Republic of the Philippines

COMMISSION ON ELECTIONS Intramuros, Manila

Attach 2 x 2

ID Photo

INFORMATION SHEET (Please type or print)

FOREIGN MEDIA

NATIONAL AND LOCAL ELECTIONS

MAY 9, 2016

Name: _____________________________________________________________________________

(Surname) (Given) (Middle)

Date of Birth: ________________________________ Place of Birth: __________________________

Status: ______________ Nationality ________________ Occupation: __________________________

Area of Expertise: ___________________________________________________________________

Employer: __________________________________________________________________________

Organization: _______________________________________________________________________

Permanent address: __________________________________________________________________

(State complete address)

Address in the Philippines: ____________________________________________________________

Cel. No.: _____________________________ Tel No.: ______________________________________

Passport No.: ___________________________ Issued at: _________________ On: _______________

Type of Philippine Visa: ______________________ Issued at: _________________ On: ___________

Date of Arrival: _______________________________ Period of Stay: _________________________

_______________________

(Signature)

Requirements:

For Visiting:

1. Endorsement letter from the newspaper, television or radio station employing the applicant.

(Editor/Station Manager)

2. 2 pcs. 2” x 2” ID photo

FOR MANILA BASED:

1. Endorseemnt letter from the Manila Bureau Chief

2. 2 pcs. 2” x 2” ID photo