Series of 2022
CEF
Poge
-I
i:
Republic of the Philippines
COMhIISSION ON ELECTIONS
O
Intranmros, Manila
(}
Instruction: Fill-in
I
signiff and mnfirm my intention to undergo the process of voter registration
tt8 years old aILd qbovel
I signify and confirm rny intention to undergo the process of voter regiitration in
the Katipunan ng Kabataan (15 to 17 years old)
completely and legibly the appropriate spares and check appropriate clroice/s in ovals.
APPLIGATION FOR REGISTRATION
lnccomplish Personal lnformation atthe back)
Note: (For Applicant with existing Registration Records)
OmpucATroN FoR TRANSFER oF REGrsrRATroN
C) within the same City/MunicipalitlDistrict.
REcoRD
another City/Municipality/District
O frOm
O from foreign post to local OEO other than original place of registration.
(Accornplish Personal lnformation at the back).
Fitipino, born
t,
O
Precincf
No.
, Barangay
on
Cfty/Anunicipality
(for
O
foreign post located
of
, a duly regisfered voter in:
Province of
loca,l voter)
in
, Country of
ffor overseas voter)
My New Residence is:
House No. & Street
Barangay
I have resided in my new residence for
City/Municipality/District_Province_
years and for _
months.
_
APPLICATION FOR REACTIVATION OF REGISTRATION RECORD
Reason for l),eactivation:
1. Sentenced by final judgment to suffer imprisonment for not less than one (1) year;
2. Convicted by finaljudgment 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;
6. Exclusion by a court order; or
7. Failure to Validate
That said ground no /onger exr.sfs, as evidenced by the attached certification/order of the court {in cases of 7,2,3,5, and 6).
APPLICATION FOR CHANGE OF NAME DUE TO MARRIAGE OR COURT ORDER/CORRECTION OF ENTRIES
IN THE VOTERS' REGISTRATION RECORD
(Aftach required suppofting documentrs such as Gertified Copy or Certificate of Couft Order or Certificate of Live Birth, and othem)
Present Data/lnformation:
N
ew/Corrected Data/l nform ation
APPLICATION FOR INCLUSION OF RECORDS IN THE BOOK OF VOTERS / REINSTATEMENT OF NAME IN
THE LIST OF VOTERS
C) Reinstatement of records due to transfer from foreign post to same local City/MunicipalitylDistrict.
() lnclusion 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.
_,
lNWlTNEsswHEREoF,lhereuntoaffixmysignaturethis-dayof,20-at-,
Philippines.
_,
Province of
Signature above printed name
SUBSCRIBED AND SWORN to before me on the above date
EO/Ad ministering Officer
2
Precinct No.
Application No.
USE
co
Jl ll
PERSONAL INFORMATION ( To be
Part 1
filted out
lndigenous
NAME
llliterate
9rff,r, lf any
{Ex: Jr.,5r.,lll)
Last
Senior Citizen
with Disability
Person
First
O Physical O
O Speech O
Middle
O
O
Non-manifest
Haru of Hearing/
O
o
tvtultiple
Disabilities
deaf
RESIDENCE/ADDRESS Province
visual
O
O
Assistor
communication .Assistance
VisualAssistance
None
Senior
Nais mo bang bumoto sa unang palapag,/ground
House No.
()
t
Assistor's
Reacquired
Naturalized
Certificate No. /Order of Approval
of-Years
No.
No. gf
Province
i
t-egally Separated
OATH, NOTICE and CONSENT ( KATIPUNAN NG KABATAAN
)
)
the above statements regarding my person are true and correct; that I possess all
I do solemnly swear
the qualifications and none of the disqualifications of a voter of Katipunan ng Kabataan; that I arn:
not registered in any precinct
E] registered in a precinct of another City/tlunicipality/District in the Philippines
staternents
I do solemnly swear that the
regarding my person are true and correct; that I possess all
the qualifications and none of the disqualifications of a voter;
tr
and that lam:
not registered in any precinct;
and that I have reviewed the entries encoded in the VRS and I confirm that the same are correct, accurate and
consistent with the information I supplied in this application form. Moreover, by affixing my siBnature below, I
authorize and give my consent to the Commission on Elections and the concerned Election Registration Board to
collect and process the personal data I supplied herein for purposes of voter's registration and elections, and for
other purposes and allowable disclosures under B.P. 81g.881, R.A. No. 8189, 10173 and 10367, and 10742 and the
registered in a precinct of another
City/ndunicipalitylDistrict in the Philippines
and that I have reviewed the entries encoded in the VRS and I
confirm that the same are correct, accurate and consistent
supplied
f]
lf Marrled
Name of
OATH, NOTICE and CONSENT (REGULAR
I
Father Name
Widowler
Single
with the information
NAME
E-Mail Address:
Contact No.:
Married
E
f]
lnthePhilippinesi i
PARENT,S
PROFESSTON/
OCCTIPATION
2
!;z::!
City/Municipality
No. o,f Ye?F
:"""-----
: , ;
i ; i
ln the CitylMun
Monthq
:c-::*:
:.-d..-E-:
PART
r"rnrt"
PIACE OF BIRTH
PERIOD OF RESIDENCE
CNIL STATUS
I
OF
Year
tVlonth
[--l
Male
sEx
naturulhedheocquhed, stote dote ol mturollzotton/reacqukttlon and Certifiete Number ol nattrdlization/order ol opprowl ol rcacqukition)
Date of Natu ralization/
Reacqu isition
vEs
Cftfren, or fPs:
:: Birth
i iev
C]TIZENSHIP
(
floor
(Accessible Polling Place) sa araw ng eleksyon?
/ Street
in this application form.
relevant resolutions €f the Commission on Elections. Furthermore, I understahd that when I reach eighteen (18)
years of age, the personal data I supplied hereln will be further processed by the Commission on Elections, and
upon approval by the Election Registration Board, will be inciuded in and consolidated with the database ofvoters
Further, by affixing my signature below, I authorize and give
rny consent to the Commission on Elections and the
concerned Election Registration Board to collect and process
the personal data I supplied herein for purposes of voter
registration and elections, and for other purposes and
who are at least eighteen {18} years of age for purposes of subsequent elections and for other lawful purposes and
allowable disclosures mentioned above, to which further processing and hs purposes I
allowable disclosures under B.P. Blg. 881, R.A. No. 8189,
LALB and 10357, and the relevant Resolutions of the
give my
do not give my consent
and that when I reach thirty one 131) years of age, my personal data in the Katipunan ng Kabataan database will be
Commission on
deleted
consent fl
f]
ROLLED THUMBPRINTS
Date
/ SpTOMEN SIGNATURES
1
Applicant
(Signatureffhurnbmark
E
2
above Printed
N
ame)
3
lection Officer/Admi nistering Officer
above Printed
ACTION BY THE ELECTION REGISTRATION BOARD
Part 3
With Precinct Assignment No.
Month
Day
Beason for disapproval
VOTER'S IDENTIFICATION NUMBER
Proy Csok
(Signature above Printed Name)
(Signature above Printed Name)
Part 4
Part
Member
Chairperson
Mernber
tsignature above Printed Name)
/Io
be
Part lll
rransfer
R*..tivation
ilrlrsh
Precinct Assignment
City/Mun/Dist Code
transfer with Reastivation
Ctl.nge of Name/Correction of Entry
n*instatement/l nclusion
to
Yeat
Name Code/ Eirth Code
your application.
Your
for ApprovallDisapproval by the Election Registration
Board (ERB). You need not appear in the ERB hearing unless required
application is subject
through
a
written notice.
Suffrr, lt any
First
Ita{t
ACKN OWLEDG EM ENT RECE IPT
Q
O
O
for
Last
>
{i,
filled out by Election Afficer)
Part ll
I
Type of Application
Registration
O
O
O
Year
lEr: lr.,St.,llll
Date
of
ERB
Hearing