AnnexB Complete

8/17/2019 AnnexB Complete

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Application No. Precinct No.

Instructions : (1) Accomplish separately in three copies; (2) print legibly; (3) check the appropriate box.

Part 1

Name Illiterate Person with Disability

Last Assisted by:

First (Please fill-up Assistor's Oath)

Middle Gender

RESIDENCE/ADDRESS Province Height Weight

City/Municipality Barangay DATE OF BIRTH

- -

House No. / Street

PLACE OF BIRTH

CITIZENSHIP By Birth Naturalized Reacquired

(If naturalized/reacquired, state date of naturalization/reacquisition and Certificate number of naturalization/order of approval of reacquisition)

Date of Naturalization/ Certificate No./Order of Approval CIVIL STATUS

Reacquisition Single Widow/er

PERIOD OF RESIDENCE Married Legally

No. of Years No. of Months No. of Years Separated

In the City / Mun in the Philippines Name of Spouse, if married

PROFESSION / OCCUPATION TIN - -

NAME OF FATHER NAME OF MOTHER

Last Last

First First

Middle Middle

Part 2 OATH

DATE - -

1. 2. 3.

Part 3 ACTION BY THE ELECTION REGISTRATION BOARDMonth Day Year

Approved - - With precinct assignment No.

Disapproved Date Reason for disapproval

Part 4

Prov Code PRECINCT NO.

DATE OF BIRTH

Last

First

Middle

ACKNOWLEDGEMENT RECEIPT Application No.

Application for RegistrationThis 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.

EO/Interviewer Signature above Printed Name

PERSONAL INFORMATION (To be filled out by Applicant)

Male Female

Year

City/Mun

Province

Month Day Year

Month Day

Member Chairman of the Board Member

ROLLED THUMBPRINTS / SPECIMEN SIGNATURES

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.

Month Day Year Signature of Applicant

Above Printed Name Left Thumb Right Thumb

EO / Administering Officer

(Signature above Printed Name)

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

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

CITY/MUN/

DISTRICT CODE

Downloaded from http://irehistro.comelec.gov.ph CEF-1B: COPY FOR THE ELECTION OFFICER (BACK)

Month Day Year



CEF-1B

Republic of the Philippines

COMMISSION ON ELECTIONS

check appropriate box):

3. Declaration of insanity or incompetence by a competent authority;

House No./Street.______________________________________________________________________________

C O P Y F O R

T H E P R O V I N C I A L

F I L E

APPLICATION FOR TRANSFER/

TRANSFER WITH REACTIVATION

APPLICATION FOR TRANSFER OF REGISTRATION RECORD

DUE TO CHANGE OF RESIDENCE

within the same city/municipality/district to another city/municipality/district

I, ______________________________________________________, Filipino, born on ______________,

First name/Middle name/Last name month/day/year

a duly registered voter in Precinct No. _____________________ of Barangay ______________________________,

City/Municipality of _________________________, Province of _____________________, single/widow/er/legally

separated/married to _________________________________, do hereby apply for the transfer of my registration

record due to transfer of my residence to :

6. Exclusion by a court order.

Downloaded from http://irehistro.comelec.gov.ph

EO/Chairman of the Election Registration Board


1,2,3, 5 and 6).

Sitio_________________________________ Barangay:_______________________________________________

City/Municipality:__________________________________Province:_____________________________________

That I have resided in my new residence for ___ years and ___ months.

(To be filled out by applicant applying for transfer with reactivation.)

1. Sentence by final judgment to suffer imprisonment for not less than one (1) year;

2. Conviction, by final judgment, of any crime involving disloyalty to the duly constituted government, etc;

4. Failure to vote in two (2) successive preceding regular elections;

5. Loss of Filipino Citizenship; or

Further, I do hereby apply for the reactivation of my registration record which was deactivated due to (please

That said ground no longer exists, as evidenced by the attached certification/order of the court (in case of

Notice to the applicant: Please accomplish the form at the back and have your biometric data i.e. your photograph, signature and fingerprints

captured digitally if: 1.) transfer is within the same city/municipality and you have not previously undergone validation procedure; or 2.) transfer is

to another city/municipality.

IN WITNESS WHEREOF, I have hereunto affix my signature this ___ day of _____, 20___ at __________,

Province of ____________________________, Philippines.


SUBSCRIBED AND SWORN to before me on the above date.





Part 1


Last Assisted by:


Middle Gender



- -

House No. / Street

PLACE OF BIRTH










Last Last

First First

Middle Middle

Part 2 OATH

DATE - -

1. 2. 3.




Part 4


DATE OF BIRTH

Month Day Year



CITY/MUN/

DISTRICT CODE










Month Day Year

Month Day

Downloaded from http://irehistro.comelec.gov.ph CEF-1B: COPY FOR THE PROVINCIAL FILE (BACK)

Year

City/Mun

Province


Male Female



CEF-1B

Republic of the Philippines

COMMISSION ON ELECTIONS

check appropriate box):

3. Declaration of insanity or incompetence by a competent authority;

House No./Street.______________________________________________________________________________

C O P Y F O

R T H E C E N T R A L F I L E

APPLICATION FOR TRANSFER/

TRANSFER WITH REACTIVATION

APPLICATION FOR TRANSFER OF REGISTRATION RECORD

DUE TO CHANGE OF RESIDENCE

within the same city/municipality/district to another city/municipality/district

I, ______________________________________________________, Filipino, born on ______________,

First name/Middle name/Last name month/day/year

a duly registered voter in Precinct No. _____________________ of Barangay ______________________________,

City/Municipality of _________________________, Province of _____________________, single/widow/er/legally

separated/married to _________________________________, do hereby apply for the transfer of my registration

record due to transfer of my residence to :

6. Exclusion by a court order.

Downloaded from http://irehistro.comelec.gov.ph

EO/Chairman of the Election Registration Board


1,2,3, 5 and 6).

Sitio_________________________________ Barangay:_______________________________________________

City/Municipality:__________________________________Province:_____________________________________

That I have resided in my new residence for ___ years and ___ months.

(To be filled out by applicant applying for transfer with reactivation.)

1. Sentence by final judgment to suffer imprisonment for not less than one (1) year;

2. Conviction, by final judgment, of any crime involving disloyalty to the duly constituted government, etc;

4. Failure to vote in two (2) successive preceding regular elections;

5. Loss of Filipino Citizenship; or

Further, I do hereby apply for the reactivation of my registration record which was deactivated due to (please

That said ground no longer exists, as evidenced by the attached certification/order of the court (in case of

Notice to the applicant: Please accomplish the form at the back and have your biometric data i.e. your photograph, signature and fingerprints

captured digitally if: 1.) transfer is within the same city/municipality and you have not previously undergone validation procedure; or 2.) transfer is

to another city/municipality.

IN WITNESS WHEREOF, I have hereunto affix my signature this ___ day of _____, 20___ at __________,

Province of ____________________________, Philippines.


SUBSCRIBED AND SWORN to before me on the above date.





Part 1


Last Assisted by:


Middle Gender



- -

House No. / Street

PLACE OF BIRTH










Last Last

First First

Middle Middle

Part 2 OATH

DATE - -

1. 2. 3.




Part 4


DATE OF BIRTH

Downloaded from http://irehistro.comelec.gov.ph CEF-1B: COPY FOR THE CENTRAL FILE (BACK)

Year

City/Mun

Province


Male Female

Month Day Year

Month Day












CITY/MUN/

DISTRICT CODE

Month Day Year

AnnexB Complete

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