Reference No.

: CEF17601020-52220911202114832080 Generated on 14 September 2021 11:52 (Philippine Standard Time)

Republic of the Philippines REVISED CEF-1

COMMISSION ON ELECTIONS
Intramuros, Manila

Instruction : Fill-in completely and legibly the appropriate spaces and check appropriate choice/s in boxes.

APPLICATION FOR REGISTRATION (Accomplish Personal Information at the back)

Note: (For Applicant/s with existing Registration Records)

I, , Filipino, born on , a duly registered voter in Precinct

No. of Barangay , City/Municipality of , Province of
, do HEREBY APPLY FOR: (Check for appropriate box/es)

APPLICATION FOR TRANSFER OF REGISTRATION RECORD

within the same City/Municipality/District from another City/Municipality/District
(Accomplish Personal Information at the back)
My New Residence is:
House No. & Street , Barangay ,
City/Municipality , Province
I have resided in my new residence for years and for months.

APPLICATION FOR REACTIVATION OF REGISTRATION RECORD

Reason for Deactivation:
1. Sentenced by final judgment to suffer imprisonment for not less than one (1) year;
2. Convicted by final judgment 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; or
6. Exclusion by a court order.
7. Failure to Validate
That said ground no longer exists, as evidenced by the attached certification/order of the court (in cases of 1, 2, 3, 5 and 6).

APPLICATION FOR CHANGE OF NAME DUE TO MARRIAGE OR COURT ORDER/CORRECTION OF

ENTRIES IN THE VOTERS' REGISTRATION RECORD
(Attach required supporting documents such as Certified Copy or Certificate of Court Order or Certificate of Live Birth, and others)
Present Data/Information:

New/Corrected Data Information:

APPLICATION FOR INCLUSION OF RECORDS IN THE BOOK OF VOTERS / REINSTATEMENT OF NAME IN

THE LIST OF VOTERS
Inclusion 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.

IN WITNESS WHEREOF, I hereunto affix my signature this ________ day of ____________, _______ at CITY OF LAS
PIÑAS , Province of NCR - 4TH DISTRICT , Philippines

Signature over Printed Name

SUBSCRIBED AND SWORN to before me on the above date.
EO/Administering Officer
 Print at the back of CEF-1
Application No. Precinct No.

Instructions : (1) Accomplish separately in three copies; (2) print legibly; (3) check the appropriate box.
Part 1 PERSONAL INFORMATION ( To be filled out by Applicant)
NAME Illiterate Person with Disability

Last MEDINA Indigenous People

MICHAEL JAY Assisted by :

First

Middle SORILLA
(Please fill-up Supplemental Data Form/Assistor's
Oath)

RESIDENCE/ ADDRESS Province NCR - 4TH DISTRICT Sex

City/ Municipality Barangay Male Female
CITY OF LAS PIÑAS TALON SINGKO
DATE OF BIRTH
House No. / Street
01 16 1999
B25 L8 SANTOL ST
Month Day Year
PLACE OF BIRTH
CITIZENSHIP FILIPINO By Birth Naturalized Reacquired
City/ Mun CITY OF LAS PIÑAS
(If naturalized / reacquired, state date of naturalization/ reacquisition and Certificate number of naturalization/ order of approval of reacquisition)

Date of Naturalization / Month Day Year Certificate No. / Order of Approval Province NCR - 4TH DISTRICT
Reacquisition
CIVIL STATUS
PERIOD OF RESIDENCE Single
No. of Years No. of Months No. of Years
Married
In the City / Mun 22 7 In the Philippines 22
Name of Spouse, If married
PROFESSION / OCCUPATION
TIN

Part 2 OATH ROLLED THUMBPRINTS / SPECIMEN SIGNATURES

REGISTRATION TRANSFER
I do solemnly swear that the above statements regarding my person are true and correct; that I
possess all the qualifications and none of the disqualifications of a voter and that I am not registered
in any precinct in the Philippines. Further, I give consent to the processing of the Information stated
herein by the Commission on Elections for registration, election and other purposes as may be
provided by law including B.P. Blg. 881, R.A. No. 8189, R.A. No. 10367 and R.A. No. 10173 also known
as the Data Privacy Act of 2012. Left Thumb Right Thumb

Date 1
Month Day Year
Signature of Applicant 2
Above Printed Name

EO / Administering Officer
Signature Above Printed Name 3

Part 3 ACTION BY THE ELECTION REGISTRATION BOARD

Month Day Year
Approved With Precinct Assignment No.

Disapproved Reason for disapproval

DATE

Member Chairman of the Board Member

(Signature above Printed Name) (Signature above Printed Name) (Signature above Printed Name)

Part 4 VOTER IDENTIFICATION NUMBER (To be filled out by Election Officer)

Part I Part II Part III

Prov Code City/Mun/Dist. Code Precinct Assignment Month Day Year Name Code
Birth Code

Type of Application ACKNOWLEDGEMENT RECEIPT Application No.

Registration Transfer with Reactivation
Transfer Change of Name/ Correction of Entry This is to acknowledge receipt of your application.
Your application is subject for Approval/ Disapproval by the
Reactivation Reinstatement/ Inclusion Election Registration Board (ERB). You need not appear in
the ERB hearing unless required through a written notice.
Application for Registration Date of ERB Hearing _________________.
Last
First
EO/ Interviewer Signature above Printed Name
Middle
 Reference No. : CEF17601020-52220911202114832080 Generated on 14 September 2021 11:52 (Philippine Standard Time)

Republic of the Philippines REVISED CEF-1

COMMISSION ON ELECTIONS
Intramuros, Manila

Instruction : Fill-in completely and legibly the appropriate spaces and check appropriate choice/s in boxes.

APPLICATION FOR REGISTRATION (Accomplish Personal Information at the back)

Note: (For Applicant/s with existing Registration Records)

I, , Filipino, born on , a duly registered voter in Precinct

No. of Barangay , City/Municipality of , Province of
, do HEREBY APPLY FOR: (Check for appropriate box/es)

APPLICATION FOR TRANSFER OF REGISTRATION RECORD

within the same City/Municipality/District from another City/Municipality/District
(Accomplish Personal Information at the back)
My New Residence is:
House No. & Street , Barangay ,
City/Municipality , Province
I have resided in my new residence for years and for months.

APPLICATION FOR REACTIVATION OF REGISTRATION RECORD

Reason for Deactivation:
1. Sentenced by final judgment to suffer imprisonment for not less than one (1) year;
2. Convicted by final judgment 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; or
6. Exclusion by a court order.
7. Failure to Validate
That said ground no longer exists, as evidenced by the attached certification/order of the court (in cases of 1, 2, 3, 5 and 6).

APPLICATION FOR CHANGE OF NAME DUE TO MARRIAGE OR COURT ORDER/CORRECTION OF

ENTRIES IN THE VOTERS' REGISTRATION RECORD
(Attach required supporting documents such as Certified Copy or Certificate of Court Order or Certificate of Live Birth, and others)
Present Data/Information:

New/Corrected Data Information:

APPLICATION FOR INCLUSION OF RECORDS IN THE BOOK OF VOTERS / REINSTATEMENT OF NAME IN

THE LIST OF VOTERS
Inclusion 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.

IN WITNESS WHEREOF, I hereunto affix my signature this ________ day of ____________, _______ at CITY OF LAS
PIÑAS , Province of NCR - 4TH DISTRICT , Philippines

Signature over Printed Name

SUBSCRIBED AND SWORN to before me on the above date.
EO/Administering Officer
 Print at the back of CEF-1
Application No. Precinct No.

Instructions : (1) Accomplish separately in three copies; (2) print legibly; (3) check the appropriate box.
Part 1 PERSONAL INFORMATION ( To be filled out by Applicant)
NAME Illiterate Person with Disability

Last MEDINA Indigenous People

MICHAEL JAY Assisted by :

First

Middle SORILLA
(Please fill-up Supplemental Data Form/Assistor's
Oath)

RESIDENCE/ ADDRESS Province NCR - 4TH DISTRICT Sex

City/ Municipality Barangay Male Female
CITY OF LAS PIÑAS TALON SINGKO
DATE OF BIRTH
House No. / Street
01 16 1999
B25 L8 SANTOL ST
Month Day Year
PLACE OF BIRTH
CITIZENSHIP FILIPINO By Birth Naturalized Reacquired
City/ Mun CITY OF LAS PIÑAS
(If naturalized / reacquired, state date of naturalization/ reacquisition and Certificate number of naturalization/ order of approval of reacquisition)

Date of Naturalization / Month Day Year Certificate No. / Order of Approval Province NCR - 4TH DISTRICT
Reacquisition
CIVIL STATUS
PERIOD OF RESIDENCE Single
No. of Years No. of Months No. of Years
Married
In the City / Mun 22 7 In the Philippines 22
Name of Spouse, If married
PROFESSION / OCCUPATION
TIN

Part 2 OATH ROLLED THUMBPRINTS / SPECIMEN SIGNATURES

REGISTRATION TRANSFER
I do solemnly swear that the above statements regarding my person are true and correct; that I
possess all the qualifications and none of the disqualifications of a voter and that I am not registered
in any precinct in the Philippines. Further, I give consent to the processing of the Information stated
herein by the Commission on Elections for registration, election and other purposes as may be
provided by law including B.P. Blg. 881, R.A. No. 8189, R.A. No. 10367 and R.A. No. 10173 also known
as the Data Privacy Act of 2012. Left Thumb Right Thumb

Date 1
Month Day Year
Signature of Applicant 2
Above Printed Name

EO / Administering Officer
Signature Above Printed Name 3

Part 3 ACTION BY THE ELECTION REGISTRATION BOARD

Month Day Year
Approved With Precinct Assignment No.

Disapproved Reason for disapproval

DATE

Member Chairman of the Board Member

(Signature above Printed Name) (Signature above Printed Name) (Signature above Printed Name)

Part 4 VOTER IDENTIFICATION NUMBER (To be filled out by Election Officer)

Part I Part II Part III

Prov Code City/Mun/Dist. Code Precinct Assignment Month Day Year Name Code
Birth Code
 Reference No. : CEF17601020-52220911202114832080 Generated on 14 September 2021 11:52 (Philippine Standard Time)

Republic of the Philippines REVISED CEF-1

COMMISSION ON ELECTIONS
Intramuros, Manila

Instruction : Fill-in completely and legibly the appropriate spaces and check appropriate choice/s in boxes.

APPLICATION FOR REGISTRATION (Accomplish Personal Information at the back)

Note: (For Applicant/s with existing Registration Records)

I, , Filipino, born on , a duly registered voter in Precinct

No. of Barangay , City/Municipality of , Province of
, do HEREBY APPLY FOR: (Check for appropriate box/es)

APPLICATION FOR TRANSFER OF REGISTRATION RECORD

within the same City/Municipality/District from another City/Municipality/District
(Accomplish Personal Information at the back)
My New Residence is:
House No. & Street , Barangay ,
City/Municipality , Province
I have resided in my new residence for years and for months.

APPLICATION FOR REACTIVATION OF REGISTRATION RECORD

Reason for Deactivation:
1. Sentenced by final judgment to suffer imprisonment for not less than one (1) year;
2. Convicted by final judgment 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; or
6. Exclusion by a court order.
7. Failure to Validate
That said ground no longer exists, as evidenced by the attached certification/order of the court (in cases of 1, 2, 3, 5 and 6).

APPLICATION FOR CHANGE OF NAME DUE TO MARRIAGE OR COURT ORDER/CORRECTION OF

ENTRIES IN THE VOTERS' REGISTRATION RECORD
(Attach required supporting documents such as Certified Copy or Certificate of Court Order or Certificate of Live Birth, and others)
Present Data/Information:

New/Corrected Data Information:

APPLICATION FOR INCLUSION OF RECORDS IN THE BOOK OF VOTERS / REINSTATEMENT OF NAME IN

THE LIST OF VOTERS
Inclusion 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.

IN WITNESS WHEREOF, I hereunto affix my signature this ________ day of ____________, _______ at CITY OF LAS
PIÑAS , Province of NCR - 4TH DISTRICT , Philippines

Signature over Printed Name

SUBSCRIBED AND SWORN to before me on the above date.
EO/Administering Officer
 Print at the back of CEF-1
Application No. Precinct No.

Instructions : (1) Accomplish separately in three copies; (2) print legibly; (3) check the appropriate box.
Part 1 PERSONAL INFORMATION ( To be filled out by Applicant)
NAME Illiterate Person with Disability

Last MEDINA Indigenous People

MICHAEL JAY Assisted by :

First

Middle SORILLA
(Please fill-up Supplemental Data Form/Assistor's
Oath)

RESIDENCE/ ADDRESS Province NCR - 4TH DISTRICT Sex

City/ Municipality Barangay Male Female
CITY OF LAS PIÑAS TALON SINGKO
DATE OF BIRTH
House No. / Street
01 16 1999
B25 L8 SANTOL ST
Month Day Year
PLACE OF BIRTH
CITIZENSHIP FILIPINO By Birth Naturalized Reacquired
City/ Mun CITY OF LAS PIÑAS
(If naturalized / reacquired, state date of naturalization/ reacquisition and Certificate number of naturalization/ order of approval of reacquisition)

Date of Naturalization / Month Day Year Certificate No. / Order of Approval Province NCR - 4TH DISTRICT
Reacquisition
CIVIL STATUS
PERIOD OF RESIDENCE Single
No. of Years No. of Months No. of Years
Married
In the City / Mun 22 7 In the Philippines 22
Name of Spouse, If married
PROFESSION / OCCUPATION
TIN

Part 2 OATH ROLLED THUMBPRINTS / SPECIMEN SIGNATURES

REGISTRATION TRANSFER
I do solemnly swear that the above statements regarding my person are true and correct; that I
possess all the qualifications and none of the disqualifications of a voter and that I am not registered
in any precinct in the Philippines. Further, I give consent to the processing of the Information stated
herein by the Commission on Elections for registration, election and other purposes as may be
provided by law including B.P. Blg. 881, R.A. No. 8189, R.A. No. 10367 and R.A. No. 10173 also known
as the Data Privacy Act of 2012. Left Thumb Right Thumb

Date 1
Month Day Year
Signature of Applicant 2
Above Printed Name

EO / Administering Officer
Signature Above Printed Name 3

Part 3 ACTION BY THE ELECTION REGISTRATION BOARD

Month Day Year
Approved With Precinct Assignment No.

Disapproved Reason for disapproval

DATE

Member Chairman of the Board Member

(Signature above Printed Name) (Signature above Printed Name) (Signature above Printed Name)

Part 4 VOTER IDENTIFICATION NUMBER (To be filled out by Election Officer)

Part I Part II Part III

Prov Code City/Mun/Dist. Code Precinct Assignment Month Day Year Name Code
Birth Code
 BRING THIS FORM TOGETHER WITH THE APPLICATION FORM
TO YOUR LOCAL COMELEC OFFICE

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Reference No. : CEF17601020-52220911202114832080 Generated on 14 September 2021 11:52 (Philippine Standard Time)

Application for : City / Municipality : CITY OF LAS PIÑAS

Registration Province : NCR - 4TH DISTRICT

Transfer / Others Application No. :
NAME OF APPLICANT (Pangalan ng Aplikante)

MEDINA MICHAEL JAY SORILLA

LAST NAME (Apelyido) FIRST NAME (Pangalan) MIDDLE NAME (Panggitna)
Thank you for using the COMELEC iRehistro Online Application Form.

Please bring the printed copy of your accomplished application form, together with the required documents, to your local COMELEC Office, which is in
CITY OF LAS PIÑAS, NCR - 4TH DISTRICT.

IMPORTANT REMINDERS TO APPLICANTS

1. PLEASE REMEMBER that accomplishing this online form DOES NOT mean that you are already a registered voter. You still have to go through the
following:
a. Go to your local COMELEC office to personally submit your Application Form. (This completes the process of submission of your application)
b. The Election Registration Board (ERB) has to approve your application.
2. PRINTING REMINDERS :
a. Be sure to print your accomplished form on a folio size (long) bond paper (8-1/2" x 13") and that the four (4) QR codes are printed clearly and
completely. If not, please reprint.
b. Make sure that you have printed the PERSONAL INFORMATION page at the back of the CEF-1 page. If not, please reprint for compliance.
3. Do not sign or affix your thumbmark on the Application Form yet. (You have to do this in the presence of the Election Officer when you go to the local
COMELEC Office for filing purposes.)
4. PLEASE BRING ANY OF THE FOLLOWING VALID IDs : Employee's identification card (ID), with the signature of the employer or authorized
representative; Postal ID; PWD Discount ID; Student's ID or library card, signed by the ID; Integrated Bar of the Philipines (IBP) ID; License issued by the
Professional Regulatory Commission (PRC); Certificate of Confirmation issued by the National Commission on Indigenous Peoples (NCIP) in case of
members of ICCs or IPS; School authority; Senior Citizen's ID; Driver's license; NBI clearance; Passport; SSS/GSIS and any other valid ID.

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