8/14/2019 Nereus Acosta Jr.

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. . Republic ofthe PhilippinesCOMMISSION ON ELECTrOM .1IIla

INSTRUCTIONS: (Read wen before filling up this form.)1. F;leth;5 In FIVE (5) LEGIBLEcones.2. Fife this ceruncete of candidacy with the Law Departme.nt. COP-1ELECMain Office, to trarourcs, r+entta, 5lartino November 20. 2009 up to

midnight of November 30, 2009. \3. Attach to thls certificate the Certificate or Party NominatIon unless you are an independent candidate. After midnight of November 30. 2009. no

certmcete of nomination shall be accepted.4. Titles such as 'DrAtty., Don, Ginoo. Se no r, Datu, Hadji, Sultan, Bai, Se nora , Kapitanor similar titles areexpressly prohlbl t ed .S. This certtffcate shall be sworn before ~ notary public o.r,any official authorized to administer oath. CO M ElEC orriclafs are not authorized to

administeroath. .,

12. I AM A 15tff2~D VOTER OFPr eci nct

I X ] Male DFemale .43.i\qj~TA .:J.R~NEREUS-' , .1:1 L2IstName 5. MY DATE OF BIRrn 15:: 0 . '5 " - :1 4 ':_ ;1966.2. ArstName ....... ',' . ::.-::::;;'.--:'~.::>:::.:::.:: > - ' . ' > . . . . ~ .. . . , : . . - - . : . . . . . - . ~ - . .. ..:.O tAIVAR : 0 "Y veer1. 3 Middle Name r-tonth6. MY PLACE OF B~JH IS ;,.."C;ty/Mun M A N U L O . r ORTICH

B U K ID N O N '2.1AM GENERALLY OR POPULARLY KNOWN BYTHE NICKNAME ORSTAGENAME(Indicate only coe nickname or sreqeneme):NERIC.. . " Province~--------~~ ..'~.~.~'.~.~'~.~....~'~.~~~~--~~~~~~~~~--~~~~~~--~~48.MYCIVrlSTATUSIS:DSi ngl e 0 WtdfYov /er[ X J Married 0 Legally Separatedo Annulled I Divorced

Full~. ' ' t 'H 'e r . t I R A J E

Polit ical Pa9. MY RESIDENCE!ADDRESS IS: 9.1 Province . B U K I D N O N9 .2 Citr/r-funlcipality 9.3 Ba ran gay:~oLci FORTIQ( ~WAN""'" 10. MY PROFESSION OR

OCCUPATION IS :PROFESSOR/TEACHER.... '.. -

9.4 House No.1 Street I Subdivision... :ACostA : 'F ARMS '; ":'11. MY POST OFFICE ADDRESS FOR ELECTION PURPOSES IS: (eoi,1d be the same as No.9)

.. ~~~ ., .. M .Al'i( )~Q.F()~Wr.gr,.1 3 t J I Z ] J ) N O N .69Y PUROK . 3,. T . A N K U L . . A . NOly/Mun MANOLO . FORrICHProvince B U K I D N O N . . .

13. MY PERIOD OF RESIDENCE IN THE PHIUPPINES BEFORE ~lAY 10, Z010 IS::..,....

: 0 : 6 : N o . of Hontl lS -------------bt UUMblllttUT .

, ,14. I AM A NA llJRAl BORN FIUPINO anZEN.15. IA~ l NOT A P ER MA NE NT RESIDENT OF, OR IM MIGRANT TO , A FORE lGNCOUN TRY ..

16.1 A M E UG IB lE FO R THEOFF ICE J SEEK TO BE ELECTED TO .17. I W IL L SUP PO RT A! 'ID DEFEN D TH E CONSTITUTION OF THE REPUBLIC OF THE

PH IL IPP INES AND W ILL M AINTAI N TRUE FA ITH AND ALL EGI ANCE THERETO . IWIL L 'OBE Y THE lAWS, L EGAL ORDERS AND DECREES PROM ULGATED BY THEDULY CONSTITUTED AUTHO RITIES . I IM POSE TH IS OBL IGAT ION UPO N M YSE LFVO LUNTAR ILY , W IT HOU T M ENTAL RE SERVATION OR PUR PO SE O F EV ASIO N.

Sign at ure of C an dtda te Ovr. =rPrlnttd.Nam'!

OATHSUBSCRIBED AND SWORN to before me this __ d ay o f November. 2009, a t , aff iant exhibiting to me his/her

c'TC {I dent ifica ti on card No. Issued by : . On : --'- _Doc. N o . 1 1 1 'f ipageNO'~;Book No. ,;;.r ;sertes of 2005

(Officer Authorized to Administer Oath)