Certificate of Candidacy 1
Certificate of Candidacy 1
Certificate of Candidacy 1
CERTIFICATE OF CANDIDACY
I, ____________________________________________________________________________,
(Surname) (First Name) (Middle/Maternal Name)
hereby announce my candidacy for the Office of _________________________ in the
______________________________ Region/ _______________________Sector in the PICPA May 16,
2022 elections and after having been sworn to in accordance with law, hereby state the following:
1. One (1) NICKNAME OR STAGE NAME (By which I am generally or popularly known):
_________________________________________________________________________________
2. OFFICIALLY NOMINATED BY: ____________________________________________________
(Attached Certificate of Nomination) verified & signed by the Regional Council
3. SEX: _________________ AGE: ____________________ CIVIL STATUS: ___________________
4. DATE OF BIRTH _______________________ PLACE OF BIRTH __________________________
5. COMPANY NAME AND ADDRESS __________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
TELEPHONE NO.: ________FAX NO.: ________ E-mail: ____________ Cell. No. ____________
6. POSITION(S) HELD _______________________________________________________________
7. RESIDENCE (Complete post office address for election purposes): ___________________________
_________________________________________________________________________________
TELEPHONE NO.: ________FAX NO.: ________ E-mail: ____________ Cell. No. ____________
8. I AM A FILIPINO CITIZEN (State if “Natural Born” or “Naturalized): ________________________
9. I AM A REGISTERED VOTER OF ___________________________________ CHAPTER
_________________ REGION ___________________________ SECTOR, WHERE I SEEK TO BE
ELECTED, FOR THE PAST _____________ YEARS AND ______________ MONTHS_________
10. I AM PICPA MEMBER IN GOOD STANDING SINCE ___________________________________
WITH RENEWED PRC ID NO. _________ AND EXPIRED ON __________ (attached photocopy)
11. PRESENT AND PAST PICPA INVOLVEMENT/POSITIONS HELD: _______________________
_________________________________________________________________________________
_________________________________________________________________________________
That all the above information are true and correct.
That I am eligible and willing to serve for said Office; that I have been a PICPA member in good standing of
the sector and chapter for at least three (3) years prior to this May 16, 2022 election; That I will continue to support
the objectives and ideals of PICPA and perform my duties and functions efficiently; That I will obey its Articles of
Incorporation, By-Laws and Directives promulgated by its duly-constituted authorities; That this obligation imposed
by my oath is assumed voluntarily, without mental reservations or purpose of evasion, and that the fact stated herein
are true to the best of my knowledge.
________________________________
SIGNATURE OVER THE PRINTED
RIGHT THUMBMARK NAME OF CANDIDATE
Doc. _________________:
Page No. _____________:
Book No. _____________:
Series of 2022 _________: ___________________
(Affix Documentary Stamp) Notary Public
File in two (2) legible copies.
(KINDLY NOTARIZE & SUBMIT TO PICPA NATIONAL OFFICE. FAX & PHOTOCOPIES WILL NOT
BE ACCEPTED) PLEASE ATTACH YOUR BIO-DATA SPECIFICALLY YOUR PICPA
INVOLVEMENT.