Annex “K-*”

*.* House No./ Street / Subdivision

3.1 Province

Male

1.1 Last Name

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CERTIFICATE OF CANDIDACY FOR

MEMBER, SANGGUNIANG

BARANGAY

1. NAME:

1.2 First Name

1.3 Middle Name

INSTRUCTIONS: (Please read well before filling-out the COC form.) 1. Fill-out the items completely. Write N/A if an item is not applicable. 2. Print the COC Form on BOTH SIDES (front and back) of a FOLIO (8.5”x13”) or LEGAL (8.5”x14”) size copy paper. 3. Titles such as Dr., Atty., Don, Ginoo, Señor, Datu, Sultan, Bai, Señora, Kapitan or other similar titles are expressly prohibited. 4. This certificate shall be sworn before a notary public or any official authorized to administer oath. The Election Officer may administer the oath on the COCs filed within their area of jurisdiction, free of charge. 5. File this in THREE (3) LEGIBLE copies with the COMELEC Office concerned, on any day from August 28, 2023 (Monday) to September 2, 2023 (Saturday), from 8:00 AM to 5:00 PM ONLY.

6. No filing fee shall be imposed.

I hereby announce my candidacy for the position of MEMBER, SANGGUNIANG BARANGAY of BARANGAY, City/Municipality of, Province of, in the October 30, 2023 Barangay and Sangguniang Kabataan (SK) Elections; and after having been sworn to in accordance with law, I hereby state the following: 3.2 City/Municipality 3.3 Barangay

15. AGE ON ELECTION DAY:

Female

14. SEX:

2. NICKNAME OR STAGENAME: (Indicate only one nickname or stage name) Month Day Year

3. RESIDENCE/ADDRESS:

City/Mun.

Province

Precinct

16. DATE OF BIRTH:

5.1 In the Philippines:

5.2 In the above-stated Barangay:

City/Mun.

Single Widow/er

Province

Married

17. PLACE OF BIRTH:

4. ADDRESS FOR ELECTION PURPOSES: (Could be the same as No.3) No. of Years No. of Months

Full Name of Spouse, if married

No. of Years No. of Months

I hereby certify that the facts stated herein are true and correct to the best of my knowledge. 18. CIVIL STATUS:

5. PERIOD OF RESIDENCE IN THE PHILIPPINES UP TO THE DAY BEFORE OCT. 30, 2023: Barangay

6. I AM A FILIPINO CITIZEN.

7. I EXECUTED A SWORN RENUNCIATION OF FOREIGN CITIZENSHIP. (IF APPLICABLE, ATTACH A COPY) 8. I AM NOT A PERMANENT RESIDENT OF, OR AN IMMIGRANT TO, A FOREIGN COUNTRY. 9. I AM ELIGIBLE FOR THE OFFICE I SEEK TO BE ELECTED TO. 10. I WILL FILE, WITH THE OFFICES OF THE COMMISSION, WITHIN THIRTY (30) DAYS AFTER ELECTION DAY, MY FULL, TRUE AND ITEMIZED STATEMENT OF CONTRIBUTIONS AND EXPENDITURES (SOCE) IN CONNECTION WITH THE ELECTION.

11. 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.

12. I SHALL NOT ADVOCATE VIOLENCE OR UNLAWFUL MEANS TO ACHIEVE MY GOALS. 13. I GIVE CONSENT TO THE COMMISSION ON ELECTIONS TO COLLECT, DISCLOSE OR SHARE, AND PROCESS THE PERSONAL DATA I PROVIDED HEREIN FOR ELECTION AND OTHER LAWFUL PURPOSES IN ACCORDANCE WITH THE PRIVACY NOTICE AT THE BACK OF THIS FORM, AND AS MAY BE AUTHORIZED BY EXISTING LAWS. 19. PROFESSION OR OCCUPATION:

21. OFFICIAL E-MAIL ADDRESS:

(For notice and election purposes)

Signature of Candidate over Printed Name

OATH

SUBSCRIBED AND SWORN to before me this day of, 2023, at, affiant exhibiting to me an Identification document/card which contains a photograph and signature bearing No. issued by on .

Doc. No. ;

Page No. ; (Affix P30.00 documentary stamp) Book No. ; (Officer Authorized to Administer Oath) Series of 2023.

THIS FORM CAN BE PHOTOCOPIED OR REPRODUCED AND IS AVAILABLE AT THE COMELEC OFFICES FREE OF CHARGE OR MAY BE DOWNLOADED FROM THE COMELEC OFFICIAL WEBSITE (www.comelec.gov.ph) FRONT 22.

Yes

(Please provide details at the back)

Have you ever been found liable for an

offense which carries with it the accessory

penalty of perpetual disqualification to

hold public office, which has become final

and executory?

No

Must be at least eighteen

(18) years old on election

day

20. I AM A REGISTERED VOTER OF:

The collected personal data will be encoded in the information system developed by the Commission on Elections (COMELEC). The personal data inputted in the information system will be used by the COMELEC in the preparation, posting and/or publication of the list of candidates and other election-related documents or forms.

For legitimate research needs and inquiries, and only for the purposes specified in the request, the COMELEC may disclose and share your COC and/or its contents. Moreover, the COMELEC may use and disclose your COC and/or its contents in any proceeding or investigation in which your COC and/or its contents is/are in issue or may find relevance. Only authorized personnel are allowed to access and process your personal data. Immediately after the election period or upon the expiration of the storage period set in existing COMELEC rules and policies, and laws and regulations, whichever applies, the physical and digital copies of your personal data will be anonymized, deleted, and discarded following the disposition procedures of the COMELEC and the National Archives of the Philippines.

You have the right to ask for a copy of your COC or any personal data it contains. Also, you may withdraw your candidacy in accordance with the COMELEC rules and policies on the matter.

If you have questions regarding this Privacy Notice, please send an email to ad0ixo@r.postjobfree.com. BACK

Case Docket Case Title Date Filed Status

Name of the Substitute Spouse, if applicable

(in case of death of candidate)

Contact this candidate