Reference No.

: CEF17404051-42140500202119340943 Generated on 19 May 2021 00:42 (Philippine Standard Time)

Republic of the Philippines REVISED CEF-1

COMMISSION ON ELECTIONS
Intramuros, Manila

Instruction : Fill-in completely and legibly the appropriate spaces and check appropriate choice/s in boxes.

APPLICATION FOR (Accomplish Personal Information at the back)

REGISTRATION
Note: (For Applicant/s with existing Registration Records)

I, , Filipino, born on , a duly registered voter in

Precinct No. of Barangay , City/Municipality of , Province of
, do HEREBY APPLY FOR: (Check for appropriate box/es)

APPLICATION FOR TRANSFER OF REGISTRATION RECORD

within the same City/Municipality/District from another City/Municipality/District
(Accomplish Personal Information at the back)
My New Residence is:
House No. & Street , Barangay ,
City/Municipality , Province
I have resided in my new residence for years and for months.

APPLICATION FOR REACTIVATION OF REGISTRATION RECORD

Reason for Deactivation:
1. Sentenced by final judgment to suffer imprisonment for not less than one (1) year;
2. Convicted by final judgment of a crime involving disloyalty to the duly constituted government, etc;
3. Declared by competent authority to be insane or incompetent;
4. Failed to vote in two (2) successive preceding regular elections;
5. Loss of Filipino citizenship; or
6. Exclusion by a court order.
7. Failure to Validate
That said ground no longer exists, as evidenced by the attached certification/order of the court (in cases of 1, 2, 3, 5 and 6).

APPLICATION FOR CHANGE OF NAME DUE TO MARRIAGE OR COURT ORDER/CORRECTION OF

ENTRIES IN THE VOTERS' REGISTRATION RECORD
(Attach required supporting documents such as Certified Copy or Certificate of Court Order or Certificate of Live Birth, and others)
Present Data/Information:

New/Corrected Data Information:

APPLICATION FOR INCLUSION OF RECORDS IN THE BOOK OF VOTERS / REINSTATEMENT OF NAME IN

THE LIST OF VOTERS
Inclusion of VRR in the precinct book of voters Reinstatement of the name of the registered voter
which has been omitted in the list of voters
I do hereby request that my name which has been omitted in the list of voters/my registration record which has not
been included in the precinct book of voters of Precinct No. , be reinstated/included therein. The said reinstatement of
name/inclusion of registration record is necessary and valid.
IN WITNESS WHEREOF, I hereunto affix my signature this day of , at QUEZON CITY ,
Province of NCR - 2ND DISTRICT , Philippines

Signature over Printed Name

SUBSCRIBED AND SWORN to before me on the above date.
EO/Administering Officer
 Print at the back of CEF-1
Application No. Precinct No.

Instructions : (1) Accomplish separately in three copies; (2) print legibly; (3) check the appropriate box.
Part 1 PERSONAL INFORMATION ( To be filled out by Applicant)
NAME
Illiterate Person with Disability
Last
BENITO Indigenous People
Assisted by :
First GABRAEL ALLEN

Middle BAÑGALAN
(Please fill-up Supplemental Data Form/Assistor's
Oath)
RESIDENCE/ ADDRESS
Province NCR - 2ND DISTRICT Se
x
City/ Municipality Barangay Male Female
QUEZON CITY KRUS NA LIGAS

DATE OF BIRTH
House No. /
Street 09 2001
9 E. RAMOS STREET
15 Year
Month Day
FILIPINO By Birth Naturalized Reacquired
CITIZENSHIP PLACE OF BIRTH
City/ Mun QUEZON CITY
(If naturalized / reacquired, state date of naturalization/ reacquisition and Certificate number of naturalization/ order of approval of reacquisition)

Date of Naturalization / Certificate No. / Order of Approval Province

Reacquisition Month Day Year NCR - 2ND DISTRICT

CIVIL STATUS
PERIOD OF Single
RESIDENCE No. of Years No. of Months No. of Years
Married
5 0 In the Philippines 20
Name of Spouse, If married
In the City / Mun
PROFESSION / OCCUPATION
TIN

Part 2 OATH ROLLED THUMBPRINTS / SPECIMEN SIGNATURES

REGISTRATION TRANSFER
I do solemnly swear that the above statements regarding my person are true and correct; that I
possess all the qualifications and none of the disqualifications of a voter and that I am not registered
in any precinct in the Philippines. Further, I give consent to the processing of the Information stated
herein by the Commission on Elections for registration, election and other purposes as may be
provided by law including B.P. Blg. 881, R.A. No. 8189, R.A. No. 10367 and R.A. No. 10173 also known
as the Data Privacy Act of 2012.
Left Thumb Right Thumb

Dat 1
e
Mont Day Year
h Signature of Applicant 2
Above Printed Name
EO / Administering Officer
Signature Above Printed Name 3

Part 3 ACTION BY THE ELECTION REGISTRATION BOARD

Month Day Year
Approved With Precinct Assignment No.

Disapproved Reason for disapproval

DATE

Member Chairman of the Board Member

(Signature above Printed Name) (Signature above Printed Name) (Signature above Printed Name)

Part VOTER IDENTIFICATION NUMBER (To be filled out by Election Officer)

4
Part I Part II Part III

Prov Code
City/Mun/Dist. Code Precinct Assignment Month Day Year Name Code
Birth Code

Type of Application
ACKNOWLEDGEMENT RECEIPT Application No.
Registration
Transfer with Reactivation
Transfer
Change of Name/ Correction of Entry This is to acknowledge receipt of your application.
Reactivation F st Middle

Application for Registration i

Last r
 Reference No. : CEF17404051-42140500202119340943 Generated on 19 May 2021 00:42 (Philippine Standard Time)

Reinstatement/Republic
Inclusion of the Philippines Your application is subject for
Approval/ Disapproval by the
REVISED CEF-1
COMMISSION ON ELECTIONS
Election Registration Board
Intramuros, Manila (ERB). You need not appear in
the ERB hearing unless required
through a written notice. Date
Instruction : Fill-in completely and legibly
of ERBthe appropriate spaces and
Hearing check
. appropriate choice/s in boxes.

EO/ Interviewer Signature above

Printed Name

IN WITNESS WHEREOF, I hereunto affix my signature this day of , at QUEZON CITY ,

Province of NCR - 2ND DISTRICT , Philippines

Signature over Printed Name

SUBSCRIBED AND SWORN to before me on the above date.
EO/Administering Officer
 Print at the back of CEF-1
Application No. Precinct No.

APPLICATION FOR (Accomplish Personal Information at the back)

REGISTRATION
Note: (For Applicant/s with existing Registration Records)

I, , Filipino, born on , a duly registered voter in

Precinct No. of Barangay , City/Municipality of , Province of
, do HEREBY APPLY FOR: (Check for appropriate box/es)

APPLICATION FOR TRANSFER OF REGISTRATION RECORD

within the same City/Municipality/District from another City/Municipality/District
(Accomplish Personal Information at the back)
My New Residence is:
House No. & Street , Barangay ,
City/Municipality , Province
I have resided in my new residence for years and for months.

APPLICATION FOR REACTIVATION OF REGISTRATION RECORD

Reason for Deactivation:
1. Sentenced by final judgment to suffer imprisonment for not less than one (1) year;
2. Convicted by final judgment of a crime involving disloyalty to the duly constituted government, etc;
3. Declared by competent authority to be insane or incompetent;
4. Failed to vote in two (2) successive preceding regular elections;
5. Loss of Filipino citizenship; or
6. Exclusion by a court order.
7. Failure to Validate
That said ground no longer exists, as evidenced by the attached certification/order of the court (in cases of 1, 2, 3, 5 and 6).

APPLICATION FOR CHANGE OF NAME DUE TO MARRIAGE OR COURT ORDER/CORRECTION OF

ENTRIES IN THE VOTERS' REGISTRATION RECORD
(Attach required supporting documents such as Certified Copy or Certificate of Court Order or Certificate of Live Birth, and others)
Present Data/Information:

New/Corrected Data Information:

APPLICATION FOR INCLUSION OF RECORDS IN THE BOOK OF VOTERS / REINSTATEMENT OF NAME IN

THE LIST OF VOTERS
Inclusion of VRR in the precinct book of voters Reinstatement of the name of the registered voter
which has been omitted in the list of voters
I do hereby request that my name which has been omitted in the list of voters/my registration record which has not
been included in the precinct book of voters of Precinct No. , be reinstated/included therein. The said reinstatement of
name/inclusion of registration record is necessary and valid.
 Reference No. : CEF17404051-42140500202119340943 Generated on 19 May 2021 00:42 (Philippine Standard Time)

Republic of the Philippines REVISED CEF-1

COMMISSION ON ELECTIONS
Intramuros, Manila
Instructions : (1) Accomplish separately in three copies; (2) print legibly; (3) check the appropriate box.
Part 1
Instruction : PERSONAL INFORMATION
Fill-in completely and legibly the(appropriate
To be filled spaces
out by and
Applicant)
check appropriate choice/s in boxes.
NAME
Illiterate Person with Disability
Last
BENITO Indigenous People
Assisted by :
First GABRAEL ALLEN

Middle BAÑGALAN
(Please fill-up Supplemental Data Form/Assistor's
Oath)
RESIDENCE/ ADDRESS
Province NCR - 2ND DISTRICT Se
x
City/ Municipality Barangay Male Female
QUEZON CITY KRUS NA LIGAS
DATE OF BIRTH
House No. /
Street 09 2001
9 E. RAMOS STREET
15 Year
Month Day
FILIPINO By Birth Naturalized Reacquired
CITIZENSHIP PLACE OF BIRTH
City/ Mun QUEZON CITY
(If naturalized / reacquired, state date of naturalization/ reacquisition and Certificate number of naturalization/ order of approval of reacquisition)

Date of Naturalization / Month Day Year Certificate No. / Order of Approval Province NCR - 2ND DISTRICT
Reacquisition
CIVIL STATUS
PERIOD OF Single
RESIDENCE No. of Years No. of Months No. of Years
Married
5 0 In the Philippines 20
Name of Spouse, If married
In the City / Mun
PROFESSION / OCCUPATION
TIN

Part 2 OATH ROLLED THUMBPRINTS / SPECIMEN SIGNATURES

REGISTRATION TRANSFER
I do solemnly swear that the above statements regarding my person are true and correct; that I
possess all the qualifications and none of the disqualifications of a voter and that I am not registered
in any precinct in the Philippines. Further, I give consent to the processing of the Information stated
herein by the Commission on Elections for registration, election and other purposes as may be
provided by law including B.P. Blg. 881, R.A. No. 8189, R.A. No. 10367 and R.A. No. 10173 also known
as the Data Privacy Act of 2012.
Left Thumb Right Thumb

Dat 1
e
Mont Day Year
h Signature of Applicant 2
Above Printed Name
EO / Administering Officer
Signature Above Printed Name 3

Part 3 ACTION BY THE ELECTION REGISTRATION BOARD

Month Day Year
Approved With Precinct Assignment No.

Disapproved Reason for disapproval

DATE

IN WITNESS WHEREOF, I hereunto affix my signature this day of , at QUEZON CITY ,

Province of NCR - Member
2ND DISTRICT , Philippines Chairman of the Board Member
(Signature above Printed Name) (Signature above Printed Name) (Signature above Printed Name)

Part VOTER IDENTIFICATION NUMBER (To be filled out by ElectionSignature

Officer) over Printed Name
4SUBSCRIBED AND SWORN to before me on the above date.
Part I Part II Part III
EO/Administering Officer
Prov Code
City/Mun/Dist. Code Precinct Assignment Month Day Year Name Code
Birth Code
 Print at the back of CEF-1
Application No. Precinct No.

APPLICATION FOR (Accomplish Personal Information at the back)

REGISTRATION
Note: (For Applicant/s with existing Registration Records)

I, , Filipino, born on , a duly registered voter in

Precinct No. of Barangay , City/Municipality of , Province of
, do HEREBY APPLY FOR: (Check for appropriate box/es)

APPLICATION FOR TRANSFER OF REGISTRATION RECORD

within the same City/Municipality/District from another City/Municipality/District
(Accomplish Personal Information at the back)
My New Residence is:
House No. & Street , Barangay ,
City/Municipality , Province
I have resided in my new residence for years and for months.

APPLICATION FOR REACTIVATION OF REGISTRATION RECORD

Reason for Deactivation:
1. Sentenced by final judgment to suffer imprisonment for not less than one (1) year;
2. Convicted by final judgment of a crime involving disloyalty to the duly constituted government, etc;
3. Declared by competent authority to be insane or incompetent;
4. Failed to vote in two (2) successive preceding regular elections;
5. Loss of Filipino citizenship; or
6. Exclusion by a court order.
7. Failure to Validate
That said ground no longer exists, as evidenced by the attached certification/order of the court (in cases of 1, 2, 3, 5 and 6).

APPLICATION FOR CHANGE OF NAME DUE TO MARRIAGE OR COURT ORDER/CORRECTION OF

ENTRIES IN THE VOTERS' REGISTRATION RECORD
(Attach required supporting documents such as Certified Copy or Certificate of Court Order or Certificate of Live Birth, and others)
Present Data/Information:

New/Corrected Data Information:

APPLICATION FOR INCLUSION OF RECORDS IN THE BOOK OF VOTERS / REINSTATEMENT OF NAME IN

THE LIST OF VOTERS
Inclusion of VRR in the precinct book of voters Reinstatement of the name of the registered voter
which has been omitted in the list of voters
I do hereby request that my name which has been omitted in the list of voters/my registration record which has not
been included in the precinct book of voters of Precinct No. , be reinstated/included therein. The said reinstatement of
name/inclusion of registration record is necessary and valid.
 Reference No. : CEF17404051-42140500202119340943 Generated on 19 May 2021 00:42 (Philippine Standard Time)

Republic of the Philippines REVISED CEF-1

COMMISSION ON ELECTIONS
Intramuros, Manila
Instructions : (1) Accomplish separately in three copies; (2) print legibly; (3) check the appropriate box.
Part 1
Instruction : PERSONAL INFORMATION
Fill-in completely and legibly the(appropriate
To be filled spaces
out by and
Applicant)
check appropriate choice/s in boxes.
NAME
Illiterate Person with Disability
Last
BENITO Indigenous People
Assisted by :
First GABRAEL ALLEN

Middle BAÑGALAN
(Please fill-up Supplemental Data Form/Assistor's
Oath)
RESIDENCE/ ADDRESS
Province NCR - 2ND DISTRICT Se
x
City/ Municipality Barangay Male Female
QUEZON CITY KRUS NA LIGAS
DATE OF BIRTH
House No. /
Street 09 2001
9 E. RAMOS STREET
15 Year
Month Day
FILIPINO By Birth Naturalized Reacquired
CITIZENSHIP PLACE OF BIRTH
City/ Mun QUEZON CITY
(If naturalized / reacquired, state date of naturalization/ reacquisition and Certificate number of naturalization/ order of approval of reacquisition)

Date of Naturalization / Month Day Year Certificate No. / Order of Approval Province NCR - 2ND DISTRICT
Reacquisition
CIVIL STATUS
PERIOD OF Single
RESIDENCE No. of Years No. of Months No. of Years
Married
5 0 In the Philippines 20
Name of Spouse, If married
In the City / Mun
PROFESSION / OCCUPATION
TIN

Part 2 OATH ROLLED THUMBPRINTS / SPECIMEN SIGNATURES

REGISTRATION TRANSFER
I do solemnly swear that the above statements regarding my person are true and correct; that I
possess all the qualifications and none of the disqualifications of a voter and that I am not registered
in any precinct in the Philippines. Further, I give consent to the processing of the Information stated
herein by the Commission on Elections for registration, election and other purposes as may be
provided by law including B.P. Blg. 881, R.A. No. 8189, R.A. No. 10367 and R.A. No. 10173 also known
as the Data Privacy Act of 2012.
Left Thumb Right Thumb

Dat 1
e
Mont Day Year
h Signature of Applicant 2
Above Printed Name
EO / Administering Officer
Signature Above Printed Name 3

Part 3 ACTION BY THE ELECTION REGISTRATION BOARD

Month Day Year
Approved With Precinct Assignment No.

Disapproved Reason for disapproval

DATE

IN WITNESS WHEREOF, I hereunto affix my signature this day of , at QUEZON CITY ,

Province of NCR - Member
2ND DISTRICT , Philippines Chairman of the Board Member
(Signature above Printed Name) (Signature above Printed Name) (Signature above Printed Name)

Part VOTER IDENTIFICATION NUMBER (To be filled out by ElectionSignature

Officer) over Printed Name
4SUBSCRIBED AND SWORN to before me on the above date.
Part I Part II Part III
EO/Administering Officer
Prov Code
City/Mun/Dist. Code Precinct Assignment Month Day Year Name Code
Birth Code
 Print at the back of CEF-1
Application No. Precinct No.
BRING THIS FORM TOGETHER WITH THE APPLICATION FORM
TO YOUR LOCAL COMELEC OFFICE

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Reference No. : CEF17404051-4214050020 2119340943 Generated 19 May 2021 00:42 (Philippine Standard Time)
on

Application for : City / Municipality : QUEZON CITY

Registration Provinc : NCR - 2ND DISTRICT

Transfer / Others e Application :
No.
NAME OF APPLICANT (Pangalan ng Aplikante)

BENITO GABRAEL ALLEN BAÑGALAN

LAST NAME (Apelyido) FIRST NAME (Pangalan) MIDDLE NAME (Panggitna)
Thank you for using the COMELEC iRehistro Online Application Form.

Please bring the printed copy of your accomplished application form, together with the required documents, to your local COMELEC Office, which is in
QUEZON CITY, NCR - 2ND DISTRICT.

IMPORTANT REMINDERS TO APPLICANTS

1. PLEASE REMEMBER that accomplishing this online form DOES NOT mean that you are already a registered voter. You still have to go through the
following:
a. Go to your local COMELEC office to personally submit your Application Form. (This completes the process of submission of your application)
b. The Election Registration Board (ERB) has to approve your application.
2. PRINTING REMINDERS :
a. Be sure to print your accomplished form on a folio size (long) bond paper (8-1/2" x 13") and that the four (4) QR codes are printed clearly and
completely. If not, please reprint.
b. Make sure that you have printed the PERSONAL INFORMATION page at the back of the CEF-1 page. If not, please reprint for compliance.
3. Do not sign or affix your thumbmark on the Application Form yet. (You have to do this in the presence of the Election Officer when you go to the local
COMELEC Office for filing purposes.)
4. PLEASE BRING ANY OF THE FOLLOWING VALID IDs : Employee's identification card (ID), with the signature of the employer or authorized
representative; Postal ID; PWD Discount ID; Student's ID or library card, signed by the ID; Integrated Bar of the Philipines (IBP) ID; License issued by the
Professional Regulatory Commission (PRC); Certificate of Confirmation issued by the National Commission on Indigenous Peoples (NCIP) in case of
members of ICCs or IPS; School authority; Senior Citizen's ID; Driver's license; NBI clearance; Passport; SSS/GSIS and any other valid ID.

iRehistro QR3 iRehistro QR4