Downloaded from: http://www.comelec.gov.ph CEF-1A Republic of the Philippines APPLICATION FOR REGISTRATION COMMISSION ON ELECTIONS (Voters Registration Record upon approval by the ERB) Application No. Precinct No. Instructions : (1) Accomplish separately in three copies; (2) print legibly; (3) check the appropriate box. PERSONAL INFORMATION (To be filled out by Applicant) Part 1 Name Illiterate Person with Disability Assisted by: Last (Please fill-up Assistor's Oath) First Gender Male Middle RESIDENCE/ADDRESS Province Female Height City/Municipality Barangay Weight DATE OF BIRTH Month House No. / Street Day Year PLACE OF BIRTH CITIZENSHIP By Birth Naturalized Reacquired City/Mun Province (If naturalized/reacquired, state date of naturalization/reacquisition and Certificate number of naturalization/order of approval of reacquisition) Date of Naturalization/ Month Day Year CIVIL STATUS Certificate No./Order of Approval COPY FOR THE ELECTION OFFICER Reacquisition PERIOD OF RESIDENCE No. of Years Widow/er Married Legally Separated No. of Years No. of Months In the City / Mun Name of Spouse, if married in the Philippines PROFESSION / OCCUPATION - TIN - NAME OF FATHER NAME OF MOTHER Last Last First First Middle Middle Part 2 Single ROLLED THUMBPRINTS / SPECIMEN SIGNATURES OATH 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 disqualification of a voter; that I have no pending application for registration in any city/municipality; and that I am not registered in any precinct in the Philippines. - - DATE Month Day Year Signature of Applicant Above Printed Name Left Thumb 1. EO / Administering Officer Right Thumb 2. 3. (Signature above Printed Name) Part 3 ACTION BY THE ELECTION REGISTRATION BOARD Month Day Year - Approved Disapproved Date With precinct assignment No. Reason for disapproval Member Chairman of the Board Member (Signature above Printed Name) (Signature above Printed Name) (Signature above Printed Name) VOTER IDENTIFICATION NUMBER (To be filled out by Election Officer) Part 4 CITY/MUN/ DISTRICT CODE Prov Code PRECINCT NO. Month Day Year DATE OF BIRTH ACKNOWLEDGEMENT RECEIPT Application for Registration Last Application No. This is to acknowledge receipt of your Application for registration. You are not yet registered unless approved by the Election Registration Board (ERB). You need not appear in the ERB hearing unless required through a written notice. First Middle EO/Interviewer Signature above Printed Name Downloaded from: http://www.comelec.gov.ph CEF1-A: COPY FOR THE ELECTION OFFICER (BACK) VOTING RECORD DATE Ballot No. Voter's Thumbmark Signature Chairman's Signature Downloaded from: http://www.comelec.gov.ph CEF-1A Republic of the Philippines APPLICATION FOR REGISTRATION COMMISSION ON ELECTIONS (Voters Registration Record upon approval by the ERB) Application No. Precinct No. Instructions : (1) Accomplish separately in three copies; (2) print legibly; (3) check the appropriate box. PERSONAL INFORMATION (To be filled out by Applicant) Part 1 Name Illiterate Person with Disability Assisted by: Last (Please fill-up Assistor's Oath) First Gender Male Middle RESIDENCE/ADDRESS Province Female Height City/Municipality Weight DATE OF BIRTH Barangay Month House No. / Street Day Year PLACE OF BIRTH CITIZENSHIP By Birth Naturalized City/Mun Reacquired Province (If naturalized/reacquired, state date of naturalization/reacquisition and Certificate number of naturalization/order of approval of reacquisition) Date of Naturalization/ Month Day Year CIVIL STATUS Certificate No./Order of Approval COPY FOR THE PROVINCIAL FILE Reacquisition Single PERIOD OF RESIDENCE No. of Years Married Legally Separated No. of Years No. of Months In the City / Mun Name of Spouse, if married in the Philippines PROFESSION / OCCUPATION - TIN - NAME OF FATHER NAME OF MOTHER Last Last First First Middle Middle Part 2 Widow/er ROLLED THUMBPRINTS / SPECIMEN SIGNATURES OATH 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 disqualification of a voter; that I have no pending application for registration in any city/municipality; and that I am not registered in any precinct in the Philippines. DATE Month - Day Year Signature of Applicant Left Thumb Above Printed Name 1. EO / Administering Officer Right Thumb 2. 3. (Signature above Printed Name) Part 3 ACTION BY THE ELECTION REGISTRATION BOARD Month Day Year - Approved Disapproved Date With precinct assignment No. Reason for disapproval Member Chairman of the Board Member (Signature above Printed Name) (Signature above Printed Name) (Signature above Printed Name) VOTER IDENTIFICATION NUMBER (To be filled out by Election Officer) Part 4 CITY/MUN/ DISTRICT CODE Prov Code PRECINCT NO. Month Day DATE OF BIRTH Year Downloaded from: http://www.comelec.gov.ph CEF-1A Republic of the Philippines APPLICATION FOR REGISTRATION COMMISSION ON ELECTIONS (Voters Registration Record upon approval by the ERB) Application No. Precinct No. Instructions : (1) Accomplish separately in three copies; (2) print legibly; (3) check the appropriate box. PERSONAL INFORMATION (To be filled out by Applicant) Part 1 Name Illiterate Person with Disability Assisted by: Last (Please fill-up Assistor's Oath) First Gender Male Middle RESIDENCE/ADDRESS Province Female Height City/Municipality Weight DATE OF BIRTH Barangay Month House No. / Street Day Year PLACE OF BIRTH CITIZENSHIP By Birth Naturalized City/Mun Reacquired Province (If naturalized/reacquired, state date of naturalization/reacquisition and Certificate number of naturalization/order of approval of reacquisition) Date of Naturalization/ Month Day Year CIVIL STATUS Certificate No./Order of Approval Reacquisition Single COPY FOR THE CENTRAL FILE PERIOD OF RESIDENCE No. of Years Married Legally Separated No. of Years No. of Months In the City / Mun Name of Spouse, if married in the Philippines PROFESSION / OCCUPATION - TIN - NAME OF FATHER NAME OF MOTHER Last Last First First Middle Middle Part 2 Widow/er ROLLED THUMBPRINTS / SPECIMEN SIGNATURES OATH 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 disqualification of a voter; that I have no pending application for registration in any city/municipality; and that I am not registered in any precinct in the Philippines. DATE Month - Day Year Signature of Applicant Left Thumb Above Printed Name 1. EO / Administering Officer Right Thumb 2. 3. (Signature above Printed Name) Part 3 ACTION BY THE ELECTION REGISTRATION BOARD Month Day Year - Approved Disapproved Date With precinct assignment No. Reason for disapproval Member Chairman of the Board Member (Signature above Printed Name) (Signature above Printed Name) (Signature above Printed Name) VOTER IDENTIFICATION NUMBER (To be filled out by Election Officer) Part 4 CITY/MUN/ DISTRICT CODE Prov Code PRECINCT NO. Month Day DATE OF BIRTH Year
