CEF – 1, Series of 2022 Page -1

Republic of the Philippines I signify and confirm my intention to undergo the process of
voter registration (18 years old and above)
COMMISSION ON ELECTIONS
Intramuros, Manila I signify and confirm my intention to undergo the process of
voter registration in the Katipunan ng Kabataan (15 to 17 years
old)
Instruction: Fill-in completely and legibly the appropriate spaces and check appropriate choice/s in ovals.

APPLICATION FOR REGISTRATION (Accomplish Personal Information at the back)

Note: (For Applicant with existing Registration Records)
APPLICATION FOR TRANSFER OF REGISTRATION RECORD
within the same City/Municipality/District
from another City/Municipality/District (Accomplish Personal Information at the back).
from foreign post to local OEO other than original place of registration.

I, ____________________________, Filipino, born on ________________, a duly registered voter in:

Precinct No. _____, Barangay ___________, City/Municipality of _____________, Province of __________________
(for local voter)

foreign post located in ___________________________, Country of __________________________

(for overseas voter)
My New Residence is:
House No. & Street Barangay ________________
City/Municipality/District________________________________Province ____________________________
I have resided in my new residence for ________ years and for ___________ months.
APPLICATION FOR REACTIVATION OF REGISTRATION RECORD
Reason for Deactivation:
Sentenced by final judgment to suffer imprisonment for not less than one (1) year;
Convicted by final judgment of a crime involving disloyalty to the duly constituted government, etc;.
Declared by competent authority to be insane or incompetent;
Failed to vote in two (2) successive preceding regular elections;
Loss of Filipino citizenship;
Exclusion by a court order; or
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
Reinstatement of records due to transfer from foreign post to same local City/Municipality/District.
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 ________ ,20_____ at _________________,
Province of _____________________, Philippines.

Signature above printed name

SUBSCRIBED AND SWORN to before me on the above date.

EO/Administering Officer
 Page 2
Application No. Precinct No.
(EO's use)
Instructions: (1) Accomplish only ONE (1) copy; (2) print legibly; and (3) check the appropriate box.
Part 1 PERSONAL INFORMATION ( To be filled out by Applicant)

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Indigenous People
NAME Illiterate (Tribe)

Last Suffix, if any Senior Citizen

(Ex.: Jr.,Sr.,III)
Person with
First Disability
Type of Disability:
Middle Deaf/Hard of Hearing Psychosocial
Intellectual Speech and Language
Learning Visual
RESIDENCE/ADDRESS Province Cancer
Mental
City/Municipality Barangay/Sitio/Purok Physical Rare Disease

House No. / Street Assistance Needed:

Assistor Visual Assistance
Communication None
Assistance
CITIZENSHIP By Birth Naturalized Reacquired SEX Male Famale

( If naturalized/reacquired, state date of naturalization/reacquisition and DATE OF BIRTH For Senior Citizens and PWDs:
Certificate Number of naturalization/order of approval of reacquisition) Are you willing to vote in the Accessible Polling Place
Date of
(APP)located on the ground floor of the voting center on the day
Naturalization/ Month Day Year Certificate No./Order of Approval
of the Elections?
Reacquisition - - Month Day Year YES NO
In the City/Mun In the Philippines PLACE OF BIRTH
PERIOD OF For Illiterate, PWDs, Senior Citizen, or IPs:
No. of Years No. of Months No. of Years City/Municipality Assistor's Name:_____________________________
RESIDENCE
Province (Fill out and attach Certification/Attestation Form)

PROFESSION/ PARENT'S NAME

OCCUPATION Contact No.: E-Mail Address:
CIVIL STATUS Single Widow/er Father's Name

Married Name of Spouse, If Married Legally Separated Mother's Maiden Name

PART 2 OATH, NOTICE and CONSENT (REGULAR ) OATH, NOTICE and CONSENT ( KATIPUNAN NG KABATAAN )

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REGISTRATION TRANSFER REGISTRATION TRANSFER
I do solemnly swear that the above statements regarding I do solemnly swear that the above statements regarding my person are true and correct; that I possess all the
my person are true and correct; that I possess all the qualifications and none of the disqualifications of a voter of Katipunan ng Kabataan; that I am:
qualifications and none of the disqualifications of a voter; and not registered in any precinct
that I am: registered in a precinct of another City/Municipality/District in the Philippines
not registered in any precinct; and that I have reviewed the entries encoded in the VRS and I confirm that the same are correct, accurate and
registered in a precinct of another consistent with the information I supplied in this application form. Moreover, by affixing my signature below, I
City/Municipality/District in the Philippines authorize and give my consent to the Commission on Elections and the concerned Election Registration Board to
and that I have reviewed the entries encoded in the VRS and I collect and process the personal data I supplied herein for purposes of voter's registration and elections, and for
confirm that the same are correct, accurate and consistent with other purposes and allowable disclosures under B.P. Blg. 881, R.A. No. 8189, 10173 and 10367, and 10742 and the
the information I supplied in this application form. Further, by relevant resolutions of the Commission on Elections. Furthermore, I understand that when I reach eighteen (18)
affixing my signature below, I authorize and give my consent to years of age, the personal data I supplied herein will be further processed by the Commission on Elections, and upon
the Commission on Elections and the concerned Election approval by the Election Registration Board, will be included in and consolidated with the database of voters who are
Registration Board to collect and process the personal data I at least eighteen (18) years of age for purposes of subsequent elections and for other lawful purposes and allowable
supplied herein for purposes of voter registration and elections, disclosures mentioned above, to which further processing and its purposes I
and for other purposes and allowable disclosures under B.P. give my consent do not give my consent
Blg. 881, R.A. No. 8189, 10173 and 10367, and the relevant and that when I reach thirty one (31) years of age, my personal data in the Katipunan ng Kabataan database will be
Resolutions of the Commission on Elections. deleted accordingly.
ROLLED THUMBPRINTS / SPECIMEN SIGNATURES
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Date - -
Month Day Year
1

Applicant 2
(Signature/Thumbmark above Printed Name)

Election Officer/Administering Officer 3

(Signature above Printed Name) Left Thumb Right Thumb
Part 3 ACTION BY THE ELECTION REGISTRATION BOARD
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Approved - - With Precinct Assignment No.

Disapproved Month Day Year Reason for disapproval

Member Chairperson Member

(Signature above Printed Name) (Signature above Printed Name) (Signature above Printed Name)
Part 4 VOTER'S IDENTIFICATION NUMBER (To be filled out by Election Officer)
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Part I Part II Part III

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Prov CodeCity/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 Election Registration
Reactivation Reinstatement/Inclusion
Board (ERB). You need not appear in the ERB hearing unless required through
Application for Registration a written notice.
Suffix, if any
Last (Ex.: Jr.,Sr.,III) Date of ERB Hearing _________________

First
Middle
EO/ Interviewer Signature above Printed Name