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Certification Sworn Statement

This document contains a sworn statement and undertaking from an individual in Alfonso, Cavite, Philippines. The individual states that they are authorized to claim and receive another person's Voter's Certification. They undertake to immediately deliver the certification to its rightful owner or return it to the local election office within seven days. The individual also acknowledges they would be liable for any legal issues if it's found they improperly received or failed to deliver the certification. The document is signed and notarized on the specified date in Alfonso, Cavite.

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296 views1 page

Certification Sworn Statement

This document contains a sworn statement and undertaking from an individual in Alfonso, Cavite, Philippines. The individual states that they are authorized to claim and receive another person's Voter's Certification. They undertake to immediately deliver the certification to its rightful owner or return it to the local election office within seven days. The individual also acknowledges they would be liable for any legal issues if it's found they improperly received or failed to deliver the certification. The document is signed and notarized on the specified date in Alfonso, Cavite.

Uploaded by

Mondster Batz
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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REPUBLIC OF THE PHILIPPINES ANNEX “A”

CITY/ MUNICIPALITY OF ALFONSO, CAVITE

SWORN STATEMENT WITH UNDERTAKING

I, _____________________________________ of legal age, Filipino and a resident of


____________________________, Alfonso, Cavite, Philippines, after having been duly sworn to, in
accordance with law, do hereby depose and say, that:
1. I am a registered voter of ___________________________________________;
2. I was duly authorized by __________________________________ to claim and receive his/her
Voter’s Certification, as shown in the authorized letter hereto attached as ANNEX “A”;
3. I undertake to deliver the said Voter’s Certification immediately from its receipt to its rightful
owner, otherwise, I undertake to return said Certification to the Office of the Election Officer (OEO)
of Alfonso, Cavite, within seven (7) days from my receipt of the same;
4. I release the Election Officer and Election Assistant of the OEO of Alfonso, Cavite of any liability
should I lose the said Certification or should I fail to deliver the same to its rightful owner;
5. I fully understand that I will be liable for perjury, theft, estafa or any other criminal liability, as the
case maybe, should it be established that I am not the duly authorized representative to receive the
said Voter’s Certification, or that I failed to deliver the same to its rightful owner.

IN WITNESS HEREOF, I hereby affix my signature this ________ day of


______________________, 2017, in the City/ Municipality of Alfonso, Cavite, Philippines.

_______________________________
Affiant

SUBSCRIBED AND SWORN to before me this _______ day of _______________________, 2017, in


the City/ Municipality of Alfonso, Cavite.

ALICIA TIBAYAN MOJICA


Election Officer III

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