COMMISSION ON ELECTI

May 13, 2019

and Local Elections

Statement of Contributions and
PART A: PERSONAL INFORMATION OF THE HEAD / TREAS
A.1. NAME OF PARTY TREASURER:
(SURNAME)

A.2. PARTY TYPE:

(Use "X" in appropriate box)
A.3. NAME OF PARTY:
(COMPLETE NAME OF T
A.4. CONSTITUTENCY OF THE POLITICAL PARTY: (Indicate "NA" if not applicable, as in the

(DISTRICT) Indicate "LONE" if only 1 (CITY/MUNICIPAL

A.5. CONTACT DETAILS OF PARTY: MOBILE/PHONE NOS.:

E-MAIL ADDRESS:
A.6. PERMANENT ADDRESS OF PARTY:
(HOUSE NO./UNIT)

(BARANGAY) (DISTRICT/AREA)

PART B: CONTRIBUTIONS RECEIVED (Itemized entries in the sched

B.1. CASH CONTRIBUTIONS RECEIVED FROM OTHER SOURCES/NON-MEMBERS:
B.2. IN-KIND CONTRIBUTIONS RECEIVED FROM OTHER SOURCES/NON-MEMBER
B.3. CASH CONTRIBUTIONS RECEIVED FROM PARTY MEMBERS:
B.4. IN-KIND CONTRIBUTIONS RECEIVED FROM PARTY MEMBERS:
TOTAL CON

PART C: EXPENDITURES INCURRED (Itemized entries in the schedu

C.1. EXPENDITURES PAID OUT OF PARTY FUNDS (EXISTING OR MEMBER CONTRIBUTIO

C.2. EXPENDITURES PAID OUT OF CASH CONTRIBUTIONS FROM OTHER SOURCES/NON

C.3. EXPENDITURES INCURRED USING IN-KIND CONTRIBUTIONS FROM MEMBERS:
C.4. EXPENDITURES INCURRED USING IN-KIND CONTRIBUTIONS FROM OTHER SOURC
TOTAL EXP
 PART D: CERTIFICATION AND ACKNO
The undersigned candidate, after being duly sworn to, hereby depose and state that:
(1) This disclosure and its attachments, are supported by receipts, vouchers, and oth
contributions received and expenditures incurred by the undersigned candidate and his
(2) The expenditures incurred are for lawful purposes and the contributions were no
contributions.
(3) The undersigned consents on the general use and sharing of information obtain
authorized purposes.
IN WITNESS WHEREOF, the undersigned hereun

AFFIX SIGNATURE HERE

SUBSCRIBED AND SWORN TO before me on

(Type of identification document) (ID Number)

Doc. No.:
Page No.:
Book No.:
Series of

THIS SECTION IS FOR COMELEC USE ONLY - DO NOT ENCODE / W

Indicate "✓" beside form code/document name if submitted, "✗" if not.
☐ SCR (Sched of Contributions Rcvd) ☐ Contribution Receipts
☐ SOE (Sched of Expenditures) ☐ Expenditure Receipts
☐ SUO (Sched of Unpaid Obligations) ☐ Obligations Payable
☐ SLE (Sum. Report of Lawful Exp.) NO. OF PAGES: _________
☐ Others: pls. specify:
 ISSION ON ELECTIONS
FORM

and Local Elections

A National
SOCE
ontributions and Expenditures
F THE HEAD / TREASURER OF THE ELECTORAL PARTY

(FIRST NAME) (MIDDLE NAME)

PARTY-LIST ORGANIZATION
POLITICAL PARTY

(COMPLETE NAME OF THE PARTY) (ACRONYM)

" if not applicable, as in the case of national parties or certain party-list groups)

(CITY/MUNICIPALITY) (PROVINCE/REGION)

(NAME OF BUILDING/SUBDIVISION) (STREET NAME)

(CITY/MUNICIPALITY) (PROVINCE)

D (Itemized entries in the schedule of contributions, indicate "N/A" if none received)

RCES/NON-MEMBERS:
OURCES/NON-MEMBERS:
MBERS:
EMBERS:
TOTAL CONTRIBUTIONS RECEIVED

(Itemized entries in the schedule of expenditures, indicate "N/A" if none received)

R MEMBER CONTRIBUTIONS):

M OTHER SOURCES/NON-MEMBERS:
NS FROM MEMBERS:
NS FROM OTHER SOURCES:

TOTAL EXPENDITURES INCURRED

CATION AND ACKNOWLEDGMENT
y depose and state that:
eceipts, vouchers, and other documents reflecting the full, true, accurate, and complete
ersigned candidate and his/her duly authorized representative;
the contributions were not received from persons or entities prohibited by law to give

ing of information obtained in this disclosure and its attachments for legitimate and

F, the undersigned hereunto affix his/her signature on [date signed].

NAME AND SIGNATURE

date notarized , affiant exhibiting his/her

issued by expiring on [date of expiry].
(Government Agency issuing the ID)

(Place Notarial Seal & Signature here)

- DO NOT ENCODE / WRITING ANYTHING BEYOND THIS LINE

REMARKS:

(This space is for the receiving date/time stamp of the receiving office)
 COMMISSION ON ELECTIONS
May 13, 2019
Nati
Schedule of Contributions Received

NAME OF PARTY:
(COMPLETE NAME OF PARTY)

DATE FULL NAME OF

RECEIPT NUMBER ADDRESS OF CONTRIBUTOR
RECEIVED CONTRIBUTOR

TOTAL CONT
 CERTIFICATION
I hereby certify that: (1) the contributions listed above were made to me as party treasurer; (2) all entries
specified above are true and correct; (3) they are supported by the official receipts issued by me upon
acceptance; (4) the contributions are from sources not prohibited by the Omnibus Election Code and
other pertinent laws.
DATA PRIVACY ACT
The undersigned consents on the general use and sharing of information obtained in this disclosure and its
attachments for legitimate and authorized purposes.

NAME AND SIGNATURE DATE SIGNED

 ON ELECTIONS FORM

National and Local Elections B

ributions Received SCR

MPLETE NAME OF PARTY) (ACRONYM)

DESCRIPTION AMOUNT/VALUE OF
(for in-kind contributions) CONTRIBUTION

TOTAL CONTRIBUTIONS RECEIVED

 ACKNOWLEDGMENT
SUBSCRIBED AND SWORN TO BEFORE ME this
affiant exhibiting his/her
issued by the [issuing office] [date of expiry].

Doc. No. ________;

Page No. ________;
Book No. ________;
Series of ________. NOTARY PUBLIC
 COMMISSION ON ELECTIONS
May 13, 2019
Nati
Schedule of Expenditures

NAME OF PARTY:
(COMPLETE NAME OF PARTY)

RECEIPT /
DATE FULL NAME of BUSINESS ADDRESS OF BUSINESS FIRM OR
INVOICE
INCURRED FIRM OR CONTRACTOR CONTRACTOR
NUMBER
 CERTIFICATION
I hereby certify that: (1) the expenses listed above were incurred by me as treasurer of the party or by my
duly authorized representative/s; (2) all entries specified above are true and correct; (3) they are
supported by the official receipts, invoices or other similar documents; (4) the expenses comply with
Section 102 of the Omnibus Election Code.
DATA PRIVACY ACT
The undersigned consents on the general use and sharing of information obtained in this disclosure and its
attachments for legitimate and authorized purposes.

NAME AND SIGNATURE DATE SIGNED

ION ON ELECTIONS FORM

National and Local Elections

C
SCE
le of Expenditures

ETE NAME OF PARTY) (ACRONYM)

TIN OF CONTRACTOR DESCRIPTION Type AMOUNT/VALUE OF

or BUSINESS FIRM OF EXPENSE (A-K) EXPENDITURE

TOTAL EXPENDITURES INCURRED

 ACKNOWLEDGMENT
SUBSCRIBED AND SWORN TO BEFORE ME this [date of oath]
affiant exhibiting his/her
issued by the [issuing office] expiring on [date of expiry].

Doc. No. ________;

Page No. ________;
Book No. ________;
Series of ________. NOTARY PUBLIC
 COMMISSION ON ELECTIO
May 13, 2019

National and Local Elect

Summary Report of Lawful Expen
PART A: PERSONAL INFORMATION OF THE ELECTORAL PA
A.1. PARTY TREASURER'S NAME:
(SURNAME)

A.2. PARTY TYPE:

(Use "X" in appropriate box)

A.3. NAME OF PARTY:

(COMPLETE NAME OF THE PARTY
A.4. CONSTITUTENCY OF THE POLITICAL PARTY: (Indicate "NA" if not applicable, as in the case

(DISTRICT) Indicate "LONE" if only 1 (CITY/MUNICIPALITY)

PART B: SUBTOTAL OF LAWFUL EXPENDITURES PER EX

Travel expenses of party's candidates and campaign personnel during the campaign
A incidental personal expenses
Compensation of campaigners, clerks, stenographers, messengers, and other persons
B in the campaign
Telephone, mobile phone usage fees, prepaid phone load, internet access, postages, fr
C courier charges

D Stationery, printing and distribution of printed materials relative to candidacy;

E Employment of watchers at the polls

F Rent, maintenance and furnishing of campaign headquarters, office or place of meeti

Political meetings and rallies and the use of sound systems, lights and decorations du
G meetings andrallies
Newspaper, radio, TV and other advertisements to promote the candidacy, including
H website/internet ad placements

PART C: EXPENDITURES INCURRED (Itemized entries in

I Employment of counsel
Copying andclassifying lists of voters, investigating and challenging the right to vot
J registered in the lists
Printing of sample ballots in such color, size and maximum number as may be autho
K Commission
TOTAL EXPENDITURES I

PART D: CERTIFICATION AND ACKNOWL

The undersigned candidate, after being duly sworn to, hereby depose and state that:
(1) This disclosure and its attachments, are supported by receipts, vouchers, and othe
complete contributions received and expenditures incurred by the undersigned cand
(2) The expenditures incurred are for lawful purposes and the contributions were n
law to give contributions.
(3) The undersigned consents on the general use and sharing of information obt
legitimate and authorized purposes.
IN WITNESS WHEREOF, the undersigned hereunto affix his/her s

AFFIX SIGNATURE HERE

SUBSCRIBED AND SWORN TO before me this

(Type of identification document) (ID Number)

Doc. No.:
Page No.:
Book No.:
Series of
ISSION ON ELECTIONS FORM

D
National and Local Elections SLE
eport of Lawful Expenditures
ON OF THE ELECTORAL PARTY HEAD OR TREASURER

(FIRST NAME) (MIDDLE NAME)

PARTY-LIST ORGANIZATION

POLITICAL PARTY

(COMPLETE NAME OF THE PARTY) (ACRONYM)

dicate "NA" if not applicable, as in the case of national parties or certain party-list groups)

(CITY/MUNICIPALITY) (PROVINCE/REGION)

UL EXPENDITURES PER EXPENSE TYPE/CATEGORY

n personnel during the campaign and

rs, messengers, and other persons employed

e load, internet access, postages, freight and

erials relative to candidacy;

dquarters, office or place of meetings

systems, lights and decorations during said

promote the candidacy, including

SUBTOTAL

NCURRED (Itemized entries in Schedule of Expenditures)

 g and challenging the right to vote of persons

maximum number as may be authorized by the

TOTAL EXPENDITURES INCURRED

ICATION AND ACKNOWLEDGMENT

to, hereby depose and state that:
ed by receipts, vouchers, and other documents reflecting the full, true, accurate, and
ncurred by the undersigned candidate and his/her duly authorized representative;
oses and the contributions were not received from persons or entities prohibited by

e and sharing of information obtained in this disclosure and its attachments for

dersigned hereunto affix his/her signature on [date signed].

NAME AND SIGNATURE

Date Notarized , affiant exhibiting his/her

, issued by expiring on [date of expiry].
(Government Agency issuing the ID)

(Place Notarial Seal & Signature here)

 COMMISSION O
May 13, 2019

Schedule of Unp

NAME OF PARTY:
(COMPLETE NAME OF

DATE CONTRACT /
NAME OF CREDITOR
INCURRED LOAN NO.

CERTIFICATION
I hereby certify that: (1) the obligations listed above were incurred by me in
my capacity as party treasurer or with my authority by my duly authorized
representative; (2) all entries specified above are true and correct; (3) they are
supported by contracts, promissory notes & other similar documents.
DATA PRIVACY ACT
The undersigned consents on the general use and sharing of information obtained in

this disclosure and its attachments for legitimate and authorized purposes.

NAME AND SIGNATURE DATE SIGNED

COMMISSION ON ELECTIONS
National and Local Elections
Schedule of Unpaid Obligations Purpose

Description of the
Obligation
(COMPLETE NAME OF PARTY)

ADDRESS OF
CREDITOR

(i.e. loan, etc.)

(for incurring
obligation)

TOTAL UNPAID OBLIGATIONS

ACKNOWLEDGMENT
SUBSCRIBED AND SWORN TO BEFORE ME this [date of oath]
affiant exhibiting his/her
issued by the [issuing office] expiring on

Doc. No. ________;

Page No. ________;
Book No. ________;
Series of ________. NOTARY PUBLIC
 FORM

l and Local Elections E

SUO
REMAINING
OBLIGATION

(ACRONYM)

AMOUNT/VALUE OF
OBLIGATION

(Partial
Payments were made)

GMENT
[date of oath]

[date of expiry].

NOTARY PUBLIC