Professional Documents
Culture Documents
The undersigned candidate/party treasurer hereby grants the authority to his/her agent,
, ,
(SURNAME) (FIRST NAME) (MIDDLE NAME)
to receive contributions and issue receipts for the same on behalf of the candidate or party,
with the understanding and undertaking that the undersigned shall be responsible for the
actions of the said agent.
AGENT INFORMATION: (Person authorized to receive contributions, whose name appears in main body)
Home/Office
Address:
Telephone &
E-mail Address:
Mobile No.:
ACKNOWLEDGMENT
REPUBLIC OF THE PHILIPPINES
City/Municipality of President Roxas
BEFORE ME, on _____ and in __________ , personally appeared the following persons
with competent evidence of their identity:
Expiry Issuing
Name Doc. Type ID No. Date Authority
Said persons acknowledged under oath to me under penalty of law, that the whole contents of this
document are true and the same are their free and voluntary acts and deeds.