Form SCE-C

COMMISSION ON ELECTIONS

Statement of Contributions & Expenditures (Candidate)

DATE OF ELECTION May 09, 2016

PART A: PERSONAL INFORMATION OF THE CANDIDATE

A.1.

CANDIDATE'S NAME:

A.2.

CANDIDATE TYPE:
(Use "X" in appropriate box)

A.3.

NAME of POLITICAL PARTY:

A.4.
A.5.

ELECTIVE POSITION:

(SURNAME)

(FIRST NAME)

(MIDDLE NAME)

INDEPENDENT CANDIDATE (Indicate "N/A" for Part A.3.)

CANDIDATE WITH SUPPORT OF A POLITICAL PARTY
(COMPLETE NAME OF THE PARTY)

(ACRONYM)

(Skip Part A.5. if national position)

CONSTITUENCY OF THE ELECTIVE POSITION:

(CITY/MUNICIPALITY)

(DISTRICT) Indicate "LONE" if only 1

A.6.

CONTACT DETAILS:

A.7.

PERMANENT ADDRESS:

(PROVINCE/REGION)

MOBILE/PHONE NOS.:
E-MAIL ADDRESS:

(BARANGAY)

A.8.

(HOUSE NO./UNIT)

(NAME OF BUILDING/SUBDIVISION)

(STREET NAME)

(DISTRICT/AREA)

(CITY/MUNICIPALITY)

(PROVINCE)

Taxpayer Identification No. (TIN)

(Refers to the personal TIN of the candidate)

PART B: CONTRIBUTIONS RECEIVED (Itemized entries in Form SCR, indicate "0.00" if none received)
B.1.

CASH CONTRIBUTIONS RECEIVED FROM OTHER SOURCES:

0.00

B.2.

IN-KIND CONTRIBUTIONS RECEIVED FROM OTHER SOURCES:

0.00

B.3.

CASH CONTRIBUTIONS RECEIVED FROM POLITICAL PARTY: (for candidates with parties only)

0.00

B.4.

IN-KIND CONTRIBUTIONS RECEIVED FROM POLITICAL PARTY: (for candidates with parties only)

0.00
0.00

TOTAL CONTRIBUTIONS RECEIVED

PART C: EXPENDITURES INCURRED (Itemized entries in Form SOE)

C.1. EXPENDITURES PAID OUT OF PERSONAL FUNDS / RESOURCES:
C.2. EXPENDITURES PAID OUT OF CASH CONTRIBUTIONS:
C.3. EXPENDITURES INCURRED USING IN-KIND CONTRIBUTIONS:
0.00

TOTAL EXPENDITURES INCURRED

PART D: CERTIFICATION & ACKNOWLEDGMENT

The undersigned candidate, after being duly sworn to, hereby depose and state that:
(1) This Statement and its attached Schedules, which are supported by receipts, vouchers, and other documents reflecting the full, true, accurate, and complete
contributions received and expenditures incurred by the undersigned candidate and his/her duly authorized representative;
(2) The expenditures incurred are for lawful purposes and the contributions were not received from persons or entities prohibited by law to give contributions.
IN WITNESS WHEREOF, the undersigned hereunto affix his/her signature on [date signed].
AFFIX SIGNATURE HERE
Err:511
SUBSCRIBED AND SWORN TO before me on

date notarized
issued by

(ID Number)

(Type of identification document)

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

, affiant exhibiting his/her

expiring on [date of expiry].

(Government Agency issuing the ID)

(Place Notarial Seal & Signature here)

THIS SECTION IS FOR COMELEC USE ONLY - DO NOT ENCODE / WRITING ANYTHING BEYOND THIS LINE

Indicate "" beside form code/document name if submitted, " " if not.
SCR (Sched of Contributions Rcvd)
SOE (Sched of Expenditures)
SUO (Sched of Unpaid Obligations)
SLE (Sum. Report of Lawful Exp.)
Others: pls. specify:

Contribution Receipts
Expenditure Receipts
Obligations Payable
NO. OF PAGES: _________
(This space is for the receiving date/time stamp of the receiving office)

Form SCR-C

COMMISSION ON ELECTIONS
DATE OF ELECTIONS

NAME OF CANDIDATE:

DATE RECEIVED

RECEIPT
NUMBER

Schedule of Contributions Received (Candidate)

May 09, 2016

0

(SURNAME)

(FIRST NAME)

MIDDLE NAME

FULL NAME OF CONTRIBUTOR

ADDRESS OF CONTRIBUTOR

Contribution TYPE &

SOURCE

CANDIDATE'S TIN:
DESCRIPTION
(for in-kind contributions)

Contributor's TIN

AMOUNT/VALUE OF
CONTRIBUTION

TOTAL CONTRIBUTIONS RECEIVED

CERTIFICATION

ACKNOWLEDGMENT

I hereby certify that: (1) the contributions listed above were made to me as a candidate; (2) all entries specified
above are true & 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.

SUBSCRIBED AND SWORN TO BEFORE ME this

affiant exhibiting his/her
0
issued by the
[issuing office]

[date of oath]
0
expiring on
[date of expiry].

Doc. No. ________;

DATE SIGNED

Page No. ________;

Book No. ________;
Series of ________.

NOTARY PUBLIC

0.00

Form SOE-C
Schedule of Expenditures (Candidate)

COMMISSION ON ELECTIONS
DATE OF ELECTIONS

May 09, 2016

NAME OF CANDIDATE
DATE INCURRED

RECEIPT NUMBER

(SURNAME)

(FIRST NAME)

(MIDDLE NAME)

FULL NAME OF BUSINESS FIRM OR

CONTRACTOR

ADDRESS OF BUSINESS FIRM OR CONTRACTOR

TIN OF CONTRACTOR or
BUSINESS FIRM

CANDIDATE'S TIN:
DESCRIPTION OF GOODS OR SERVICES

0
Exp Type
(A-K)

AMOUNT/VALUE OF
EXPENDITURE

0.00

TOTAL EXPENDITURES INCURRED

CERTIFICATION

ACKNOWLEDGMENT
SUBSCRIBED AND SWORN TO BEFORE ME this

I hereby certify that: (1) the expenses listed above were incurred by me as a candidate or by my duly authorized representative/s; (2) all
entries specified above are true & 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.

affiant exhibiting his/her

issued by the

[date of oath]

0
[issuing office]

0
expiring on

Doc. No. ________;

Page No. ________;
Book No. ________;
Series of ________.
DATE SIGNED

NOTARY PUBLIC

[date of expiry].

Form SLE-C

COMMISSION ON ELECTIONS
DATE OF ELECTION

Summary Report of Lawful Expenditures (Candidate)

May 09, 2016

PART A: PERSONAL INFORMATION OF THE CANDIDATE

A.1.

CANDIDATE'S NAME:

(SURNAME)

A.2.

(MIDDLE NAME)

INDEPENDENT CANDIDATE (Indicate "N/A" for Part A.3.)

CANDIDATE TYPE:

CANDIDATE WITH SUPPORT OF A POLITICAL PARTY

(Use "X" in appropriate box)

A.3.

(FIRST NAME)

NAME of POLITICAL PARTY:

0
(COMPLETE NAME OF THE PARTY)

A.4.
A.5.

ELECTIVE POSITION:
CONSTITUENCY OF THE ELECTIVE POSITION:

(Skip Part A.5. if national position)

(DISTRICT) Indicate "LONE" if only 1

A.6

(ACRONYM)

(CITY/MUNICIPALITY)

Taxpayer Identification No. (TIN)

(PROVINCE/REGION)

0 (Refers to the personal TIN of the candidate)

PART B: SUBTOTAL OF LAWFUL EXPENDITURES PER EXPENSE TYPE/CATEGORY

A

Travel expenses of candidate & campaign personnel during the campaign & incidental personal expenses

0.00

Compensation of campaigners, clerks, stenographers, messengers, & other persons employed in the campaign

0.00

Telephone, mobile phone usage fees, prepaid phone load, internet access, postages, freight & courier charges

0.00

Stationery, printing & distribution of printed materials relative to candidacy;

0.00

Employment of watchers at the polls

0.00

Rent, maintenance & furnishing of campaign headquarters, office or place of meetings

0.00

Political meetings & rallies & the use of sound systems, lights & decorations during said meetings & rallies

0.00

Newspaper, radio, TV & other advertisements to promote the candidacy, including website/internet ad placements

0.00
0.00

SUBTOTAL

PART C: EXPENDITURES INCURRED (Itemized entries in Form SOE)

I

Employment of counsel

0.00

Copying & classifying lists of voters, investigating & challenging the right to vote of persons registered in the lists

0.00

Printing of sample ballots in such color, size & maximum number as may be authorized by the Commission

0.00
0.00

TOTAL EXPENDITURES INCURRED

PART D: CERTIFICATION & ACKNOWLEDGMENT

The undersigned candidate, after being duly sworn to, hereby depose and state that:
(1) This Statement and its attached Schedules, which are supported by receipts, vouchers, and other documents reflecting the full, true, accurate, and complete
contributions received and expenditures incurred by the undersigned candidate and his/her duly authorized representative;
(2) The expenditures incurred are for lawful purposes and the contributions were not received from persons or entities prohibited by law to give contributions.
IN WITNESS WHEREOF, the undersigned hereunto affix his/her signature on [date signed].
AFFIX SIGNATURE HERE
Err:511
SUBSCRIBED AND SWORN TO before me on

date notarized
issued by

(Type of identification document)

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

(ID Number)

, affiant exhibiting his/her

expiring on [date of expiry].

(Government Agency issuing the ID)

(Place Notarial Seal & Signature here)

THIS SECTION IS FOR COMELEC USE ONLY - DO NOT ENCODE / WRITING ANYTHING BEYOND THIS LINE

(This space is for the receiving date/time stamp of the receiving office)

Form SUO-C
Schedule of Unpaid Obligations (Candidate)

COMMISSION ON ELECTIONS
DATE OF ELECTIONS

May 09, 2016

0

NAME OF CANDIDATE
DATE
INCURRED

Contract / Loan
No.

(SURNAME)

(FIRST NAME)

(MIDDLE NAME)

NAME OF CREDITOR

ADDRESS OF CREDITOR

Taxpayer ID No. (TIN) of

CREDITOR

CANDIDATE'S TIN:
Description of the Obligation (i.e.
loan, etc.)

Purpose (for incurring

obligation)

AMOUNT/VALUE OF
OBLIGATION

TOTAL UNPAID OBLIGATIONS

CERTIFICATION

ACKNOWLEDGMENT

SUBSCRIBED AND SWORN TO BEFORE ME this

affiant exhibiting his/her
0
I hereby certify that: (1) the obligations listed above were incurred by me as a candidate or with my authority
issued by the
[issuing office]
by my duly authorized representative; (2) all entries specified above are true & correct; (3) they are supported

[date of oath]
0
[date of expiry].
expiring on

by contracts, promissory notes & other similar documents.

DATE SIGNED

Doc. No. ________;

Page No. ________;
Book No. ________;
Series of ________.

NOTARY PUBLIC

0.00

Contribution Type & SourceNature of Exp.

Cash from others
A
Cash from party
B
In-kind from others
C
In-kind from party
D
E
F
G
H
I
J
K