COMMISSION ON ELECTIONS Form SCE-C

DATE OF ELECTION May 09, 2016 Statement of Contributions & Expenditures (Candidate)

PART A: PERSONAL INFORMATION OF THE CANDIDATE

A.1. CANDIDATE'S NAME:
(SURNAME) (FIRST NAME) (MIDDLE NAME)

A.2. CANDIDATE TYPE: INDEPENDENT CANDIDATE (Indicate "N/A" for Part A.3.)
(Use "X" in appropriate box)
CANDIDATE WITH SUPPORT OF A POLITICAL PARTY
NAME of POLITICAL PARTY:
A.3.
(COMPLETE NAME OF THE PARTY) (ACRONYM)

ELECTIVE POSITION:
A.4. (Skip Part A.5. if national position)
A.5. CONSTITUENCY OF THE ELECTIVE POSITION:

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

A.6. CONTACT DETAILS: MOBILE/PHONE NOS.:

E-MAIL ADDRESS:

A.7. PERMANENT ADDRESS:

(HOUSE NO./UNIT) (NAME OF BUILDING/SUBDIVISION) (STREET NAME)

(BARANGAY) (DISTRICT/AREA) (CITY/MUNICIPALITY) (PROVINCE)

A.8. 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
TOTAL CONTRIBUTIONS RECEIVED ₱0.00

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:
TOTAL EXPENDITURES INCURRED ₱0.00

PART D: CERTIFICATION & ACKNOWLEDGMENT

The undersigned
(1) This Statementcandidate, after being
and its attached duly sworn
Schedules, to,are
which hereby depose
supported byand state that:
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 , affiant exhibiting his/her

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

Doc. No.:
Page No.:
Book No.:
Series of (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) ☐ 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: (This space is for the receiving date/time stamp of the receiving office)
COMMISSION ON ELECTIONS Form SCR-C
DATE OF ELECTIONS May 09, 2016 Schedule of Contributions Received (Candidate)

NAME OF CANDIDATE: 0 0 0 CANDIDATE'S TIN: 0

(SURNAME) (FIRST NAME) MIDDLE NAME

DATE RECEIPT FULL NAME OF Contribution TYPE & DESCRIPTION AMOUNT/VALUE OF

ADDRESS OF CONTRIBUTOR Contributor's TIN
RECEIVED NUMBER CONTRIBUTOR SOURCE (for in-kind contributions) CONTRIBUTION

TOTAL CONTRIBUTIONS RECEIVED ₱0.00

CERTIFICATION ACKNOWLEDGMENT
SUBSCRIBED AND SWORN TO BEFORE ME this [date of oath]
I hereby certify that: (1) the contributions listed above were made to me as a candidate;
affiant exhibiting his/her 0 0
(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 issued by the [issuing office] expiring on [date of expiry].
prohibited by the Omnibus Election Code and other pertinent laws.
Doc. No. ________;
Page No. ________;
Book No. ________;
DATE SIGNED Series of ________. NOTARY PUBLIC
COMMISSION ON ELECTIONS Form SOE-C
DATE OF ELECTIONS May 09, 2016 Schedule of Expenditures (Candidate)

NAME OF CANDIDATE 0 0 0 CANDIDATE'S TIN: 0

(SURNAME) (FIRST NAME) (MIDDLE NAME)

RECEIPT FULL NAME OF BUSINESS FIRM ADDRESS OF BUSINESS FIRM OR TIN OF CONTRACTOR or DESCRIPTION OF GOODS OR Exp Type AMOUNT/VALUE OF
DATE INCURRED
NUMBER OR CONTRACTOR CONTRACTOR BUSINESS FIRM SERVICES (A-K) EXPENDITURE

TOTAL EXPENDITURES INCURRED ₱0.00

CERTIFICATION ACKNOWLEDGMENT
SUBSCRIBED AND SWORN TO BEFORE ME this [date of oath]
affiant exhibiting his/her 0 0
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, issued by the [issuing office] expiring on [date of expiry].
invoices or other similar documents; (4) the expenses comply with Section 102 of the Omnibus Election Code.
Doc. No. ________;
Page No. ________;
Book No. ________;
Series of ________.
DATE SIGNED NOTARY PUBLIC
COMMISSION ON ELECTIONS Form SLE-C
DATE OF ELECTION May 09, 2016 Summary Report of Lawful Expenditures (Candidate)

PART A: PERSONAL INFORMATION OF THE CANDIDATE

A.1. CANDIDATE'S NAME: 0 0 0
(SURNAME) (FIRST NAME) (MIDDLE NAME)

A.2. INDEPENDENT CANDIDATE (Indicate "N/A" for Part A.3.)

CANDIDATE TYPE:
(Use "X" in appropriate box) CANDIDATE WITH SUPPORT OF A POLITICAL PARTY

A.3. NAME of POLITICAL PARTY: 0

(COMPLETE NAME OF THE PARTY) (ACRONYM)

A.4. ELECTIVE POSITION: 0 (Skip Part A.5. if national position)

A.5. CONSTITUENCY OF THE ELECTIVE POSITION:

0 0 0
(DISTRICT) Indicate "LONE" if only 1 (CITY/MUNICIPALITY) (PROVINCE/REGION)

A.6 Taxpayer Identification No. (TIN) 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
B Compensation of campaigners, clerks, stenographers, messengers, & other persons employed in the campaign ₱0.00
C Telephone, mobile phone usage fees, prepaid phone load, internet access, postages, freight & courier charges ₱0.00
D Stationery, printing & distribution of printed materials relative to candidacy; ₱0.00
E Employment of watchers at the polls ₱0.00
F Rent, maintenance & furnishing of campaign headquarters, office or place of meetings ₱0.00
G Political meetings & rallies & the use of sound systems, lights & decorations during said meetings & rall ₱0.00
H Newspaper, radio, TV & other advertisements to promote the candidacy, including website/internet ad placements ₱0.00
SUBTOTAL ₱0.00

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

I Employment of counsel ₱0.00
J Copying & classifying lists of voters, investigating & challenging the right to vote of persons registered in ₱0.00
K Printing of sample ballots in such color, size & maximum number as may be authorized by the Commis ₱0.00
TOTAL EXPENDITURES INCURRED ₱0.00

PART D: CERTIFICATION & ACKNOWLEDGMENT

TheThis
(1) undersigned
Statementcandidate, after being
and its attached duly sworn
Schedules, to, are
which hereby deposebyand
supported state that:
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 , affiant exhibiting his/her

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

Doc. No.:
Page No.:
Book No.:
Series of (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)
COMMISSION ON ELECTIONS Form SUO-C
DATE OF ELECTIONS May 09, 2016 Schedule of Unpaid Obligations (Candidate)
0 0 0 0
NAME OF CANDIDATE CANDIDATE'S TIN:
(SURNAME) (FIRST NAME) (MIDDLE NAME)

DATE Contract / Loan NAME OF CREDITOR ADDRESS OF CREDITOR Taxpayer ID No. (TIN) of Description of the Obligation Purpose (for incurring AMOUNT/VALUE OF
INCURRED No. CREDITOR (i.e. loan, etc.) obligation) OBLIGATION

TOTAL UNPAID OBLIGATIONS ₱0.00

CERTIFICATION ACKNOWLEDGMENT
SUBSCRIBED AND SWORN TO BEFORE ME this [date of oath]
I hereby certify that: (1) the obligations listed above were incurred by me as a candidate or
affiant exhibiting his/her 0 0
with my authority by my duly authorized representative; (2) all entries specified above are
true & correct; (3) they are supported by contracts, promissory notes & other similar issued by the [issuing office] expiring on [date of expiry].
documents.
Doc. No. ________;
Page No. ________;
Book No. ________;
DATE SIGNED Series of ________. NOTARY PUBLIC
Contribution Type & Source Nature 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