COMMISSION ON ELECTIONS
October 30, 2023 FORM
Barangay and Sangguniang Kabataan
Elections Statement of Contributions
1
and Expenditures
PART I: PERSONAL INFORMATION OF THE CANDIDATE
1
NAME OF CANDIDATE: (SURNAME) (FIRST NAME) (MIDDLE NAME)
GENDER:
(EXTENSION)
2 ELECTIVE POSITION:
3 CONSTITUENCY OF THE ELECTIVE POSITION:
(BARANGAY) (CITY/MUNICIPALITY) (PROVINCE (REGION)
PART II: TOTAL ELECTION CONTRIBUTION AND EXPENDITURE
II. A. CONTRIBUTIONS RECEIVED (Itemized entries in the schedule of contributions, indicate "0.00" if none received)
1 CASH CONTRIBUTIONS RECEIVED FROM OTHER SOURCES:
2 IN-KIND CONTRIBUTIONS RECEIVED FROM OTHER SOURCES:
TOTAL CONTRIBUTIONS
RECEIVED
II. B. EXPENDITURES (Itemized entries in the schedule of expenditures, indicate "0.00" if none received)
1 EXPENDITURES PAID OUT OF PERSONAL FUNDS / RESOURCES:
2 EXPENDITURES PAID OUT OF CASH CONTRIBUTIONS:
3 EXPENDITURES INCURRED USING IN-KIND CONTRIBUTIONS:
TOTAL EXPENDITURES
INCCURED
PART III. SUMMARY REPORT OF LAWFUL EXPENDITURES
III. A : SUBTOTAL OF LAWFUL EXPENDITURES PER EXPENSE TYPE/CATEGORY
Travel expenses of candidate and campaign personnel during the campaign and incidental personal
A expenses
Compensation of campaigners, clerks, stenographers, messengers, and other persons employed in the
B campaign
Telephone, mobile phone usage fees, prepaid phone load, internet access, postages, freight and courier
C charges
Stationery, printing and distribution of printed materials relative to candidacy;
D
Employment of watchers at the polls
E
Rent, maintenance and furnishing of campaign headquarters, office or place of meetings
F
Political meetings and rallies & the use of sound systems, lights and decorations during said meetings
G and rallies
Newspaper, radio, TV and other advertisements to promote the candidacy, including website/internet
H ad placements
SUB- TOTAL (Item A to H)
III. B : EXPENDITURES INCURRED (Itemized entries in Schedule of Expenditures)
Employment of counsel
I
Copying and classifying lists of voters, investigating and challenging the right to vote of persons
J registered in the lists
Printing of sample ballots in such color, size and maximum number as may be authorized by the
K Commission
SUB-TOTAL (Item I to K)
TOTAL EXPENDITURES
INCURRED
NAME AND DATE SIGNED
SIGNATURE
THIS SECTION IS FOR COMELEC USE ONLY - DO NOT ENCODE / WRITING ANYTHING
BEYOND THIS LINE
not.
☐ FORM 1 ☐ Contribution Receipts
☐ FORM 2 ☐ Expenditure Receipts
☐ FORM 3 ☐ Obligations Payable
☐ Others: pls. specify: NO. OF PAGES:
(This space is for the receiving date/time stamp of the receiving office)
Page 1 of 3
COMMISSION ON ELECTION
October 30, 2023 SCHEDULE OF ELECTION CONTRIBUTION AND EXPENDITU
NAME OF CANDIDATE:
(SURNAME) (FIRST NAME)
Schedule of Contributions Received
TYPE OF CONTRIBUTION
DATE RECEIPT NUMBER FULL NAME OF ADDRESS OF DE
RECEIVED CONTRIBUTOR CONTRIBUTOR (CASH OR IN KIND) (for in-
October 19,2023 203 NESTORIO CANDARE JR. HUGO PEREZ, TRECE MARTIRES IN KIND
CITY
October 19,2023 204 MARISSA ESCALLAR HUGO PEREZ, TRECE MARTIRES IN KIND
CITY
October 19,2023 205 ROEL ORTIGAS LA PAZ HOMES, CABEZA, TRECE IN KIND
MARTIRES CITY
TOTAL CONTRIBUT
Schedule of Expenditures
RECEIPT/ INVOICE FULL NAME OF BUSINESS ADDRESS OF BUSINESS TIN OF CONTRACTOR or
DATE NUMBER FIRM OR FIRM OR BUSINESS FIRM DESCRI
INCURRED CONTRACTOR CONTRACTOR EXPENS
October 19,2023 0205/0204/0203 Prin
October 19,2023 6021 Prin
October 19,2023 5903578 Ris
Oct 20 & 26, 2023 2427/38109 N/a N/a Traver ex
campaig
N/a N/a Comm
Schedule of Unpaid
Obligations
DATE CONTRACT / LOAN NAME OF CREDITOR ADDRESS OF CREDITOR DESCRIPTION OF THE OBLIGATION
INCURRED NO. (for in
N/A N/A N/A
NAME AND SIGNATURE
NOTE: Use additional sheet/s if necessary
COMMISSION ON
ELECTIONS ay and
3
CERTIFICATION AND CONSENT ON DATA PRIVACY
The undersigned candidate, after being duly sworn to, hereby depose and state that:
(1) The contributions listed in Form 1,2 and other supporting were made to me as a candidate and it was received by me and/or my duly aithorized representative;
(2) The expenses listed in Form 1, 2 and other supporting documents were incurred by me as a candidate or by my duly authorized representative/s;
(3) The obligations listed in Form 2 were incurred by me as a candidate or with my authority by my duly authorized representative
(4) This disclosure and its attachments, 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 my duly authorized representative;
(5) The contributions received and expenditures incurred are in accordance with the campaign finance laws and regulations;
(6) I consents on the general use and sharing of information obtained in my report and supporting documents for legitimate purposes; and
(7) All entries specified on my report on Election Contributions and Expenditures and supporting documents are true and correct.
IN WITNESS WHEREOF, the undersigned hereunto affix his/her signature on [date signed].
AFFIX SIGNATURE HERE □
NAME AND SIGNATURE
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)
