No. of Years Precinct 13. I AM A FILIPINO CITIZEN. 14. I AM A MEMBER OF THE KATIPUNAN NG KABATAAN IN THE BARANGAY WHERE I SEEK TO BE ELECTED. 15. I AM A RESIDENT OF THE BARANGAY WHERE I SEEK TO BE ELECTED FOR AT LEAST ONE YEAR BEFORE THE SANGGUNIANG KABATAAN ELECTION. 16. I AM NOT A PERMANENT RESIDENT OF, OR IMMIGRANT TO, A FOREIGN COUNTRY. 17. I POSSESS ALL THE QUALIFICATIONS AND NONE OF THE DISQUALIFICATIONS FOR THE OFFICE I SEEK TO BE ELECTED. 18. I WILL SUPPORT AND DEFEND THE CONSTITUTION OF THE REPUBLIC OF THE PHILIPPINES AND WILL MAINTAIN TRUE FAITH AND ALLEGIANCE THERETO. I WILL OBEY THE LAWS, LEGAL ORDERS AND DECREES PROMULGATED BY THE DULY CONSTITUTED AUTHORITIES. I IMPOSE THIS OBLIGATION UPON MYSELF VOLUNTARILY, WITHOUT MENTAL RESERVATION OR PURPOSE OF EVASION. 19. I RECOGNIZE THE AUTHORITY OF THE ELECTION OFFICER OR HIS REPRESENTATIVE NOT TO ACCEPT MY CERTIFICATE OF CANDIDACY IN CASE I AM NOT A MEMBER OF THE KATIPUNAN NG KABATAAN IN THE BARANGAY. Barangay City / Mun. Province ROLLED THUMBPRINT Right Thumbprint I hereby certify that the facts stated herein are true and correct of my own personal knowledge. Signature of Candidate Above Printed Name OATH SUBSCRIBED AND SWORN to before me this his/her Identification Card No. Issued by: day of , 2015 at On: (Afx documentary stamp) , afant exhibiting to me . (Oficer Authorized to Administer Oath) . _. Book No. _.Doc. No. _. Series of 2015. Page No.