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