7/31/2019 PhilRES - Absentee Voting Application Form
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Petition for PhilRES Members Right to Vote in Another Voting Center
ABSENTEE VOTING APPLICATION FORM
FOR REGIONAL / SPECIAL VOTING CENTER @
_______________________________________________
18 November, 2012 Synchronized National Elections
Mother Chapter : PhilRES - _____________________ [ ] City [ ] FCM [ ] Province
Region: [ ] NCR -1 [ ] NCR -2
Region: [ ] North Luzon [ ] South Luzon
Region: [ ] Visayas [ ] Mindanao
Region: [ ] Others, pls. specify ________________________________
Requesting Member : LAST NAME - ___________________________________________
FIRST NAME - ___________________________________________
MIDDLE NAME - ______________ AIPO RECEIPT NO.: ___________
[ ] Brokers License No. : _________________________________
[ ] Appraisers License No. : (Private) __________________________
(Government) ______________________
[ ] Consultants License No.: _________________________________
Residence : ___________________________________________
Residence : ___________________________________________
Mobile Numbers: ___________________________________________
E-mail Address : ___________________________________________
Reason for Request : ___________________________________________________________
___________________________________________________________
Members Signature : __________________________________ Date: _________________
--------------------------------------------------------------------------------------------------------------------------------------------------------------------
NATIONAL COMELEC APPROVALI hereby certify that above member is
[ ] Eligible [ ] Not Eligible reason: __________________________________________
to receive an Absentee Ballot to be transmitted to above voting center. To be signed by Chairman with
concurrence of two (2) regular members.
___________________________ ___________________________ ___________________________
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