Affix photo

taken within the

CERTIFICATE OF CANDIDACY FOR last six (6)
months
PROVINCIAL GOVERNOR Passport Size

INSTRUCTIONS:
1. File this Certificate of Candidacy (COC) in FM (5) LEGIBLE copies with the COMELEC Office concemed, from 8:00 AM to 5:00 PM ONLY, from October 7 to 8,2024,
including Saturday and Sunday.
2. Attach to this COC, the Certificate of Nomination and Acceptance (CONA), if applicable.
3. Do not leave blank entries md indicate N/.A, if an entry is not applicable. Print the front and back pages of the COC on a single shet (back to back) of folio or legal-size paper.
4. Thts COC shall be sworn before a notary public or any official authorized to administer oath. COMELEC officials ue not authorized to administer oath, even in their
capacities as Notary Public.
5. No filing fee shall be imposed.
6. This COC will be posted on the official website of the Commission in accordance with the Data Privacy Act and its implementing rules and regulations.

IherebvannouncemycandidacvforthepositionofPRoVINCIALGovERNo&Provinceof-intheMay12,2025NationaIand
Local Elections (NLE) and BARMM Parliamentary Elections (BPE); and after having been swom to in accordance with law, I hereby state the following:

1. NAME: 9. SEX: 10. AGE:

1.1 Last Name I

tl flrr" ! ru-ur"
I
1.2 First Namc
I I
11. DATE OF BIRTH:
't.3 N{iddle Name

Month Dav Yea

2. NICKNAME OR STAGENAME: ltndicatc onlv onc nicknamc or stagc namc) 12. PLACE OF BIRTH:
I CitylMun

3. OFFICIALLY NOMINATED BY: (Atrach coNA) Province

13. CIVIL STATUS:

(Political Partv/Coalition of Political Parties)
Widorv/er
4. Name to appear on the
number, symbol and punctuation)
Official Ballot not to exceed thirty (30) characters: (including spacc, lettcr, !st"er" !rvrarled
Full Namc of Spousc, if manicd

(Last Name, First Name OR Nickname, and Acronym of Political Party Affiliation as stated in ltems 1 to 3)
(ln case of a legallv married female candidate, she has the option to choose either her maiden name, manied name or both) 14. PROFESSION OR OCCUPATION:
5. RESIDENCE/ADDRESS
5.1 Province 15.
5.2 Citv/ Municipality
5.3 Barangav E I AN,I A ITECISTEI{ED VOTEIT OF

I I I
tl
Barangay
I \ITLI- BE A RECISTERED VOTER OF:

5..4 House Street Subdivision Ciry/I,lun

Provincc
I

6. PERIOD OF RESIDENCE IN THE PHILIPPINES UP TO THE DAY BEFORE MAY 72,20251 1,6. Have you ever been found liable for an
6.1 ln the I'hilippines No. of Ycars I I I No.ofMonths offense which carries u'ith it the accessorv
62 ln thc abovc-statcd Provincc No. of Years No. of Months
penalty of perpetual disqualification to
holcl public office, which has become final
and executory?
7. ADDRESS FOR ELECTION PURPOSES: ,couid bc rhe sam! as No rl
f] Yes (Plcasc providc details at thc back)

E N-o

8.E-MAILADDRESS'(Notclncascoichang€o1addrcssandc.nail,
'"t**i]i5l *"riE6*imices b *rvd.)
pleasc notilv immdiatctu ,n. COvtl tC Crri." sent to the he'ein indi.atd addrgs sha)t demed

77. I ANI ELICIBLE FOR THE OFFICE I SEEK TO BE ELECTED TO,

18. I AM A FILIPINO CITZEN.
79, I ,A.N,I NOT A PERNIANENT RESTDENT OF, OR AN IMMIGRANT TO, A FOREIGN COUNTRY.
20. I EXECUTED A SWORN RENUNCIATION OF FOREIGN CITIZENSHIP, (F APPLIC^BLE, ATTACH A COPY)
27, I IVILL FILE, IVITH THE OFFICE OF THE COMMISSION. WITHIN THIRTY (30) DAYS AFTER ELECTION DAY, MY FULL, TRUE AND ITEMIZED STATEM ENT OF CONTRIBUTIONS AND
EX?ENDITURES (SOC-E) IN CONNECTION WITH THE ELECIIONS.
22. I WILL ABIDE BYIHE RULES AND REGULATIONSOFTHE COMMISSION, INCLUDINC TTSCODEOF CONDUCTONSOCIAL MEDIA.
23. I SHALL NOT ADVOCATE VIOLENCEOR UNLAWFUL MEANSTO ACHIEVE MYGOALS.
24. I WILLSUPPORT AND DEFENDTHE CONSTITUTIONOFTHEREPUBLICOFTHE PHILIPPINESANDWILL MAINTAINTRUE FAITH AND ALLEGIANCETHERETO, IWILOBEYT}IE LAWS,
I-EGAL ORDERS AND DECREES PROMULCATED BY THE DULY CONSTITL'IED AUTHORITIES,
25. I CIVE MY CONSENT TOTHE COMMISSION ON ELECTIONSTOCOLLECI, DISCLOSE ORSHARE, AND PROCESS THE PERSONAL DATA I PROVIDED HEREIN FOR ELECTION AND OTHER
I,AIVFUI- PURPOSES IN ACCORDANCE WITH THE PRIVACY NOTICE AT THE BACK OF THIS FORM, AND AS MAY BE AUTHORIZED BY EXISTINC LAWS,
26. I IMPOSE THISOBLIGATION UPON N{YSELF VOLUNTARIL' WITHOUTMENTALRESERVATIONORPURPOsE OF EVASION.

I hereby certifu that the facts stated herein are true md correct to the best of my knowledge.

Sienature of Candidate Over Printed Name

OATH
SUBSCRIBED AND SWORN to before me this _ day ol at affiant exhibitinq to me an Identification document/card which
contains a photograph and signature bearing No. issued by on

Doc. \r,. : -
Page No. __; (Affix P30.00 dcumentaro stamp)
Book No. __; -
(Officer Authorized to Administer Oath)
Series of -
THIS FORM CAN BE PHOTOCOPIED OR REPRODUCED AND IS AVAILABLE AT THE COMELEC OFFICES FREE OF CHARGE
OR NIAY BE DOWNLOADED FRONI THE COMELEC OFFICIAI- WEBSITE (u'ww.comelec.gov.ph) FRONT
 VAJL TITLL STATUS

The collected personal datawill be encoded in the infomation system developed by the Comission on Elections (COMELEC). Your COC, as
well as the personal data inputted in the information system, will be evaluated by the Law Department in accordmce with the relevant
COMELEC rules and policies. After evaluation, your personal data will be used by the COMELEC in the preparation, posting and/or
publication of the list of candidates and other election-related documents or foms, and printing of official ballots.

For legitimate research needs and inquiries, and only for the purposes specilied in the request, the COMELEC may disclose md shae your
COC md/or its contents. Moreover, the COMELEC may use and disclose you COC and/or its contents in any proceeding or investigation in
rvhich your COC and/or its contents is/are in issue or mav find relevance.

Only authorized personnel are allowed to access and process your personal data. Immediatelv after the election period or upon the expiration
of the storage period set in eristing COMELEC rules and policies, and laws and regulations, whichever applies, the phvsical and digital copies
of your personal data u'ill be anonymized, deleted, and discarded following the disposition procedures of the COMELEC and the National
Archives of the Philippines.

You have the right to ask for a copy of your COC or any personal data it contains. Also, you my withdraw your candidacy in accordance with
the COMELEC rules and policies on the matter.

lf you have questions regarding this Privacy Notice, please send an email to ifpqS'corrrt lro-grrl-,p/r.

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